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ADHD and Adderall®: Effects on the Heart and Personality?
October 5, 2009
Today, there are many new methods, remedies, and treatments in health psychology that are exploiting the youth of the science as a means to attract the general public. It is our job as citizens of humanity to question the validity and truthfulness of the claims made by the proprietors of these novel businesses as to the effectiveness and safety of their products. As an example, I bring forth to you a very common psychological disorder that affects ”3-10% of the general population”( http://www.ncbi.nlm.nih.gov/pubmed/16756025), ADHD, and one of its medications, Adderall®. As well as provide an effective means for treating the symptoms of ADHD, Adderall® has also been known to have a negative effect on its users’ personality.
As few as 9 million and as many as 30 million people are afflicted with ADHD in the US, a huge number of people, and thus, a huge market for drug companies to penetrate. Since its designation as an “official” mental disorder in 1980 by the National Institute of Mental Health, ADHD has been a focus of many researchers mainly because of its sheer prevalence in the general population (http://www.add-adhd-help-center.com/newsletters/newsletter_15july03.htm). Additionally, diagnosis of ADHD has increased about 3% each year between 1997 and 2006 (http://www.cdc.gov/ncbddd/adhd/data.html). Thus, it is quite natural for drug companies to have expressed an interest in attempting to formulate a remedy and/or treatment for ADHD. First, however, everyone must understand what ADHD is, what the physiological effects of the disorder are, and how it also affects an individual’s behavior.
WHAT EXACTLY IS ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder, and those who are properly diagnosed are marked by a clear inability to maintain focus for long periods of time. This is often a problem for young children in school, as well as adults at work. The lack of attention that ADHD patients suffer is mainly brought about by the abnormal functioning of two major neurotransmitter systems, the dopaminergic and noradrenergic systems (http://www.ncbi.nlm.nih.gov/pubmed/16756025). Dopamine and noradrenaline (norepinephrine) are excitatory neurotransmitters that have the effect of stimulating the central nervous system and are also linked to feelings of enjoyment, euphoria, and fear. For example, a commonly experienced phenomenon is the “fight or flight” response that we encounter when we are faced with a relevant or threatening stimulus. In this response the sympathetic nervous system is activated causing one to react firstly by attending solely to the stimulus, and then the individual makes a decision to deal with it or flee from it (http://www.psychologistworld.com/stress/fightflight.php). Increased release of dopamine and norepinephrine, although not completely responsible for the fight or flight response does play a major role in our heightened awareness and attention during the phenomenon. Thus, a lack of attention would seem to be associated with a lack of dopamine and norepinephrine release and/or uptake by neurons. This understanding, therefore, offered a starting point for drug companies in creating their remedies.
(http://www.helpyourautisticchildblog.com/date/2008/06/) (left image)
WHAT IS ADDERALL®? WHAT DO WEBPAGES HAVE TO SAY?
Specifically, the drug Adderall® is a mixture of four different amphetamine salts originally designed as a diet drug because of its effects on decreasing the appetite (http://www.associatedcontent.com/article/1268435/adderall_history_uses_side_effects.html?cat=70). The amphetamine salts in Adderall also work by increasing the levels of dopamine and norepinephrine in the nervous system, which leads to heightened awareness and concentration. In 1996 Adderall® was available to the prescribed public as an ADHD medication because of the effects of its component amphetamines on the neurotransmitter systems that function abnormally in ADHD patients (http://www.adderall.net/). Many of the pro-Adderall® websites distinguish it as a “miracle drug” because of its clear ability to greatly improve the attention of ADHD patients. Ideally, an ADHD patient prescribed to the drug may use the drug, and by way of the mechanisms previously described, will be able to pay better attention to the tasks at hand. Eureka! We have found the cure for ADHD! It is not that simple, however. As with any drug, Adderall® and other ADHD medications come with many potentially harmful side effects which, many of the websites fail to consider. However, there are a vast number of web pages that do discuss concerns about the negative complications of using Adderall®, and their discussions are very thorough and parallel with one another.
AMPHETAMINES: A PROBLEM?
Amphetamines are also commonly known as “speed” because of their effect of increasing awareness and wakefulness. Users often appear to be extremely active and responsive hence, the street name “speed.” An illegal variant of the “basic” amphetamine known as crystal methamphetamine is commonly abused. Crystal methamphetamine, or “meth,” is very dangerous in that it is extremely addictive, and long term use may lead to many life threatening physiological side effects. It is often referred to as “the single most dangerous drug on earth.” Meth’s addictive qualities come from its component amphetamines which activate the “reward centers” of the brain, causing the user to want more (http://www.recoveryconnection.org/drug_index/methamphetamine.php). It is for this reason that Adderall® acts as a double-edged sword. Although drug treatment of ADHD with stimulants (Adderall®) provides a convenient and effective means of controlling some of the negative behaviors associated with ADHD, the addictive qualities of its constituent amphetamines can be very dangerous. It is critical that an individual be well informed about the possible side effects associated with stimulant usage.
ADDERALL®: CARDIOVASCULAR SIDE EFFECTS
Some of the most concerning side effects of stimulant usage are those that affect cardiovascular systems of the body. Some of these side effects include heart palpitations and tachycardia, high blood pressure, cardio myopathy, and even sudden death (http://www.rxlist.com/adderall-drug.htm). Thus, for physiological reasons alone, it is wise for an individual who may be considering drug therapy to also consider alternative treatment options. The good news for drug therapy, however, is that the most severe of these side effects have occurred in very rare incidences. For example, Canada suspended the sale of Adderall® in 2005 after 12 deaths had been associated with the drug from 1999-2003. Of the 12 victims, five also had severe heart abnormalities (http://www.dyslexia-adults.com/t145.html). Compared to an average of 11 million methylphenidate/amphetamine prescriptions filled per year, during this period (http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html), the death rate associated with stimulant drugs mirrored the death rate of the general population. Since the incidence of these severe effects is so rare, whether or not the complications are really associated with stimulant use is somewhat ambiguous. The neurological side effects associated with Adderall® use can be much more insidious than the more obvious cardiovascular complications.
ADDERALL®: NEUROLOGICAL/BEHAVIORAL SIDE EFFECTS
The neurological side effects of Adderall® include, but are not limited to, psychotic episodes, overstimulation, restlessness, irritability, insomnia, depression, headache, and motor tics (http://www.rxlist.com/adderall-drug.htm). In many cases, an individual may experience just one of these which, on a single incidence basis, may not necessarily be severe. For example, the prevalence of insomnia is very common in the general population; about 1 in 8 people are dealing with it at any given time (http://www.wrongdiagnosis.com/i/insomnia/prevalence.htm). Although it can be very frustrating for an individual to experience insomnia, it is by no means life threatening on an individual basis. However, because each of these complications is somewhat common, the rate at which two or more may occur in conjunction with one another is also relatively high. Therefore, long term exposure to these effects has been known to exacerbate negative behaviors and potentially alter an individual’s personality permanently (http://www.add-adhd-help-center.com/adderall_side_effects.htm). These more severe complications can hurt family relationships as well as peer to peer acceptance. Although most of these effects are not directly life threatening, they can greatly reduce the quality of life of the individual and that of his or her family members. In the most drastic cases, suicide may seem to be the only coping mechanism for individuals.
SCIENTIFIC EVIDENCE: ADDERALL® AS AN EFFECTIVE MEANS OF TREATMENT
Biederman, J. and Faraone, SV. (2002) conducted a meta analysis on the efficacy of various drug therapy treatments for ADHD. The specific interventions that the studies were selected for included doses of Adderall® 12.5 mg. up to 30 mg. twice daily and for a 3-7 week duration. They concluded that from six available studies, “Adderall® was efficacious for symptoms of inattention, hyperactivity, and aggression.” Across all six studies, similar results were found as to the degree of efficacy of Adderall® on alleviating these symptoms as compared to a placebo (Faraone & Biederman, 2002).
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