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Tuesday, May 21, 2013
Attention Deficit Hyperactivity Disorder
Scientific Proof of Medication
I posted a question recently. I am a college student, and I was recently diagnosed with ADD. I have seen a lot of testimonial evidence online that the ADD medications are helpful. But I would like to know about some scientific evidence on the effect that they have on the brain. I have read about them increasing neurotransmitters, but can you give a little better explanation of how we really know that they do this?
Also, I have one other concern about taking the medications. I have read about some side effects. For instance, I am aware that the stimulants can increase heart rate and blood pressure. And I have read that Strattera can occasionally cause liver problems. But I have been unable to find any long term studies on what these drugs do to the brain. I have always been told that street drugs like cocaine and marijuana kill brain cells, and I have also read that Adderall is chemically similar to cocaine. Have there been any long term studies on, say IQ scores or any other cognitive functioning tests, of people on these medications? Thanks very much for your help.
Ah-h-h...you ask many questions and that's a good sign when one is considering taking a new medication! Hopefully I can give you the answers you seek although I'm afraid you are going to be disappointed with some of them.
First, regarding how we know neurotransmitters are affected by medications. I am not sure of your background so I am not sure how technical to get. I have attached two suggested web sites where you can find out at least some of the information.
Side effects are greatly dependent on the individual. Please take a look at my answer on 02/11/04---I think it covers this.
There are no studies I would call "long term." The U.S. Food and Drug Administration often uses the term "long term" for studies greater than a few years old but I don't think of that as long and I sense you would not either. Since the way studies are paid for in this country is primarily by pharmaceutical companies who are willing to pay to get their drug on the market, once out on the market they are only done under duress. What we do know is that stimulants have been around more than half a century and we have not seen negative effects during that time when prescribed and taken appropriately.
Stimulants do have some chemical similarities to cocaine but they have enough differences that they function in a very different way. Although similar chemical structure can sometimes mean some similar effects, two medications can have similar structure but do VERY different things. Think of it this way---if you take all of the water (H20) around you and change it to a "similar" but different structure by adding just one oxygen atom you can get H202 which is hydrogen peroxide. I sure would not want to swim in a pool with H202 even if it is "similar" to water.
What it all comes down to is, just as with every medication, one is taking some chances. The question becomes whether the chances one takes without medication seem to outweigh those with medication. It is extremely rare (maybe nonexistent?) to have really good studies based on even a few decades on any drug. That's why using medication that has been out longer is generally much more prudent than one that is new, whenever possible
I hope this at least answers part of what you were looking for.
Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati