Politics, Religion, and ADHD Meds
At a dinner meeting a couple of weeks ago I met two psychiatrists who work at Kaiser Permanente, the large HMO system that boasts a 24% health insurance market share in California. (This has nothing to do with my story really. I just think it's amazing that a quarter of all insured Californians are Kaiser patients.) As we described our practices, I mentioned that I recently helped a patient stop his Adderall, the amphetamine combination drug given for Attention Deficit Hyperactivity Disorder or ADHD. The patient had come to me on a very high dose and was complaining of many side-effects: anxiety, muscle twitching, severe insomnia, weight loss. I gradually tapered and eventually discontinued the stimulant over several weeks, with resolution of most of these symptoms. He thanked me and said he felt much better. I related this story with some pride, and mentioned to my dinner companions that I've had more success stopping high-dose medication, especially for ADHD, than I've had starting ADHD medication. Moreover, I opined that ADHD is too readily diagnosed in adults, resulting in a lot of unnecessary amphetamine being prescribed.
I had not anticipated how odd these statements sounded coming from a psychiatrist. One of the Kaiser docs, a child psychiatrist, quickly noted how many kids she'd helped by identifying and treating their ADHD. It's an under-recognized problem, she assured me. The other psychiatrist only saw adults, yet he too underscored how Adderall, Ritalin, and other stimulants helped his patients. Someone mercifully changed the subject, and we let the matter drop.
It got me thinking though. First, could we all be correct? I have no reason to doubt the experience of child psychiatrists who see their young patients perform better, achieve more, and get along better with others when treated for ADHD. I don't see children myself, and am basically a bystander in the debates over medicating children for ADHD and behavioral problems. Moreover, even in adult psychiatry I believe that prescribed stimulants can sometimes help, not only for ADHD but also for depression in the severely medically ill, and in some other situations.
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