The New ADD/ADHD Drugs: Are They Really Better?
If you ask about new drug treatments for ADD/ADHD, the short answer is that nothing is really new. Almost all the ‘latest’ drugs in the market for inattention and hyperactivity are forms of amphetamines and methylphenidate, Schedule II drugs with a high potential for abuse and addiction.
Methylphenidate (most commonly prescribed under the brand name Ritalin) and amphetamines (Adderall is the most commonly prescribed form) have been used to treat children with severe attention and hyperactivity problems from at least the 1930s. In the 1990s, as the ADD/ADHD diagnosis rates rose and more and more children were being prescribed drugs for it, drug companies rushed to develop drugs which had fewer unpleasant side effects and could not be abused as easily.
But while the newer drugs are easier to administer and help children stay attentive and calm longer, they are generically almost identical to the old drugs amphetamine or methylphenidate. The only other new, non-stimulant drug used to treat the disorder is Strattera, but this has its own problematic side-effects.
Here are a few of the newer ADHD drugs in the market (those approved after 2000), and how they are better than the old drugs:
1. New methylphenidate drugs
Focalin XR, Ritalin LA, Concerta, and Metadate CD are some of the drugs recently in the market. These need to be taken just once a day - the dose is effective longer than for the older medicines. Some can be sprinkled on food or apple sauce (Ritalin LA) for giving to children, but most in tablet form are designed to be swallowed whole. Crushing or breaking them with destroy the extended release mechanism and release too much medicine at a time into the body.
Another long-acting form of the drug is Daytrana, a patch designed to be worn on the hip and transfer medicine through the skin for children who are not able or willing to swallow tablets.
2. New amphetamine and dextroamphetamine drugs
Again, what is new about the most recent amphetamine and dextroamphetamine drugs (Dextrostat, Dexedrine Spansules, Adderall XR) is that their effect lasts a longer time. Also, Dextrostat is now the only drug in the market which is approved for children under 6 (but not under 3).
The advantages of the long-acting forms of ADHD drugs is that one dose in the morning is enough for the day. Because they wear off slower than the short-acting forms of the drugs, the long-acting drugs have less of a rebound effect (your child starts acting out as the drug’s effect wears off later in the day). One disadvantage is that they take a longer time to take effect - except for Adderall XR (and Concerta among the methylphenidate drugs) which will make your child calmer within half an hour of taking it.
3. Non-stimulant drugs
Strattera (atomoxtine) is the most recently developed non-stimulant drug. Because it is not a stimulant, it cannot be abused and is not in included in Schedule II. It can be used by people who have a history of substance abuse.
The problems with the new drugs
1. The same abuse and addiction potential
Although the newer versions of methylphenidate and amphetamines prescribed for ADD/ADHD are not as easy to abuse as the older forms of the drugs, people who are determined seem to keep finding ways to misuse them - to work late or lose weight or party or get high (and more and more people seem to be doing it). Ritalin, the oldest and most commonly prescribed ADD/ADHD drug, is one of the ten most commonly stolen drugs, and the newer versions of Ritalin are also stolen.
2. The same side-effects
All the stimulant ADD/ADHD medicines may cause sleeplessness, irritability, dry mouth, loss of appetite and weight loss, stomach aches and headaches. Some of them have a rebound effect - as the effects of the medicine wear off you can expect your child to be even more hyperactive and inattentive than usual. This is one of the side-effects listed for Ritalin LA, though some other long-acting drugs are designed to lower this rebound effect.
Strattera (atomoxetine) might also give your child stomach aches and reduce his appetite, though it will not make him sleepless. It might cause liver damage.
Another scary side-effect is the danger of children on these drugs becoming depressed and suicidal (a side-effect listed for Strattera) or psychotic (a danger with all the amphetamines).
3. They still have not been tested for safety for children under 6.
None of these medicines except one have been proved safe for children below 6 - something important that parents should remember. That one medicine approved for children below 6, Dextrostat, has not been proven safe for children below 3.
So it all boils down to this - give drugs only if nothing else works. Of course there are a few children who may need these drugs, but when an improved diet, or individually tailored education, or better family atmosphere might work, we need to give these treatments a fair trial before choosing medication.
Tags: Attention Deficit Disorder | Attention Deficit Disorder | ADD/ADHD medication | ADD/ADHD medication | New ADD/ADHD drugs | New ADD/ADHD drugs | methylphenidate | ADD/ADHD | Adderall | Ritalin | Ritalin