A Confession: No More Dangerous Prescriptions for ADHD

I took a sobering look at treatment side effects and have decided to change the recommendations I make to my patients with ADHD.

For background, let me point to an outpouring of popular press articles recently lamenting an ‘epidemic‘ of ADHD over-diagnosis and an ‘alarming‘ rise in use of stimulants.  Every one of them refers to the side effects of Side Effect word cloudmedication and basically shames physicians and parents for short-cutting to medication’s “quick fix” when exercise, psychotherapy and tolerance (“let boys be boys”) should be used first and–according to these articles’ authors–exclusively in “all but a handful of cases”.

The argument that we should use the safest, least risky and most effective method for treating ADHD is so ridiculously obvious that I feel bad for using your computer’s pixels to point it out.  Why would someone recommend stimulants if exercise works well enough for most?

The argument against stimulant use in each of the articles has been that they cause side effects.  Not that they don’t work, but that they are dangerous.  This point has been central to each article, emphasized so clearly and repeatedly that I felt compelled to do a little research. How common and how dangerous are stimulant side effects? Can they cause permanent disability? Actual death?

It’s hard for parents to make sense of risks when patient handouts are so detailed (and boring!), so I picked two of my most-often-recommended therapies to create this comparison.  Let’s call them Treatment ‘A’ and Treatment ‘B’. The results, laid side-by-side, were sobering.

Treatment ‘A’ Treatment ‘B’
Annual emergency room visits to treat side effects 2.6 per 100 patients 1.7 per 100 patients
Annual rate of side effects involving brain injury or damage 3 per 1000 patients No reported cases
Deaths in US every year resulting from prescribed treatment 50 cases No reported cases

Laid out in black and white, the side effects of ‘A’ are making me nervous, while ‘B’ is looking comparatively better. So what is the safer-appearing of the two? Treatment ‘B’ is prescription methylphenidate, better known as Concerta or Ritalin.

Treatment ‘A’ is exercise.  No kidding! I’ve unconditionally recommended it to virtually every ADHD patient for years, and that needs to change. Clearly, I need to warn patients and their parents about the risks of exercise for treating their ADHD. After all, people should think soberly about their treatment options, discount the latest fads or trends and consider potentially safer alternatives.

All kidding aside, there will be changes.  All exercise is not equal. I’m still going to recommend it, but will ask people to accept a few guidelines to lower the risks.  I’ll encourage people to moderate their exercise, increase slowly.  I’m warn about the risks of football, hockey, lacrosse, soccer, rugby, boxing, kayaking, equestrian and bicycling. Helmets are a must. Signs of over-exertion must be learned and heeded. 

One more sobering thought. Sports injury rates are almost twice as high for children with ADHD. Exercise, for children with ADHD, may have even more side effects than my analysis shows. We don’t know yet if medications lower that additional risk.

Nothing is completely good or completely bad. The notion that exercise done properly is a safer option than medication taken properly, though, has been getting a free pass, and that needs to end.

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

Posted in ADD, ADHD, exercise, medications, side effects
12 comments on “A Confession: No More Dangerous Prescriptions for ADHD
  1. and lets be very careful about water, it can be deadly, even if pure, which often is not the case. but are people aware of the risks?

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  2. chaddgr says:

    Great points! ‘Never thought of that! And compare treatment to the risk of not treating AD/HD. It doesn’t make sense to say people shouldn’t be in denial about needing professional help for substance abuse, but blame them for getting professional help for AD/HD.

    Looking forward to seeing you, Dr. Mason,Tuesday, April 15th, at our meeting of CHADD of Grand Rapids, MI, 7-9 pm, at St. Luke’s Lutheran Church, at 4 Mile and the E. Beltline. Open to all interested. No cost, pre-registration, or membership is required to attend, though membership to CHADD National is encouraged.

    Thanks so much for donating your time, to help people make informed decisions! (A great incentive for people to get their taxes done!)

    Liked by 1 person

  3. Phillipa says:

    wow…very interesting. Point well made.
    My son does seem much better in summer when he golfs pretty much non stop…but what do I do to convince a 16 year to exercise in winter :/
    Maybe I will try pointing out and explaining how much happier and more even keeled he seems when he is golfing/exercising and point him to some of the references about how exercise can help.

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  4. or perhaps you could offer him a choice between shoveling snow and playing golf?

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  5. Pete Zaslow says:

    What/where lists of medications with ratings is available?

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  6. […] Picture Reference: https://attentionality.wordpress.com/2014/04/11/dangerous-prescriptions/ […]

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Oren Mason MD
Oren Mason MD

Oren Mason MD

Physician specializing in diagnosis and management of attention deficit disorders and related conditions.

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