Confirming the Hazards of Stimulant Drug Treatment
By Peter R. Breggin, M.D. Director
International Center for the Study of Psychiatry and Psychology,
Bethesda, Maryland

Until recently, no studies have systematically examined the rate of
psychotic symptoms caused by routine treatment with stimulant drugs
such as methylphenidate (Ritalin) and amphetamine (Dexedrine,
Adderall). Doctors who prescribe stimulant drugs often seem oblivious
to the fact that they can cause psychoses, including manic-like and
schizophrenic-like disorders. Without providing a scientific basis,
the literature often cites rates of 1% or less for stimulant-induced
psychoses (reviewed in Breggin, 1998, 1999). Recently on television I
debated a well-known expert in child psychiatry who took the position
that prescribed stimulants "never" cause psychoses in children.
The rate of psychotic symptoms that first appear during stimulant
treatment has recently been investigated in a 5-year retrospectives
study of children diagnosed with Attention Deficit Hyperactivity
Disorder (ADHD) (Cherland and Fitzpatrick,1999). Among 192 children
diagnosed with ADHD at the Canadian clinic, 98 had been placed on
stimulant drugs, mostly methylphenidate. Psychotic symptoms developed
in more than 9% of the children treated with methylphenidate.
According to Cherland and Fitzpatrick, "The symptoms ceased as soon
as the medication was removed" (p. 812). No psychotic symptoms were
reported among the children with ADHD who did not receive stimulants.
The psychotic symptoms caused by methylphenidate included
hallucinations and paranoia. The authors conclude that, due to poor
reporting, the rate of stimulant-induced psychosis and psychotic
symptoms was probably much higher.
In my practice of psychiatry, I am frequently consulted about
children who are taking three, four, and sometimes five psychiatric
drugs, including medications that are FDA-approved only for the
treatment of psychotic adults. The drug treatment typically began
when the children developed conflicts with adults at home or at
school. In retrospect, the conflicts could easily have been resolved
by interventions such as family counseling or individualized
educational approaches. Usually under pressure from a school, the
parents instead acquiesced to put their child on stimulants
prescribed by psychiatrists, family physicians, or pediatricians.
When these children developed depression, delusions, hallucinations,
paranoid fears and other drug-induced reactions while taking
stimulants, their physicians mistakenly concluded that the children
suffered from "clinical depression," "schizophrenia" or "bipolar
disorder" that has been "unmasked" by the medications. Instead of
removing the child from the stimulants, these doctors mistakenly
prescribed additional drugs, such as antidepressants, mood
stabilizers, and neuroleptics. Children who were put on stimulants
for "inattention" or "hyperactivity" ended up taking multiple adult
psychiatric drugs that caused severe adverse effects, including
psychoses and tardive dyskinesia.
It is time to recognize that the supposedly increasing rates
of "schizophrenia," "depression," and "bipolar disorder" in children
in North America are often the direct result of treatment with
psychiatric drugs. They should be classified as adverse drug
reactions, not as primary psychiatric disorders. Doctors need to
become more expert at identifying these adverse drug reactions in
children and more aware of how and why to taper children from
psychiatric medications (Breggin and Cohen, 1999).
When parents are willing to take a fresh approach to disciplining and
caring for their children, or when the children's school situation
can be improved, it is usually possible to taper them off of all
psychiatric medications. The parents are then relieved and gratified
to see their children increasingly improve with the removal of each
drug.
What's the answer to this widespread, unwarranted use of medication
in the treatment of children? As long as we respond to the signals of
conflict and distress in our children by subduing them with drugs, we
will not address their genuine needs. As parents, teachers,
therapists, and physicians we need to retake responsibility for our
children (Breggin, 2000). We must reclaim them from the drug
companies and their advocates in the medical profession. At the same
time, we must address the needs of our children on an individual and
societal level. On the individual level, children need more of our
time and energy. Nothing can replace the personal relationships that
children have with us as their parents, teachers, counselors, or
doctors. On a societal level, our children need improved family life,
better schools, and more caring communities.
Bibliography
Breggin, P. (1998). Talking Back to Ritalin. Monroe, Maine: Common
Courage Press.
Breggin, P. (1999). Psychostimulants in the treatment of children
diagnosed with ADHD: Risks and mechanism of action. International
Journal of Risk and Safety in Medicine, 12, 3-35
Breggin, P. (2000). Reclaiming Our Children. Cambridge,
Massachusetts: Perseus Books.
Breggin, P. and Cohen, D. (1999). Your Drug May Be Your Problem: How
and Why to Stop Taking Psychiatric Medications. Cambridge,
Massachusetts: Perseus Books.
Cherland, E. and Fitzpatrick, R. (1999, October). Psychotic side
effects of Psychostimulants: A 5-year review. Canadian Journal of
Psychiatry, 44, 811-813.
(reprinted from Vol. 2, Issue 3, Ethical Human Sciences and Services,
in press)




--- In ADD_ADHD_LD@yahoogroups.com, "netifel" <netifel@...> wrote:
>
> I read a news item this am indicating that ADHD drugs like Ritalin,
> Concerta, Adarall and others can cause psychosis and mania in some
> patients, including some with no obvious risk factors.
>
> I know that there's always a study about something, but if someone
> knowledgeable can offer some comment? The link is here:
>
> http://news.yahoo.com/s/nm/20090126/hl_nm/us_adhd_drug
>
>
> nettie feldman
> email: netifel@...
>