What is ADHD?

ADHD is an extremely common disorder that is characterized by difficulty paying attention, distractibility and hyperactivity. And some say it’s even more common than previously thought.

For one, it’s now believed to be common in adults – not just children – and that a diagnosis of ADHD doesn’t always have all the symptoms commonly associated with it.

That means you don’t have to be hyperactive to have ADHD, though what you have would then be characterized by ADD, or Attention Deficit Disorder, not Attention Deficit Hyperactive Disorder.

Types of ADHD

It turns out there are several types of ADHD each with its own criteria. There’s the typical hyperactive form and then the inattentive form, characterized by poor attention. And then there’s the combined form, which has both. That puts the total at three, but some have argued for the existence of six different types.

There are good and bad aspects to this wider approach. On the one hand, it means that effected adults will greater understand what’s going on in their life and potentially get access to treatment. On the other, it’s part of a trend that increasingly makes normal human experiences into mental disorders.

After all, it’s only human to occasionally feel restless, unable to focus, or distractible. And despite claims of some ADHD proponents, there’s still no real test for ADHD like there is for Diabetes. There are diagnostic lists, but ultimately no black and white physical signs of the condition.

That said, there is a recent test, the quantitative electroenchephalogram, that famous author Dr. Hallowell reports is 90% accurate in diagnosing ADHD.  Additionally, ADHD is perhaps the single most heritable of all the psychological conditions – if your parent has it, then you have a 60%-90% of having it.

Combined that with the consistent discovery of brain differences in people with ADHD and the evidence for its existence is almost 100% definitive.

ADHD Treatment

Treatment for ADHD is no simple matter. Although the medications seem to be safe, they are potent stimulants, all of which have been used as street drugs. Adderall, for instance, is also popular as “speed.” While medications work most of the time, especially when combined with supportive therapy, it’s not clear what that means.

Stimulant medications are, after all, also used by college studies to cram for tests. Some say that they would help anyone focus and be less impulsive. Proponents respond that stimulants seem to have a paradoxical calming effect on people with ADHD. Instead of making them hyperactive and energetic, stimulants might calm them down and help them be focused.

Ultimately, however, stimulant treatment can be a life saver.  As Dr. Wender, a famous psychiatrist, puts it, some people who have ADHD and take stimulants can, “for the first time in their lives“(!) enjoy studying, having long conversations and so on.  Instead of getting C’s and D’s in college, they work hard and get B’s and A’s.  Instead of endlessly chasing new ideas, they settle down and function better than they ever had.

The difference is remarkable, consistent, and lasts typically for as long as the medication is taken.  These are effects that are far beyond the simple high that someone who abuses a stimulant medication might get.

Coronary heart disease (CHD) is the single biggest cause of health problems and death in the USA and the world.

Statins offer a way to help treat CHD, but have become perhaps too heavily pushed. And the target level of cholesterol to reach may have been lowered too far.

What causes CHD?

CHD is most often caused by the build up of plaques on arteries and other blood carrying vessels. The plaque is made of various components, but deposits of cholesterol tend to play a key role. When it becomes too thick, it can stop blood flow, causing a heart attack or other damage.

The plaque can also break off and float around the body. If that happens, it can harmlessly dissolve. Or it can clog a blood vessel pretty much anywhere, potentially causing a stroke, heart attack, or thrombosis.

Statins discovered

The late 1980s heralded the discovery of a class of drugs called the statins.

These medications, technically termed 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, lower levels of cholesterol. Because of the role cholesterol plays in plaque formation, the statins were found to dramatically decrease risk of serious heart damage.

Statins were so effective that a lot of influential doctors argued that the lower cholesterol levels were, the better. LDL, or low density lipoprotein, was specifically targeted. And in the early 2000s, aggressive new targets for treatment were released. LDL levels should be lowered below 100 mg/dL.

But a lot of the proponents of the new, lower levels were found to be on the pay for major drug companies. And it’s not entirely clear if aggressive lowering of LDL levels provides the most benefit.

LDL must be lowered?

It’s most likely that lowering of LDL follows a logarithmic pattern. In at risk patients, a small reduction provides a major reduction in risk of having a heart attack. As levels are lowered even further, however, the benefit becomes increasingly smaller.

A few major studies support the idea that LDL levels shouldn’t be over aggressively lowered. The HARP study showed that lowering levels below 100 mg/dL showed no increased benefit.

The WOSCOPS study gave similar results, as well as AFCAPS.  Additionally, several major studies into the non-statin drug Ezetimibe showed that its reduction of LDL did not mean better clinical results for patients.

Potential side effects:

There may be a downside to over aggressive treatment.  Low levels of LDL may theoretically contribute to hemorrhagic stroke. Statin therapy does have side effects including myopathy and we know especially little about the effects of the high doses needed to achieve the lowest levels of LDL.

Some data show a slight increase in certain types of cancer for statin use, although such an effect may be statistically insignificant.

Conclusion

There is no doubt that statins have played a major role in reducing heart disease across America. But it is also not entirely clear who should be given them, and how heavily they should be used.

With the guidelines for cholesterol treatment being written substationally by doctors on the payroll of major drug companies, skepticism is called for.

Sources:

The Aggressive Low Density Lipoprotein Lowering Controversy
“The Lower the Better” in Hypercholesterolemia Therapy: A Reliable Clinical Guideline?

Do Vaccines Cause Autism?

There’s nothing more scary for parents than the thought that they might hurt their children. The controversy about vaccines and autism is frightening, but seems to have little scientific backing.

It started in 1998. The Lancet reported on 12 children with gastrointestional problems that they believed were caused – at least partly – by vaccinations. They claimed those problems contributed to autism and other conditions in the children.

Initial research seemed to support their argument: Unusual levels of measles virus RNA (a type of DNA) was found in certain parts of the kid’s bodies. But on two levels their analysis was refuted: by massive analysis of hundreds of thousands of children and autism, and by carefully examining their scientific method.

Epidemiological studies

Massive amounts of evidence shows that the large increase in autism over the past few decades is not associated with vaccination.

One study in Denmark compared 500,000 children vaccinated against 100,000 who weren’t. They had pretty much the same chance of autism.

The measels, mumps and rubella (MMR) vaccine was started in 1988 in London and no correlation was found between that and an increase of autism. Additionally, the vaccination efforts initially were distributed in clusters: not everyone got it at once. No such cluster effect was found in autism rates.

Similar data show that introduction of MMR in Japan in 1993 was not correlated with increase in autism rates.  One thing is consistent: analysis of tens of thousands of kids shows again and again no risk for autism associated with vaccine use.

Refuting the science

How might vaccines cause autism? The most prominent theory was that they somehow trigged an “aberrant immune reaction” that caused damage to the brain. The gastrointestional upset, for instance, might allow toxic proteins to reach the brain that otherwise wouldn’t.

The evidence for this theory was that a few kids with autism had been shown to have measles virus RNA in parts of the body where they shouldn’t be, like inside certain blood cells.

Suspicion of this theory was raised when multiple other studies were unable to replicate the findings.

D’souza et al carefully analyzed the reports and showed that their results were most likely because of mistakes. Either because of false positives or because of mistakes in the lab with how the materials were dealt with.

Thimerosal

Another theorized problem was the presence of thimerosal in vaccines. Superficially, it seems insane to include it; it is, after all, mercury, and we all know how dangerous that is.

Thimerosal, however, is a specific type of mercury called ethyl mercury, which is biodegradable and does not cause toxic build up in the body. Similarly large epidemiological studies have shown that it is not associated with autism.

Finally, all vaccines are now available without thimerosal.

Conclusion

There is no denying that diagnoses of autism have really, really increased over the last few decades. But it’s hard to say why. Increased recognition must play a large part, as well as diagnosing milder cases that would have previously been ignored.

It is also possible that other environmental issues play a role.

Vaccines are extremely important to protect children from diseases.

Next Article: Treatments of Autism

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Sources:

Vaccines and Autism: Evidence Does Not Support a Causal Association
No Evidence of Persisting Measles Virus in Peripheral Blood Mononuclear Cells From Children With Autism Spectrum Disorder
Has the Measles-Mumps-Rubella Vaccine Been Fully Exonerated?

1) 1/10 people in America are currently taking an antidepressant (AD)

2) Michael Jackson was reportedly taking Zoloft and Paxil when he died.  Antidepressants have been shown to contribute to heart disease.

3) Luvox was being taken by a shooter in the Columbine High School shootings.

4) We have no idea how antidepressants actually work

5) Effexor’s side effects include vomiting and nausea, while Zoloft is associated with diarrhea

6) Almost all of the new ADs work similarly well (or badly) – the only significant difference is what side effects they have

7) ADs can cause extreme anger in some people, and there are many lawsuits against AD drug companies for resulting violence

8) Prozac is the best recognized AD with the most references to it in music and popular culture

9) Anna Nicole Smith’s son was taking Lexapro when he died

10) Paxil is one of the hardests ADs to quit.

11) ADs can be extremely hard to quit.  Withdrawal, which is a very common problem, can involve “brain zaps” and general horrible feelings.

12) Some antidepressants work only 50% of the time.  Placebo?  That works about 30%.  Big difference?

13) Remeron has been linked to immune system failure

14) Antidepressants can cause suicidal thinking in children and perhaps adults

15) Celexa is used in autistic children who have OCD-like behavior, but it doesn’t seem to help

16) Antidepressants can possibly cause birth defects

17) Tricylcic antidepressants are poisonous and can be deadly if an overdose happens

18) The SSRIs (including Zoloft and Prozac) cause sexual dysfunction in most people who take them

19) Kids as young as two have been put on antidepressants

20) Wellbutrin very often causes extreme anxiety and can rarely make the taker lose touch with reality

21) Bonus: Women who take antidepressants are at a 45% increase risk of having a stroke.

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10 Ways Scientists Lie About Drugs

What did you think about this post?

Does the FDA keep us safe?

Research into new medications is how we learn if they work and if they’re safe.  It’s the only protection we have against snake oil and worse.  But disasters like Thalidomide and Vioxx – not to mention the dozens of products recalled monthly – remind us that the FDA screws up every now and then.

That’s because drug companies often pretty much lie to get their drugs approved.  Here’s how.

1) Report results that didn’t happen

Amazingly enough, some drug companies take studies that show their product doesn’t work, and they report that it does!  This has happened at least 11 times with studies into antidepressants.

Another form of this is to write a conclusion that’s different from what the actual results show.  Because of time pressure, doctors don’t have time to actually read all the papers thrown at them, and often just read the abstract, which contains the pro-drug message like:  “Conclusion:  Fake drug has been shown to be safe and efficacious in treating extreme bladder discomfort.”

2) Use faulty statistics

There’s a reason Benjamin Disraeli said “there are lies, damn lies, and statistics.”  The sheer amount of ways to manipulate the data from studies by statistics is mind-boggling.  The simplest is to report that something is statistically significant when that doesn’t mean anything.

For instance, a drug can have a statistically significant effect on blood pressure – but that effect is tiny and meaningless.

3) Use inappropriate measuring systems

Some things are easy to measure, like someone’s height or weight.  Others, like mental states and attitudes, are a lot harder.  Psychological assessments range from solid to extremely shaky, like the infamous Rorschach blotch test.

Thank God no drug has been approved because of results of a Rorschach blotch test.  But drug companies always use the measuring system that puts their drug in the best light, even if it doesn’t mean it actually works.

4) Don’t use placebo

When you don’t test your treatment against placebo, absurd things happen.  Like the gastric freezing procedure to treat ulcers, which consists of putting a balloon full of frozen liquid into the stomach to cool it off.  It worked great – until it was tested against a placebo, or a fake treatment.

Guess what?  The placebo worked better.

5) Don’t test against other drugs

You’d have to be crazy to forget about testing against a placebo.  But what drug companies almost never do is test their drugs against other drugs that already exist.

Vyvanse, for instance, is a new medication for ADHD that is chemically identical to Dexedrine.  It’s a hell of a lot more expensive, so there’s no way that it’s ever going to be tested if it’s actually better to the treatment that already existed.

6) Ignore the FDA

This is by the far the stupidest thing a drug company can do.  You’d have to be crazy to ignore what the FDA tells you to do in testing your medication.  But that’s exactly what Sam Waksal did with the breakthrough cancer drug Erbitux.

They told him to conduct certain studies and change some of his protocols.  He didn’t.  The worst part is, Erbitux was a drug that could help treat cancer in some of the worst cases.  Then Sam was surprised when his drug was rejected!

7) Pressure patients to give the results you want

If you give patients a test at the start of the trial, like a mood inventory scale, and then again at the end of the trial, they won’t answer the same.  Their past experience biases how they respond the second time around.

Also, you can subtly pressure participants to give results you want by leading questions.

8)  Test it for short periods of time

Take a drug that needs to be taken for months if not years, like an anti-depressant.  Why not just test it for a few weeks?  Not only will you save money, you won’t have to learn about the nasty side effects caused by long term use.

Everyone wins, except the patients.

9) Test it on a few people

Who cares if your drug will be taken by millions?  Test it on only several hundred people.  That makes it even easier for you to run the test again if you are so unlucky as to get bad results.

10) Test it on people who’re different

Test your drug on people who are healthier than those who will eventually take it.  You’re almost guaranteed better results.

Prozac, for instance, while now used for dozens of reasons including pain management, was initially tested on mild-to-moderately depressed people – not people who were extremely depressed.  Stuff like that explains why antidepressants don’t work nearly as well as they’re supposed to.

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Do you trust the drug companies?  Why or why not?

ADHD is most often treated by stimulants like Ritalin, Adderall, and Dexedrine. I’m sure you’ve heard of these medications – but what are they? What do they do?

And most importantly – are they safe?

Are Stimulants Safe?

Stimulants are powerful medications, potentially addictive, and can have very serious side effects.

They’re commonly used because they’re effective.  Up to 70% of people experience significant symptom relief on them.  And the majority of the millions of people who use them are fine.  But they do have common side effects, and can rarely cause some quite nasty things.

The most common issues with stimulant use include increased anxiety, nausea or loss of appetite, and insomnia.

The rarer and very serious side effects?  To quote an ad for Vyvanse, an ADHD medication, “new psychosis, mania, aggression, growth suppression and visual disturbances” are possible.

Heart Damage?

Stimulant use might cause heart damage over time. Stimulants typically increase heart rate by ~3-5 beats per minute and also raise blood pressure.  One study of more than 50,000 children using stimulants showed an 20% increase in risk of emergency treatment for heart problems.

Use of stimulants by someone with a preexisting heart condition is a big no-no, as they may increase risk of cardiac failure or sudden death.

Psychological problems

As mentioned, a rare but serious side effect is that stimulants can cause psychosis, or a break with reality such as paranoia, delusional thinking and hallucinations.  Most psychosis occurs in people who were already at risk – but stimulants can cause psychosis in normal people at normal doses.

Stimulants can also cause serious problems with regulating or controlling mood. They can trigger mania in bipolar patients, and cause extreme mood variation even in people not normally at risk for bipolar.

Stimulants change the brain

Do stimulants cause brain damage?  Maybe.

Studies in rats have shown that extremely high doses of amphetamines given over a short period of time cause serious damage to the production of dopamine and its transport in the brain.  This happens by causing build up of radicals and reactive oxygen species.  Methylphenidate, or Ritalin, does not cause this damage, possibly because it only blocks the receptors for reception of dopamine.

But what about normal use?

The rats did not experience neural changes or damage from doses in the normal range.  The news isn’t all good, though. Baboons and monkeys, however, did experience brain damage at normal doses, showing a significant reduction in natural production and handling of dopamine.

It’s not clear what this means.  Children who take ADHD medication, after all, have larger white brain matter than unmedicated children, indicating a neuro-positive effect.

Remember: use of stimulants in children requires extreme caution and psychological analysis because they are young, more susceptible to side effects, and still developing.

Do stimulants like Adderall and Ritalin stunt growth?

This question is extremely contentious. A number of studies have shown that stimulant use is associated with slightly reduced growth, and, on the other hand, a number have shown that they aren’t.

The evidence, in my opinion, seems to be in favor of a slight reduction in height associated with long term use.

Both sides agree  that stimulant use initially slows growth somewhat; the question is if that delay is made up for in the long run.

Stimulant use is, however, associated with some degree of weight loss in the long run.

Conclusion:

Stimulants are extremely commonly used for a reason. They work. That said, they are potent substances, and often require supportive psychological therapy on the side to achieve best results.

For someone with a history of anxiety or other psychological problems, or someone with cardiac issues, use of stimulants should be exceptionally cautious if at all.  Use in children should also be done with extreme caution and only after appropriate psychological evaluation.

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Sources:

Potential Adverse Effects of Amphetamine Treatment on Brain and Behavior: A Review
Comparative Efficacy of Adderall and Methylphenidate in Attention-deficit/Hyperactivity Disorder: A Meta-Analysis
Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD

Note: This is an editorial

Antidepressants – what’s going on?

One out of ten Americans are currently on antidepressants.  That’s just the beginning.  More than 25% of college students at some schools are on them.

Everyone is being given them for all sorts of reasons.  Are they really that effective or safe?  Maybe.  That said, there is a horrible secret.

We don’t know how antidepressants work.  We don’t know if they are safe for long term use.  And finally, we don’t know how well they work, and for what reasons they should be prescribed.

There’s too much money at risk for the big drug companies to bother to answer these questions.

After all, antidepressants are ideal money-makers, $80 billion annually.  They have to be taken daily for months if not years, and it can be impossible to tell if they’re working.  And they have serious side effects, like possibly doubling your risk of committing suicide.

Flawed studies

Everything we know about antidepressants comes from medical studies.  But the studies are really screwed up.

First, who runs the studies?  The drug companies.  What do they have at stake?

Good results mean that they make hundreds of millions of dollars.  Bad results mean they’ve wasted years of research and development.  What do you think happens?

Positive results in the studies are inflated on average 32%.  One analysis of 74 trials covering 12,500 patients showed that 36 studies gave negative results – and a shocking 11 of those were reported as being positive!  And if the negative studies can’t be spun positive, then we simply don’t hear about them.

Studies on antidepressant safety and efficacy are 94% positive – but if negative studies were published, they’d only be 51% positive.  The difference between what we hear and what is actually going is especially big for new drugs like Remeron.

The less time spent testing the drug means the less chance of picking up annoying side effects and saves operating costs.  Because of that, most studies don’t track long term use, and some studies last only a month.

That’s right.  Despite antidepressants being taken for months if not years, most research into them only goes on for a month or two, ignoring long term risks.

Extremely limited research

Millions of people take antidepressants.  By contrast, the studies which confirm their efficacy and safety study at most a thousand patients.

The initial studies for Prozac that approved its use had only a few hundred patients complete the study.

Some quick math.  30 million people have taken Prozac.  Now imagine there’s a serious side effect that occurs in 1/10,000 of the people who use it, and was missed in the initial studies.  That’s 3,000 people.

Antidepressants aren’t benign drugs, far from it.  They can cause thoughts of suicide in up to 4% of children, anger and violence in adults, alongside more mundane issues like nausea, restlessness and sexual dysfunction.

The Serotonin Hypothesis – a myth?

We don’t know how the medications work.  The Serotonin Hypothesis – that reduced levels of serotonin in the brain cause depression – is inaccurate and lacks scientific basis.

Lowering the level of serotonin in the brain doesn’t cause depression.  Increasing its levels directly doesn’t do much, either.  And if low levels of serotonin were to blame for depression, antidepressants wouldn’t take several weeks to work – they would work within days because that’s how fast they raise levels.

To cap it off, antidepressants that don’t target serotonin – like Wellbutrin – work at about the same rate as those that do.  Clearly the serotonin hypothesis is a vast over simplification that’s convenient for the drug companies.

Use in bipolar?

Antidepressants are very heavily used in patients with bipolar disorder.  Unfortunately, the data seems to be at best only moderately in support of such use, and there are no antidepressants approved for use in Bipolar (July 2008).

The STEP-BD, Systemic Treatment Enhancement Program for Bipolar Disorder, a study run by the National Institute of Mental Health, seems to show that antidepressants are only as effective as placebo for bipolar depression.

And while antidepressants aren’t much better than placebo for bipolar patients, they may exacerbate mood cycling.

Use for depression

A similar major study of antidepressant efficacy for regular depression, STAR*D, showed similarly lackluster results.

STAR*D’s data is open to interpretation, but at the least indicates that antidepressants are not as effective as thought.  About only 50% of patients experienced improvement initially, and over a year span efficacy was only about 25%.

For the vast majority of uses, antidepressants may work only as well as placebo, or a sugar pill.  Placebos, after all, show about the same 25% efficacy.  Due to the psychological nature of depression, the placebo effect absolutely must be monitored for.

Conclusion

Antidepressants do help some people, and do save lives.  A black-box warning in 2003 which sharply reduced their use may be linked to a significant increase in teen suicides.

But they are also huge money makers with highly inflated efficacy rates, and should not be as heavily prescribed as they are.  In many populations, they are no more effective than placebo, but unlike placebo have significant side effects.

Their use in Bipolar patients should be carefully examined.

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Sources:

Why antidepressants are not antidepressants: STEP-BD, STAR*D, and the return of neurotic depression
Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature
The Shocking Truth – Boston Magazine

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