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Attention Deficit Hyperactivity Disorder

Dangers of Ritalin

04/04/2008

Question:

Please could you help me, my daughter has recently been diagnoised with ADHD and medication of ritalin has been mentioned. Could you tell me if ritalin is safe as I have read so many things to suggest that is can kill you if you have been on it a few years and do you become addicted as I do not want to endanger my daughters life? Is there an alternative?

Answer:

To answer your last question first, there are many alternatives, but none as well proven as stimulant medicines like Ritalin. Stimulants are well enough proven that they have FDA approval for treating ADHD. (So does atomoxetine, Strattera, which is not a stimulant but is similar.)

Any medicine, of course, has the potential to kill someone, especially if misused. A boxed warning was recently added to the prescribing information for all stimulants based on the fact that they, as adrenergic agents, affect the cardiovascular system. Unexplained sudden deaths have been reported for stimulants at about half the rate for the general population, in both adults and children. Many, but not all, of these were in people with already weakened hearts, such as adults with coronary artery disease or children with congenital heart abnormalities. Everyone agrees that the sudden deaths are underreported and the fact that the reported rate is lower than average for people not taking stimulants should not be taken to mean that stimulants protect from sudden death. What we don't know is how much underreporting there is, so we don't know whether the real rate exceeds the average for the whole population. No evidence has been found that taking a stimulant for ADHD leads to addiction, even though many scientists have been looking for such evidence in vain. ADHD carries increased risk for substance abuse later in life regardless of whether treated with stimulant. Nonstimulant medicines that have been proven beneficial for ADHD include atomoxetine (the only nonstimulant at this point with FDA approval for ADHD), certain antidepressants, guanfacine (Tenex), antipsychotics, and even nicotine. There are also new ones in development. These are not necessarily safer than stimulants; in fact, some definitely carry more risk.

Another proven treatment is behavioral treatment. Combining behavioral treatment with stimulant medicine can give the same benefits with a lower dose of stimulant, thus decreasing any risk. The results may also be slightly better, even with a lower dose. There are many other treatments advocated with varying degrees of evidence. You can find more details in my handbook "A Family Guide to ADHD" from Handbooks in Health Care, Newtown, PA, www.HHCbooks.com.

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Response by:

L Eugene Arnold, MD, MEd L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University