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Does Attention Deficit Disorder Medication “Work”?

I’ve been skeptical of the official narrative on many mental illnesses for some time.  The evidence that many psychoactive drugs work is weak, at best. In many cases, there is reason to believe that interventions with less unpleasant side effects work as well. In fact, in many cases, doing nothing at all produces better long term results than medicating.

This lengthy paper on the subject is interesting:

it is quite simply hard to see how drugs such as methylphenidate and atomoxetine can have been licensed to “treat ADHD” in the UK. Once we probe behind the “symptom reduction” claim the alleged “benefits” of the drugs are difficult to ascertain. Claims tend to be somewhat folksy such as “improving the quality of life”. The only certain positive effect of stimulant drugs is a short-term increase in ability to concentrate; an effect which is the same for everyone whether or not they have an ADHD label. But the ADHD narrative concedes that this does not translate into an improvement in long-term outcomes. The actual “beneficiaries” of ADHD drugging may be those parents and schools who are glad to see a reduction in the disruptive behaviours which constitute an ADHD diagnosis. But this is not an advantage to the young person. On the other hand the harms are real and tangible and accrue to the young person. For example, methylphenidate routinely causes insomnia and stomach aches. Imagine the effect of suffering from drug induced insomnia throughout your childhood. Atomoxetine is linked to suicidal thinking and suicidal attempts.

If you’re of a certain age, the whole ADHD concept strikes you as strange; We just called such children hyperactive or troublemakers and teachers and parents just dealt with them. There’s no known “cause” for ADHD, as Wylie points out. It is a checklist driven diagnostic category.

Whenever an article like this is written, someone who suffers from the diagnosis will pop up in comments and say “It works for me!” A great, many things work for a great, many people (and the placebo effect is strong), but that isn’t really the point.  The point is whether the medication is beneficial  enough to outweigh any negative side effects.

When behavioral therapy is almost as effective as drugs with nasty side effects, as is the case with ADHD, it’s hard not to suggest that CBT should be done instead, and first, and drugs should be used, if at all, only after behavioral therapy has failed.

But behavioral therapy is expensive, takes trained practitioners to apply and it is hard to centralize the profit-making from it.  Giving the kid a pill makes the problem (for parents and teachers) go away, and if it isn’t as good for the child as therapy, well, it’s easy.

(And, as usual, exercise also works well for people with ADHD, as it does for depression, and many other mental issues.)

Read Wylie’s full paper.

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  1. subgenius

    Also, let’s not forget that giving pills serves some purpose:

    1) Keeps the meme “the Dr. knows best” alive

    2) Keeps the patient happy that they are “treated”

    3) …while simultaneously requiring no effort (beyond pill-taking) by the patient

    4) Profit!

    Questions in need of an answer, illustrating this – how long has it been known that influenza is a virus? how long has it been known antibiotics work only against bacteria? how long have antibiotics been prescribed for influenza?

  2. DMC

    Back when they were still calling it hyperactivity, they gave me Dexedrine(among other things). The progress of pharmacology is such that they’re now prescribing things somewhat less crude and one hopes less given to side effects. That was certainly the story with antidepressants. The Selective Serotonin Reuptake Inhibitors were suposedly no more effective than the Tri-Cyclics they replaced but they had fewer side effects and they tended to be less severe. I’m no fan of Big Pharma but there are some things no amount of talking is going to help.

  3. Ian Welsh

    The evidence on depression is that in all cases except the most severe exercise works just as well as SSRIs. It also has MUCH better side effects.

    The article I linked from 2010 has more details. SRRIs are nasty, and they are harder to get off of than opiates.

    Behavioral cognitive therapy does, indeed, help depressives, actually.

  4. ffd

    Back when I was in elementary school, the principal made the hyperactive kids run up and down the stairs ten times. The kids got to work off steam and the only long term side effect was improved cardiovascular functioning.

  5. Spinoza

    There’s a joke that I think ralphie may said….

    Here in the South we take our meds when we’re better.

  6. steeleweed

    In my experience over decades with myself and a few dozen others, I have found that even if a psychoactive drug has tolerable side effects, any improvement is temporary. It may ease symptoms for awhile, providing a ‘window’ for cognitive therapy to – hopefully – accomplish some long-term improvement. It’s as if one is determined to be depressed, anxious, manic, etc and the mind eventually finds a way to circumvent the meds. The subconscious motivation for the disorder has to be disrupted by cognitive therapy.

    All too often the side effects are worse than the disease. My brother was diagnosed schizoid (incorrectly, in my semi-professional opinion) and found lithium so deadened his considerable intellect that the quit taking it. He has a few quirks but they’re manageable.

  7. Mary McCurnin

    I am taking medication for ADD. I started last year. I am 65. It has changed my life and made me able to function as a web developer. I have been able to keep my job. I used to freelance because I didn’t want anyone to know how long it took me to get the job done. When I had the luxury of being a fine artist and a poet, I could get in the “zone” and work for hours. But it all had to be on my time table and calibrated to my energy level. My family is full of ADD, ADHD and dyslexic artist types. Some of us use meds. Some of us don’t. My daughter was diagnoses with ADHD when she was around 14. She lasted about three days on the medication and has used exercise to solve the problem.

    All of this being said, I believe that ADD/ADHD is grossly over diagnosed. I think my biggest problem in grade school was boredom. Massive, deathly boredom.

  8. Mary McCurnin

    Massive, deadly boredom.

    Never could spell either.

  9. compound f

    methylphenidate is related to amphetamine. It gums up dopamine re- uptake in brain, does shit in liver, arouses autonomics, etc, It has specifically been shown to organize circadian rhythms in animals rendered arrhythmic via lesions of the central pacemaker (suprachiasmatic nucleus). According to the Honmas, this action occurs in the parietal lobe, of all fuggin places. Clock genes are friggin everywhere. whodanode?

  10. a simple behavioral pattern is to not publish the antidepressants, and in fact would a negative stimulus on them. give them out if asked for, but drag your feet. remember, it is the nurses, in general, which subscribe most of the antidepressants. if you get the nurses on your side, then they doctors will not mention it. I had to fight my nurses had MGH, because they would prescribe them even if I not did not allow it. the simple behavior is to make the nurses against antidepressants, rather than for them.

  11. John

    All those prescription drugs have made some serious fortunes among the “maker” and “job creator” class, our oligarchic overlords. More predatory capitalism: diagnose inability to submit to the borg as an illness, drug’em young and often, ka=ching, ka=ching…if they self medicate, send ’em to prison…another profit center. You will submit!

  12. DMC

    Psychoactive drugs are much like anything else in life. You have to decide if the game is worth the candle, as the saying goes. Is the alleviation to whatever degree of the symptoms worth the trade-off in terms of the side effects. “Suicidal ideation down 80% but now I’ve got no libido”. And anybody you could get to excercise sufficiently to effect their depression wasn’t all that depressed in the first place. “Run around the block? I’m not getting out of bed!”

  13. steeleweed

    Whatever treatments may be, the first thing is to understand the illness.
    The best I’ve seen is this video, well worth everyone’s time:

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