Okay, on the surface, an academic subject. But upon closer examination, probably one we all care about. This past week, the FDA announced it is looking into the link between stimulant medication and heart arrhythmias. It has come to light that there may be valid evidence that the use of stimulant medication contributes to stroke, heart attacks, arrhythmias, and sudden death. I quote a paragraph from a bulletin that the American Academy of Child and Adolescent Psychiatry mailed to me today:
Last Thursday, the Food and Drug Administration (FDA) Drug Safety and Risk Management Advisory Committee voted (8-7, with one abstention) to require black box warnings on methylphenidate. The committee had reviewed reports of 25 deaths, 19 of them under age 18, and a preliminary analysis of post marketing surveillance reports that suggested that stimulants might increase the risk of strokes, myocardial infarctions, and arrhythmias in children and adults. Sudden death was described, although the rate never exceeded one in a million for any stimulant drug.
I welcome the FDA digging deeper into this issue and the thing I found most interesting about the report was the fact that it appears that the majority of this evidence comes from results of the explosion of prescription drugs written to adults for "Adult ADHD." It seems there is more risk of these rare problem if a person has pre-existing risk factors for cardiac disease. I'm hopeful this concern by the FDA and the Academy reaches both adults seeking help for their distractedness and inattention as well as parents of children with hyperactive/distractedness/inattentive symptoms. And I hope it prompts them to not be so eager to look to a pill to solve the complex problems they may be facing in themselves and their children. On the other side of the issue, there will always be a place for prudent use of medication. It's just more and more clear that there will never be a place for "the quick fix."
As a practicing child psychiatrist, I often see situations where the real treatment needed for a child's ADHD should be administered to the parent rather than the child. It's not at all unusual to discover that the parent is the one that needs to get into therapy for anxiety and/or depression, etc... Not only does my recommendation for individual therapy frequently get turned down, but also, unfortunately, family therapy is usually next to impossible to convince parents to consider. They don't have the time. They don't see the problem. Or they don't have the financial resources, or a combination of all three. Time and money issues fuel a resistance that I can see surrounding any suggestion of in-depth therapeutic work.
There is a resistance to therapy in our society today (where bombing instead of in-depth diplomatic work seems to capture the imagination of our country... but I digress). And it is a reality that intensive psychotherapy (i.e. psychoanalysis) is not in vogue at the moment. That's a shame. All the way around. The situation is further exacerbated by the insurance companies that are only too eager to cover a Ritalin prescription for years on end, but do everything in their power to limit psychotherapy sessions to twelve per year. That's once a month. Apparently the insurance companies are also buying into to the idea of a pill to take away the symptom. Of course, we all know why. Money rules. Unfortunately, in this case, ignorance also rules.
Ours is a culture that has been seduced by the "quick fix". But no matter what they tell you on TV, we don't get in shape without exercising and emotional/cognitive/mind-brain problems aren't cured by a little yellow pill. The Rolling Stones had a song on this subject...
What a drag it is getting old
"Kids are different today,"
I hear ev'ry mother say
Mother needs something today to calm her down
And though she's not really ill
There's a little yellow pill
She goes running for the shelter of a mother's little helper
And it helps her on her way, gets her through her busy day
Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old
"Life's just much too hard today,"
I hear ev'ry mother say
The pursuit of happiness just seems a bore
And if you take more of those, you will get an overdose
I look forward to a day when parents and adults come into my office and instead of asking for a little yellow pill, they talk about working on themselves and trying to get better without "the quick fix." Sure, it's a longer road in the short term, but a smoother one in the long run.