What is the Feingold Association's
position on the use of drugs for ADHD?Including information we believe all parents should be given before they agree to use drugs for treatment of ADHD.
The Feingold Association is not "for" or "against" the use of drugs for ADHD. However, we believe that they are often used inappropriately.
Drugs can save lives and can enhance the quality of one's life. They can also take lives and cause serious damage. While we believe that most people with ADHD symptoms can successfully address those symptoms without them, we recognize that drugs can provide benefits. Some parents have found that a combination of diet and stimulant medicine works well for their child, and that by using the Feingold Program they can reduce the amount of drugs needed. We offer assistance and support to people whether or not they opt for medication.
The primary criticism we have is that parents and/or patients are not given complete, accurate information on all of the options available.
We believe that parents and/or patients have the right to be told all of the potential side effects of drugs, not only their benefits, and that extreme caution should be taken when more than one drug is used, since the combination of two or more preparations can have serious consequences.
Various medicines have been used for ADHD symptoms for many years, but it is only recently that the full implications of their use have been made public.
On September 30, 2005, the New York Times reported that the Food and Drug Administration has ordered a Eli Lilly to place a prominent Black Box warning -- the FDA's most serious alert -- on the label of the drug Strattera, commonly used for ADHD as an alternative to stimulants. While not a stimulant drug, Strattera is similar to antidepressants, which have been implicated in triggering suicidal thinking in children and adults. Strattera, although not a controlled substance, carries the warnings of both the stimulants and the antidepressants.
Today, the stimulants all carry substantial Black Box Warnings. You can see the entire Ritalin monograph here, and scroll through to see the three Black Box Warnings, reprinted here from Novartis' website:
- Heart-related problems:
- sudden death in patients who have heart problems or heart defects
- stroke and heart attack in adults
- increased blood pressure and heart rate
Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child carefully for heart problems before starting RITALIN®.
Your doctor should check your or your child’s blood pressure and heart rate regularly during treatment with RITALIN®.
Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking RITALIN®.
- Mental (Psychiatric) problems:
Children and Teenagers
- new or worse behavior and thought problems
- new or worse bipolar illness
- new or worse aggressive behavior or hostility
- new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms
Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression. Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking RITALIN®, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.
RITALIN® is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep RITALIN® in a safe place to prevent misuse and abuse. Selling or giving away RITALIN® may harm others, and is against the law.
Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs.
Ritalin should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abusive use can lead to marked tolerance and psychological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during withdrawal from abusive use, since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.
Other warnings on the Ritalin site (and other stimulat sites), besides the usual list of side effects, include the following:Back
There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.
- Visual Disturbance
Difficulties with accommodation and blurring of vision have been reported with stimulant treatment.
- Use in Children Under Six Years of Age
Ritalin should not be used in children under 6 years, since safety and efficacy in this age group have not been established.
Patients with an element of agitation may react adversely; discontinue therapy if necessary.
Last Updated 8/14/11