Why Ritalin makes me MAD!

Saturday afternoon at the Wits Club in Jo’burg and Dr Shabeer Jeeva steps up to the microphone. The audience of 50-odd therapists, parents and educators perch attentively on their blue plastic chairs as he launches forth at a machine gun pace on the treatment of Attention Deficit Disorder/Hyperactivity (ADHD) in adults.

South African-born Jeeva studied medicine in Dublin and trained in Canada as a psychiatrist specializing in ADHD. He has over 20 years’ experience treating the restless, the impulsive, the distracted, the disobedient and the disorganised of every age. He is widely acknowledged as one of the country’s leading experts on ADHD.

So why am I so gob-smacked by his presentation at this annual seminar organized by ADHASA, the support group for ADHD sufferers (www.adhasa.co.za)?

Reason 1:
Jeeva tells us that short-acting Ritalin (which lasts for 4 hours) can be taken often – “just like Smarties” — and taken nogal on top of the sustained-release version of the same psycho-stimulant.

Reason 2:
One drug is not enough. He says the most effective treatment for ADHD amongst teens and adults often consists of cocktails of amphetamines and anti-depressants such as of Ritalin and Xyban, Concerta and Epilim or Prosac.

Reason 3:
South Africans are not getting enough of these drugs because our doctors are under-dosing. More not less is needed.

Reason 4:
Finally, he says, with some irritation, that all drugs have side-effects, so why are we singling out Ritalin (which has been blamed for causing severe depression, even suicide, amongst children)?

I am left reeling from this assault on my sensibilities and sensitivities about the treatment of ADHD.

Let me state my vested interest here. Over the last few years I have devoted a good deal of time to finding out about attention deficit because I distribute marine and organic oils containing Omega-3 Essential Fatty Acids that are believed to be helpful in the treatment of ADHD.

My research has led me towards the various drug-free alternatives in the treatment of ADHD, towards nutrition and supplementation as well as various therapies. But as much as I have wanted to embrace a 100% drug-free approach, the evidence seems depressingly clear: in severe instances of ADHD there appears to be little alternative to the drugs. The #@&! stuff works!

I thought I had stumbled on solid ground when I came across a middle path: the “integrative” school of medicine that draws upon the best practices of orthodox medicine as well as complementary/alternative therapies.

Pioneered by Dr Andrew Weill in the US, this approach does not reject drugs per se, but will include them as part of an holistic strategy that includes nutrition, supplementation and natural remedies, the removal of known toxins and allergens, and various supportive therapies. Integrative medicine appeals to me: it looks at the total person in the context of their lived environment. It certainly does not rely on the prescription pad alone. Now all I need is to find someone who practices it!

Somehow, naively, I was hoping Jeeva’s talk would touch on that thinking. After all, he’s a global professional in touch with the latest trends and he must be acutely aware of how freaked out many parents are about having their kids on these drugs with their myriad side effects ranging from nausea to depression and even suicide.

But Jeeva wasn’t giving an inch. Not once did he mention dietary or lifestyle issues, or the role of occupational therapy, counselling, meditation etc. He did, however, warn that ADHD has a strong genetic component, further fuelling the sense of lack of control we have over our restless minds.

Jeeva took us on a whistle-stop tour of the psychiatrist’s drug cupboard, explaining which upper/downer combinations worked best depending on various orders of preference and “co-morbidities” such as depression and anxiety.
Drugs like Ritalin, Strattera and Concerta all act on an apparent imbalance in neurotransmitters in the brain and help “normalize” the message flow of these chemicals.
Exactly how they work is not clear. But behaviourally they tend to reduce spontaneity and curiosity, and subdue socialization.

Jeeva believes ADHD is by no means a childhood illness that kids grow just out of. On the contrary, he warns there is a higher than 60% chance of ADHD continuing into adulthood, which means kids could be on these drugs for ever. In broad brush-strokes, the typical treatment regime looks something like this:

Children 7-12: Psycho-stimulants such as Ritalin/Concerta, or Strattera.

Adolescents: Stimulants/Strattera with occasional anti-depressants.

Adults: Anti-depressants first and then stimulants/Strattera if necessary Jeeva has treated many hundreds of patients and clearly he gets results. Scattered brains start paying attention. Impulsive minds start thinking twice. Demand for instant gratification is denied/delayed. Broken families are put back together and sanity is restored to the classroom. Who can argue with such vast clinical experience, such proven efficacy? But before you put your child on such medication, I suggest you swallow a tablet of Ritalin yourself and experience the subtle mental dullness that quietly creeps up on you. Yes, there’s definitely an increase in focus, but it’s wrapped in cotton-wool, a gossamer narcotic cloud that renders you distant, self-absorbed, even aloof (it’s not surprising that one of the side-effects is reported loneliness and the inability to make friends). Well, that’s my experience anyway.

The idea that a young person (and they start drug therapy from the age of seven) can be dosed with such potent mood-altering drugs year in, year out, perhaps all the way through adulthood, is a chilling prospect indeed.

In the course of my business I have had numerous conversations with parents about the treatment of their ADHD children. Few ever mention that their doctors have suggested integrated approaches or discussed issues of diet and supplementation. All they seem to be getting are prescriptions, dosage tweaks and/or multi-drug cocktails.

Just about all of them seem desperate to get their kids off this stuff. While they acknowledge that the drugs help, they can see the personality changes and it worries them. They can see the side-effects and it scares them.

Jeeva’s presentation certainly scared the hell out of me. I know I was not the only one who felt this way. Walking out of the hall at the end of his talk I heard one delegate muttering to herself: “Smarties! Hmmmmmph! Smarties!” ü Bruce Cohen is CEO of Absolute Organix, a Johannesburg-based distributor of natural and organic products.
He can be contacted at bcohen@mweb.co.za