Josh, and the terrible, horrible, no-good, very bad side effect
Josh was very bright, very fidgety, very talkative and very distracted. He was in 3rd grade when his parents who had tried “everything else” for his ADHD symptoms chose to try a time-release stimulant.
The first few hours on the first dose were remarkable. Josh had his best school day ever. He paid excellent attention in his morning classes and was quite calm. In the afternoon, he seemed fidgety again, as if the medication wasn’t lasting well. At suppertime, he was so hyperactive that he didn’t eat anything.
By bedtime, he was distraught and couldn’t stop moving or talking, especially about jumping out a window and flying. His mom held him close and calmed him. At 3 am, he finally fell asleep. She cried herself to sleep some time later.
As a physician, I guided this family through a harrowing, potentially dangerous situation. As a person, I felt awful that my prescription had caused such misery. It’s worth a closer look at just how badly an intention to help can affect people.
Exactly how bad are ADHD medication side effects?
In the world of ADHD medication side effects, this one was terrifying and awful. It was also temporary. Josh was sleep-deprived the following day and entirely himself the next. The side effect cleared up as soon as the medicine was out of his system and there have been no lasting effects.
Side effects of ADHD medications are often cited as arguments against their use, which would make perfect sense if side effects were permanent. But ADHD medication side effects are temporary. Most, like decreased appetite and insomnia, get better as the body gets used to the medication.
A few side effects continue or are severe, so the medication has to be stopped. Rapid pulse goes away when the medication is stopped, Dysphoria–bad mood–clears up. Emotional “flatness”, a not uncommon complaint in teenagers, resolves the day you stop the drugs.
Everything has side effects.
Humans are complex biological organisms. It is impossible to make a change in the system and have purely beneficial, desirable consequences. Psychotherapy can fail, which delays better treatment. In some cases it can even worsen symptoms. Yoga can strain ligaments and fracture ribs. Essential oils can incite life-threatening allergies. Organic foods can carry deadly bacteria. Band-Aids can cause skin to slough. When I was a kid, my dad bear-hugged me and cracked one of my ribs. Even love has side effects.
Exercise, for all its benefits, has side effects which can have permanent consequences worse than ADHD medications: sprains, blown knees, heart attacks. Marathon runners die at the rate of 1 per 100,000 races. Where is the chorus of do-gooders shouting, “Exercise has side effects. DON’T DO IT!”
It is often said that kids with ADHD need more exercise and less medication. Given the small but real dangers of exercise and the increase in accident rates for children with unmedicated ADHD, that approach might be short-sighted. The smart money is on medication AND exercise.
The rest of Josh’s story
Josh’s experience is not typical. It’s the single, worst side effect I’ve seen in 14 years of prescribing ADHD medications all-day, every day. But it cleared up quickly and hasn’t had any lasting effects. We found a different medication that has been very helpful for him.
So what’s the worst ‘side effect’ I’ve seen in untreated ADHD? In my own practice, it has to be the five young men who have taken their own lives.
I’m far more afraid of ADHD than any of its treatments.
In our next post, we’ll look at approaches that make more sense than fear and avoidance.