Speed-like stimulants prescribed for adult ADHD part of ‘psychiatric fad,’ risk being used for mental edge
Sharon Kirkey, Postmedia News | July 23, 2015 3:45 PM ET
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Sardaukar Blackfang / Wikipedia Once considered rare, adult ADHD is rising sharply. In Canada, adults now account for more than a third of all prescriptions for ADHD medications, and while children still surpass adults as the main users of ADHD drugs (64 per cent versus 36 per cent), the number of adults on the drugs is increasing faster, according to Shire, makers of the ADHD drug Vyvanse.
The growing number of adults being prescribed speed-like stimulants to help them focus risk becoming an epidemic of over-diagnosis, warns a leading Canadian doctor who says adult ADHD has become the newest “psychiatric fad.”
Once considered rare, adult ADHD is rising sharply. In Canada, adults now account for more than a third of all prescriptions for ADHD medications, and while children still surpass adults as the main users of ADHD drugs (64 per cent versus 36 per cent), the number of adults on the drugs is increasing faster, according to Shire, makers of the ADHD drug Vyvanse.
In 2014, the adult ADHD market grew by 17 per cent, vs. 10 per cent for children. In all, more than 4.5 million prescriptions worth more than $408 million were filled by Canadian drugstores in 2014, according to market research firm IMS Brogan.
In an article published this month in the Canadian Journal of Psychiatry, McGill University psychiatrist Dr. Joel Paris says the diagnostic criteria for adult ADHD are so broad they could easily describe anyone who has trouble focusing.
“A rapidly increasing frequency of a once-rare condition may reflect increased recognition,” Paris writes, “but may also constitute a diagnostic epidemic.”
He and others worry the drugs are being used by growing numbers of healthy people as pharmacological brain enhancers to improve concentration and give people an edge at the office. Social forces “can motive patients to seek stimulant prescriptions,” Paris and his co-authors write. And a prescription requires a diagnosis of ADHD.
But Paris is more worried that people are being misdiagnosed with ADHD when other issues, such as anxiety, depression or substance abuse may be at play.
“It’s what I call a psychiatric fad, in which you have a medication which is known to work for certain people and you say, ‘let’s try it here, let’s try it there,’” Paris said in an interview.
“And some of these patients do have a little bit more focus after you give them stimulants, because everybody is somewhat better focused if they get a stimulant.
“But when people report this back to their doctor, this is seen as, ‘I knew it was ADHD, and I’m right.’”
Christinne Muschi for Postmedia NewsMcGill University psychiatrist Dr. Joel Paris
ADHD, Paris said, is a neurodevelopmental disorder rooted in childhood. According to the official diagnostic criteria, an adult can’t have ADHD if he or she did not have it as a child.
“I do a lot of consultations for family doctors, a couple of hundred a year,” he said. “And some patients are coming in having received this diagnosis and stimulants without sufficient data to support it.
“They complain of various things — I can’t focus or I can’t multi-task, I can’t get things done, I’m disorganized,” he said. But they have no history of ever having been in trouble at school, or being sent to the principal’s office or pulled out of class.
“Once you’re on stimulants, and you feel they help you a little bit you may just take them for the rest of your life,” Paris said. High doses of stimulants can cause high blood pressure and arrhythmias, or erratic heart beat in people with underlying structural changes in their heart. Health Canada recently strengthened warnings that an array of ADHD drugs can increase the risk of suicidal thoughts.
Stimulants can also make mental disorders worse. “You don’t want to take speed — and this is essentially speed — if you’re schizophrenic or have bipolar disorder, anxiety disorder, sleep problems or a whole host of other psychiatric conditions,” said Dr. Allen Frances, a professor emeritus at Duke University who chaired the task force that produced the fourth version of the DSM, the Diagnostic and Statistical Manual of Mental Disorders used the world over to diagnose mental illness.
Pharma has already created a wild and dangerous epidemic of prescription narcotics. Next on its agenda is pushing the sale of prescription speed
“Pharma has already created a wild and dangerous epidemic of prescription narcotics,” Frances said. “Next on its agenda is pushing the sale of prescription speed.”
“If we want to allow people to take speed for performance enhancement, or make it legal for recreational purposes, there should be a discussion of that,” said Frances, author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma and the Medicalizaiton of Ordinary Life.”
However, an expert in ADHD says there is no evidence of an “epidemic” of over-diagnosis. Dr. Anthony Rostain says the rate of adult ADHD is increasing largely because it’s a relatively recently recognized phenomenon.
“The other important point they seem to be missing is that having ADHD is a truly disabling disorder,” said Rostain, professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania.
ADHD looks different in adults, Rostain said. “Fidgety and squirmy may be things we notice in children,” he said, “but in adults it may be more restlessness and an inability to get things done and constantly being late or disorganized.”
Some adults were never treated for ADHD in childhood and it’s only after their own children were diagnosed, “that the doctor would say, ‘do you have any of these symptoms, did you have them as a child?’ And the parents would say, ‘oh my God, yes I did. In fact, I was just like my son.”
Studies suggest more than half of children who meet criteria for ADHD never outgrow it. But one recent study from New Zealand also found many people had symptoms in adulthood without having had them in childhood.
Life can be “chaotic” for adults with ADHD, Rostain said. Some are impulsive; they drive too quickly, get into accidents frequently or get angry easily. Many have trouble keeping jobs or relationships, he said.
“There is no question that there are forces at work to push people to increase productivity” and that stimulants are being misused, Rostain said. “Sometimes it’s very conscious — like: ‘I’m just going to go in (to see a doctor) and say I have it when I don’t.’ That would be a form of malingering; it’s feigning ADHD.
“We have to be careful not to jump to the diagnosis too quickly without going through proper steps of assessment,” he said.
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