Interviewer: One of the side effects of these stimulants could be lack of sleep and maybe they do not gain weight as well, is that true?.
Interviewee: Yes, and it is children that are very small that can be an issue. In bigger kids, it is not usually a major problem.
Interviewer: There seems to be a phenomenon going on in colleges, a lot of kids who are normal are trying to take these kind of medicines, is that somewhat of a danger?
Interviewee: Sure, and sometimes kids in college will take lots of it. They will take it to stay up to study. They may even take it recreationally. If you take a hundred of these pills and squeeze them down, and take it all at once. So, there is a real risk for abuse of there medications, some more than others. The major risk is if you take a lot of this stuff, it can have cardiovascular effects, meaning, it can increase heart rate and blood pressure which can be bad for you.
Interviewer: If a kid had underlying cardiac problem, undiagnosed, is there any risk of taking these medicines?
Interviewee: Taking it properly, there is probably very little risk. There is some data that even taking a regular dose may increase your blood pressure just a little bit. There is really right now no clear data that giving this to a large population that it increases a risk in any individual patient. I think it is more of a theoretical risk, so if a child does have a heart problem that we know of, we certainly we would have that patient cleared before giving these medications.
Interviewer: Several moths ago, there were some report of 25 kids allegedly died taking a stimulant, do you feel this just happened to be 25 kids that died and happened to be on the medicine or there is a risk factor?
Interviewee: I think every medicine has every risk in the world and we know the people can die from Tylenol and Motrin, and everything else including Benadryl but it is very rare. The actual death rates from these medications that I have seen are no worse than people not on the medications. One of medications specifically Adderall was actually banned in Canada for a short period of time because they had a few children that died, but when they looked at their data, as far as it could be determined the risk of death in children, Adderall was not higher than the risk of death in children not on medication.
Interviewer: Is there any medicine that does not stimulate the body and controls kids who have this?
Interviewee: Yes, there are several. These are what I term second line medications. The best study honestly is there are probably two best studies is clonidine or Catapres which is an old blood pressure drug, but that was actually studied for safety and for effectiveness with Ritalin in a study that was sponsored by NIH about five years ago and was found to be safe for the heart and the blood pressure with Ritalin and without Ritalin and also did work. So, this is a second line drug that I sometimes give as a patch.
Other second line medications are Strattera which is related a little bit to antidepressant. Strattera came out about four years ago, but this medication has certain advantages in certain subgroups, and certain disadvantages in others. And, sometimes people have used other medications including Wellbutrin which some of you may know is the medication that is used to stop smoking in adults.
There have been some data that this can be helpful but the best study in second line drugs really are clonidine or Catapres and Strattera, the newer medication that as just developed just for ADHD.
Interviewer: So in other words, it is a problem that can be controlled somewhat with medicine, there are rough failures obviously, any doctor who gives the medicine has to monitor the kid very carefully, is that true?
Interviewee: That is correct and furthermore is one should not be rushing to give medicine to any child, and I think one warning for a parent is that if you go to the doctor and they want to give medicine on the first visit, that should be a warning sign.
There are some children that actually do need them on the first visit. They are getting thrown out of first grade because they are off the banisters and running around, but for most children, it should not be something that should be given without going through the scales and discussing risk factors, and side effects, and I think most careful neurologists or psychiatrists will not rush into giving stimulants on the first visit unless it has already been worked out in great detail.
Interviewer: So in other words, there is no side effect to any drug we do not prescribe?
Interviewee: That is correct and all drugs have every known side effect and that is always the risk, but these drugs in general are very safe but should be only be given if one is relatively sure a child has ADHD first, and secondly, if one is relatively sure that the child is falling behind in a way that is affecting their academic or social or their frustration threshold which is actually a major issue because once a child falls behind, because of ADHD, they become quite frustrated in can get depressed secondarily to it.
Interviewer: So a doctor should discuss the risk and benefit from all medication use.
Interviewee: That is correct and I think that any parent should really be wary of any doctor, if a patient walks in, and the doctor wants to give you Ritalin, for example on the first visit without doing scales and without going over the risks, and maybe seeing the patient probably twice before starting it.
Interviewer: Thank you.
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