Tag Archives: ritalin

Have an ADHD Kid? 5 Tips to Use Less Ritalin and More Parenting

What causes hyperactivity and ADHD (attention deficit/hyperactivity disorder)? A combination of temperament, environment and parenting. The most important factors are parenting skills and resources, especially those that can help create some calm. You can learn them.

“I would suggest we can head off many cases of ADHD in the first 2 years of life,” says W. Douglas Tynan, PhD, ABPP, director of Integrated Care at the American Psychological Association. Tynan’s psychology practice served more than 55,000 kids and their families over 13 years at the Nemours Pediatrics primary care and Alfred I. duPont Hospital for Children in Delaware. I interviewed him at the recent Lown Conference in Washington, DC.

“Everyone likes to blame the parents, particularly the mothers,” Tynan acknowledges. But there are some specific skills that he has been teaching parents that make a real difference.

“For example, if you have 2 kids who are very hyperactive at age 2,” Tynan notes. “If the daycare provider and the parents are consistent and do some of the things we recommend — which intuitively lots of parents do anyway — I predict you’ll have a very active first-grader, who may never quite reach criteria for ADHD. But if the parents get caught in the coercive cycle — punishment, lots of yelling — by the time we get to first grade, that child is going to have significant problems.” We cannot prevent all cases of ADHD, but we can certainly lessen how severe these problems become by intervening early.

Meds or Skill Development?

A very good study Tynan quotes compared 2 groups of families with a hyperactive or ADHD child. One group started with behavioral therapy (incorporating the 5 rules from below). The second group started with ADHD medicine. In both groups, if the child wasn’t making enough progress then medicine (for the first group) or behavioral therapy (for the second group) was added. And how were things a year later? Both sets of families were happier and more successful in their interactions. But starting with behavioral therapy saved money — drugs are more expensive than therapy — and established skills that kids who only got the meds didn’t learn.

Tynan’s 5 “Rules” for Effective Parenting

1. Increase the amount of positive interaction time between you and and your child

The most important words you say to your child are the positive ones. A hyperactive child can cause any parent to be snappish. Try to find things your child has done well and praise him or her constantly.

Between work, school, homework and scheduled activities, families sometimes forget to play together. Here are some websites with ideas for fun (and free!) activities:

2. Establish a scheduled routine, even on weekends

Use a calendar or chart on the wall.

3. You have to have the ability to implement consequences

If your child disobeys you, don’t give him or her a pass. Make punishments small, short and reasonable.

  • Take away a privilege
  • Require a chore
  • Time out

4. Give clear directions — be polite but direct

“Jason, please put your toys away now.” Don’t put a direct request in the form of a question, e.g., “Jason, would you put your toys away?” It’s not Jason’s choice. When you can give a choice, make it simple — 2 choices like, “Sandra, would you like to wear the red pants or the blue skirt?”

5. Follow through on the good and the bad

If you promise a reward for homework or chores, don’t put off the reward. Positive reinforcement is very important. One threat and one punishment is enough; don’t cycle up from no screen time to no Christmas gifts. Very brief negative consequences, consistently delivered, are effective. Threats of punishment are usually ineffective.

One last story from Tynan

In order to evaluate a child for ADHD, he interviewed the child’s teacher. As it happens, the regular teacher (who had started the evaluation process for ADHD for the child) was out on maternity leave. The substitute teacher was a very, very senior-aged nun, retired after 45 years of teaching.

When asked about the child’s behavior that the regular teacher had complained of, she said, “Oh yes, he swings his leg constantly. And he’s easily distracted and taps his pencil.” Was that a problem, Tynan asked. “No, I moved his seat to the end of the row so he could swing his leg easily and I put a big eraser on the end of his pencil so it would make less noise when he tapped. You should see the little stories he writes! And he’s really very good at math.”

By focusing on his great qualities and understanding his need to fidget, this substitute teacher redirected the child’s life in a positive way.

Kids don’t come with instructions, and while many parents intuitively implement some or all of these rules, most parents could use some help. Tynan recommends parent support based on the principles of “Triple P Parenting” (good for all ages) and an e-newsletter “Just in Time Parenting.”

For children under 3 who are experiencing problems, all states have federally mandated Birth to 3 programs that can provide evaluation and support. These are usually done through the local public schools and in some areas through the public health system.

Surge in ADHD Prescriptions Filled by Women

Attention deficit/hyperactivity drug (ADHD) medication use for women in their late 20s and early 30s jumped 700% between 2013 and 2015, which has raised concerns because there is little information about the drug’s safety before and during pregnancy. Overall, the number of women ages 15-44 who filled a prescription for an ADHD medicine increased by 354%, according to a report in the CDC’s Morbidity and Mortality Weekly Report.

“Half of all pregnancies in the United States are unplanned, and women may be taking prescription medicine early in pregnancy before they know they are pregnant,” Coleen Boyle, PhD, director of CDC’s National Center on Birth Defects and Developmental Disabilities, said in a statement. “Early pregnancy is a critical time for the developing baby. We need to better understand the safest ways to treat ADHD before and during pregnancy.”

There was a 560% increase among women aged 30 to 34. In 2015, the most commonly filled ADHD medicines among this group of women were Adderall (mixed amphetamine salts), Vyvanse (lisdexamfetamine) and Ritalin (methylphenidate).

Quick Hits: FDA Approves New Antibiotic, ADHD Med, and Opioid Use in Depressed Patients

The FDA has approved Baxdela (delafloxacin), a fluoroquinolone antibiotic that is used to treat acute bacterial skin and skin structure infections (ABSSSI). The drug is available as a tablet or intravenous injection. Labeling for the drug includes a “black box” warning due to serious adverse and potentially irreversible reactions that have been associated with fluoroquinolones, such as tendinitis and tendon rupture, peripheral neuropathy and central nervous system effects. In trials, the most common adverse reactions in patients observed were nausea, diarrhea, headache, elevations of the enzyme transaminase, which can indicate liver damage, and vomiting. Posted June 19, 2017. Via Melinta Therapeutics.

A new once-daily treatment for attention deficit/hyperactivity disorder (ADHD) has won FDA approval. Mydayis, a stimulant for patients 13 years and older, contains the same active ingredients as Adderall (amphetamine/dextroamphetamine), but lasts for up to 16 hours compared to up to 6 for Adderall and 12 for Adderall XR. Adderall and Adderall XR are both available as a generic. Like other stimulant medications, such as methylphenidate (Ritalin, Concerta, Daytrana), Mydayis has a “black box” warning because it has a high chance for abuse and can cause physical and psychological dependence. Posted June 20, 2017. Via Shire.

Patients with low back pain who also suffer from depression are more likely to be given opioids that are prescribed at higher doses. This is problematic, since patients with depression are at a higher risk of misuse and overdose of opioids. Researchers examined data on opioid prescriptions from 2004-2009 and found that those with low back pain who also had depression were twice as likely to be prescribed an opioid than those without depression. And over a year, they typically got more than twice the usual dose, according to the study published in the journal Pain Reports. The authors noted more study is needed to determine the risks and benefits of prescribing such powerful painkillers to those who are depressed. Posted June 20, 2017. Via University of Rochester Medical Center.

Can 6 Questions Diagnose Adult ADHD? Probably Not.

I had a terrible time writing this blog today. While I was working, I was texting my sister, making a dentist appointment and helping my kid with his homework. I was restless and kept jumping to my feet for a glass of water or to let the cat out. Even when my blog was done, I couldn’t relax. There were just too many things on my mind. Thank goodness my husband made the doctor’s appointment for our child’s school physical. I kept forgetting.

Sound familiar? Be careful before you say yes. I just demonstrated plenty enough traits to qualify for a diagnosis of ADHD. Distraction, restlessness, trouble unwinding, putting things off until last minute and depending on others to keep my life in order. With that story and the recollection of tardiness as a child and I, too, could get a lifetime prescription for Ritalin, a powerful stimulant and popular ADHD drug

But hold the trigger. Distraction can be a symptom of depression, which is more serious and life threatening than ADHD. Restlessness could be a symptom of an overactive thyroid. See where I’m going?

The medical definition of ADHD has changed several times in the past decade and it seems to get broader each time. Now the World Health Organization has devised a list of 6 questions that, they claim, accurately identifies those adults with ADHD.

What are the questions like? Here are a couple. How often do you have difficulty unwinding and relaxing when you have time to yourself? How often do you depend on others to keep your life in order and attend to details?

Possible responses are never, rarely, sometimes, often or very often. Each response has a different numerical value. Higher overall scores indicate a strong likelihood of ADHD.

The medical definition of ADHD has been changed several times over the last decade and it seems to get broader each time.

When the teachers at my child’s school asked that I put him on Ritalin, I took him for neuro-psych testing. It was lengthy, intense and expensive. I think we paid about $3,500 (many school systems will pay for the testing) and it took 4 interviews/testing sessions with my child and multiple interviews with his teachers to make a full diagnosis. The outcome? There was some evidence of ADHD. But more importantly, we learned that my child had previously undiagnosed and undetected learning disabilities. By addressing those disabilities with behavioral therapy, he improved and became successful. In his case, no need for Ritalin

I feel like a conspiracy theorist, but I’m not alone in questioning why the diagnosis for ADHD has become so simple and broad. As reported on NPR, Alan Schwarz, the author of the book ADHD Nation and a former investigative reporter for The New York Times, has investigated the ties between pharmaceutical companies and doctors.

“The 6-question screening instrument that was endorsed by the World Health Organization was devised by doctors with a very long history in ADHD research,” he says. “These are, generally, men who have been enriched by the pharmaceutical industry in order to churn out research and churn out things like this that merely expand the ADHD market.

“What we’ve seen over the past 10 [to] 20 years is a constant enthusiasm on the part of the ADHD lobby to get more and more adults to consider the possibility that they, too, have ADHD,” Schwarz says.

If you have a symptom — or 3 — that you think is ADHD that is keeping you from being able to work or enjoy life then go ask your doctor. But self-diagnosing reminds me of the old saying, “The lawyer who represents himself has a fool for a client.”

Quick Hits: Invokana and Amputations, Nonprescription Ritalin Side Effects, & a Postmarket Studies Lag

Patients Taking Invokana Have an Increased Risk of Leg and Foot Amputations
The FDA reports that the type 2 diabetes medicine Invokana (canagliflozin) causes an increased risk of leg and foot amputations. Two large clinical trials showed that leg and foot amputations occurred about twice as often in patients treated with canagliflozin compared to patients treated with placebo. Amputations of the toe and middle of the foot were the most common. Some patients had more than one amputation, some involving both limbs. Based on the clinical trial findings, the FDA is now requiring the most prominent Boxed Warning to be added to canagliflozin drug labels. Via FDA. Posted May 16, 2017.

Nonprescription use of Ritalin linked to adverse side effects, UB study finds
A University of Buffalo study found that the nonprescription use of the stimulant drug Ritalin was linked to unwanted side effects. Researchers examined changes in the brains of rats that received regular doses of Ritalin during what would be equivalent to adolescence in humans, a time of significant brain growth and development. Results found changes in brain chemistry associated with risk-taking behaviors, disruptions in the sleep/wake cycle and problematic weight loss. Via University of Buffalo. Posted May 17, 2017.

Too many postmarketing studies are never published
The FDA requires postmarket studies, including submission of status reports, for certain drugs. FDA researchers queried an internal database to identify all reportable postmarket drug studies classified as having been “fulfilled” by the FDA between 2009 and 2013. As of July 2016, 183 of the 288 postmarket studies (63.5%) meeting inclusion criteria were published in either the scientific literature or on the ClinicalTrials.gov website. More studies were published in journals than in the trial registry. Although there have been calls for more data sharing, publication rates for completed postmarket studies required by FDA remain low. Via JAMA. Posted May 15, 2017.

Do Your Psychiatric Drugs Keep You Up at Night?

If you take a medication for a psychiatric condition, you may have experienced troubled sleep — insomnia, daytime sleepiness, or any other numbers of sleep-related disorders. I have treated patients with myriad sleep difficulties who take antidepressants, antipsychotics and even medications to treat attention deficit/hyperactivity disorder (ADHD).

While no one wants to experience a poor night of sleep, it’s important to recognize whether the sleep problem you are having is a result of a side effect of a drug (or drugs) you are taking, or something completely independent of medication. That is why if you are on psychiatric medication – or any drug for that matter – and you find yourself having difficulty catching some Zs, it’s important to talk to your primary doctor, who may change your medication or refer you to a sleep specialist for further evaluation. In many cases, the benefits of a drug may outweigh the sleep-deficit side effects. Your physician can work with you to minimize the impact of them.

However, it’s a good idea to know what some of the sleep-related side effects are that have been reported with different types of drugs which act upon the brain. Let’s start with antidepressants. The most commonly prescribed ones are known as SSRIs (selective serotonin reuptake inhibitors) and have names including Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine). Complaints of both insomnia and daytime sleepiness have been reported in patients with depression on SSRIs. Prozac’s impact on sleep has been the most widely studied. Interestingly, it has been shown to have both a sedating and energizing effect depending on the individual. Prozac can also cause decreased sleep efficiency, awakenings during the night, and interrupted REM (rapid eye movement) sleep, an important period during the sleep cycle that allows a person to dream vividly.

Antidepressants and Vivid Dreams

Another class of antidepressants, SNRIs (serotonin norepinephrine reuptake inhibitors), are known to cause sleep problems similar to those in SSRIs, as well as vivid dreams. Common SNRIs are Effexor (venlafaxine), Pristiq (desvenlafaxine) and Cymbalta (duloxetine).

Treatment with Effexor has also been associated with a condition known as dyskinesia that is characterized by occasional movement of one’s limbs, repetitive and involuntary movements of the extremities – typically the legs – usually during or just before falling asleep. There have also been cases where these involuntary movements have been seen a week after a person stopped taking Effexor.

One antidepressant, Wellbutrin (bupropion), has been associated with insomnia. However, studies that have examined electrical activity of the brain in patients taking bupropion indicate the drug actually increases REM sleep time.

It’s important to recognize whether the sleep problem you are having is a result of a side effect of a drug (or drugs) you are taking, or something completely independent of medication.

Antipsychotics are usually prescribed for schizophrenia and other psychotic disorders, though they are also prescribed for bipolar disorder and to supplement antidepressants in the treatment of depression. One of the most popular antipsychotics, Seroquel (quetiapine), has been associated with faster sleep onset and longer overall sleep time. A typical antipsychotic, Clozaril (clozapine) has also been associated with improving sleep onset and sleep time.

RLS (restless legs syndrome) can ruin a good night’s sleep and antipsychotics and antidepressants have been known to lead to cause it. The strong urge that RLS causes to uncontrollably move one’s legs can make it hard to sleep, lead to sleeplessness, irritability and depressed mood. Remeron (mirtazapine), an older, atypical antidepressant, is most likely to cause RLS. A case study found that RLS appeared to be provoked in patients on a low-dose of Seroquel. Interestingly, some evidence has shown that Wellbutrin may actually help to alleviate RLS.

Lifestyle Changes May Help Curb Sleep-Related Side Effects

However, you might find relief from RLS through lifestyle changes and/or taking certain vitamins. For example, going to the bed at the same time every night and getting up at the same time each morning can help. Also, there are some indications that a lack of some vitamins and minerals, such as iron, folic acid, magnesium, and vitamin B, can contribute to RLS.

Not surprisingly, insomnia and delayed sleep onset are associated with stimulants such as Adderall and Ritalin (methylphenidate), that are used in the treatment of ADHD. However, the effect of Ritalin on sleep may depend on the amount of time a child has been on the drug and when the medication is given. There have also been reports of children having difficulty falling asleep as they are being weaned off the medication.

Sleep is an important part of staying healthy and feeling good. Again, if you feel you are experiencing sleep issues as a result of medication, speak to your doctor without delay. Sleep-related side effects due to drugs impact relatively few patients. And if it ends up your sleep problems are not drug-related, the good news is there are steps you can take to rectify the situation. Changes in sleep hygiene and even in your bedroom environment can provide some of the most effective improvements, as can making sure you are getting enough sleep in the first place. As we are in the middle of Sleep Awareness Week, I recommend visiting the National Sleep Foundation’s website for more helpful tips.

This piece is based on an article, Adverse Effects of Psychotropic Medications on Sleep, published in the journal Psychiatric Clinics of North America in 2016.

Feeling Anxious? Depressed? Check Your Meds

If you find yourself feeling on edge for no apparent reason while taking a cold medicine or diuretic, you most likely wouldn’t connect the two. However, anxiety happens to be just one of many mood-altering symptoms that can be brought on by certain meds.

“Many medications, whether prescribed or found over the counter, can cause psychiatric symptoms,” says Shiyun Kim, PharmD, BCACP, BCPP, CDE, a clinical pharmacist and clinical assistant professor at the University of Illinois Hospital & Health Sciences System, and a spokesperson for the American Pharmacists Association.

She explains that a wide range of factors influence the way a drug affects each person, including things like metabolism, underlying illness, and interactions with other drugs. “Any variations that occur, such as with improper doses or individual reactions, can result in undesirable psychiatric symptoms,” though they are relatively uncommon.

If you feel that you may be suffering from these side effects, notify your providers immediately. “Keep in mind that some medications can be stopped abruptly, while others need to be tapered to prevent further adverse effects,” Dr. Kim emphasizes. “Your provider can make the best decision with you.”

Take note of the following medications that can have these kinds of effects, and read on to find out how to minimize the risks.

Oxycontin and Similar Pain Medications

“Most prescription pain medication, such as oxycodone (OxyContin) or hydrocodone, can cause drowsiness, which can make one feel ‘cloudy’ and lack motivation — and these symptoms closely mimic depression,” according to Bree Meinzer, PharmD, CTTS, a pharmacy practice resident at Ohio Northern University. Opioids can also lead to more severe symptoms like paranoia, hallucinations, psychosis and dementia, especially at high doses. Signs that you may have taken too much of an opioid include trouble breathing and unconsciousness. People with opioid dependence and those who suffer from HIV, liver or lung disease or suffer from depression may be more susceptible to these effects, according to the World Health Organization. If you are on a pain medication that makes you drowsy or “cloudy” and you do not like how it makes you feel, you should talk to your doctor about other ways to adequately manage your pain.

Lasix, Microzide and Other Diuretics

Medications that reduce fluid retention and swelling, including furosemide (Lasix) and hydrochlorothiazide (Microzide), increase urination. This can lead to dehydration, especially in the elderly, and can result in hallucinations and dizziness, says Dr. Meinzer. SGLT2 inhibitors such as canagliflozin (Invokana) and empagliflozin (Jardiance), which are drugs used to treat diabetes, can also increase urination and cause dehydration. If you are taking these types of medication, be sure to drink plenty of water to stay sufficiently hydrated. The amount of water to drink should be discussed with your doctor and is dependent on your weight. “These medications should also be taken in the morning or early afternoon to avoid frequent urination at night,” which could disrupt sleep, she advises.

Ask your doctor to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.

Requip and Other Dopamine Agonists. Medications like ropinirole (Requip), often prescribed for restless leg syndrome and Parkinson’s disease, increase the brain chemical dopamine, which helps regulate mood and behavior. Too much dopamine can cause hallucinations, notes Dr. Meinzer, and more extreme potential side effects include confusion, mania, depression and impulse control disorders like compulsive gambling or eating. “There are other options for restless leg syndrome that don’t increase dopamine, though medications like ropinirole typically work best.” There are also different medications for Parkinson’s, though you and your doctor should carefully consider your particular treatment needs. If you experience these kinds of symptoms while taking this type of medication, it may be that your dose is too high.

Ritalin, Adderall and Other Stimulants

Drugs that are commonly used for the treatment of attention-deficit hyperactivity disorder (ADHD) include those sold under the brand names Ritalin and Adderall. Although these stimulant medications “help children and adolescents focus and stay on task, side effects include increased heart rate and insomnia, which can often cause anxiety and restlessness,” says Dr. Meinzer. Stimulants “excite the central nervous system and can disrupt normal communication between cells in the brain,” adds Dr. Kim. “This class of drugs may also cause bizarre behavior, agitation, mania, paranoia and nightmares.” Dr. Meinzer suggests talking to your healthcare provider if you feel extremely restless and anxious while taking this type of medication. Again, it is possible that your dose is simply too high.

Corticosteroids

Medications like prednisone, cortisone and methylprednisolone are often prescribed “to help respiratory symptoms and decrease inflammation with chronic diseases,” Dr Meinzer explains. They are typically only “used for a short term to help alleviate symptoms, but if you are on these medications for a long time, they can cause some unwanted side effects.” Use of these drugs for more than a few months can increase the chances of experiencing mania, anxiety, depression, paranoia and psychosis, which have mostly been reported by patients using high doses or abusing the medication, says Dr Kim. Though experts are unclear about the exact reasons for such side effects with these drugs, research suggests that it may have to do with the way steroids work in the area of the brain that influences memory and emotion. It is also possible that “high levels of steroids result in brain damage and cause cognitive dysfunction.”

Zarontin and Other Anticonvulsants

Medications such as ethosuximide (Zarontin), which are used to control seizures in people with epilepsy, can cause symptoms resembling depression. These drugs have also been found to increase suicidal thoughts and behavior. “If you start to experience these symptoms on an anticonvulsant, you should talk to your doctor about other regimens,” Dr. Meinzer recommends. “There are other medications in the same class that are less likely to cause this side effect,” though your doctor may want you to stay on the medication because it may be the one that is most effective for you. “Anticonvulsants are usually tricky to dose and may need lab monitoring to make sure they are in the proper range.”

Dr. Kim offers the following general tips to help prevent or deal with these side effects:

  • When you are prescribed a drug, ask your provider about potential side effects that are commonly noted and reported.
  • Ask your provider to take a look at your current medication regimen to rule out potential drug-drug interactions that could cause psychiatric side effects.
  • Withdrawal of some drugs can cause symptoms such as anxiety, agitation or depression. Therefore, call your doctor before stopping medications on your own.
  • When purchasing an over-the-counter (OTC) medication, take the time to read the instructions on the package. If anything is unclear, ask the pharmacist for guidance.

Long-Term ADHD Stimulant Med Use May Stunt Growth

Children with attention-deficit/hyperactivity disorder (ADHD) that are treated with stimulant drugs into adulthood not only face the risk of stunted growth, but also receive no benefit in terms of reducing the severity of symptoms.

Results came from the Multimodal Treatment Study, a long-term follow-up study that included 515 patients with ADHD who were between 7 and 9 when the study began, and 289 control patients of the same age.

The children with ADHD that continued to take a stimulant medication into adulthood, on average, were 2.36 centimeters shorter than their peers who stopped taking or only took the meds occasionally, researchers reported in the Journal of Child Psychology and Psychiatry. However, the severity of ADHD symptoms in adulthood were similar in both groups.

“My position is that it probably shouldn’t be considered a medication that has a long-term benefit, and you shouldn’t give it to get a long-term benefit if there’s no longer a benefit,” lead author James M. Swanson, PhD, director of the Child Development Center and a professor of pediatrics at the University of California, Irvine, told Medscape Medical News.

ADHD and Homework: Skip the Stimulants in Favor of Behavioral Interventions

Behavioral interventions are better than stimulant medication in helping children with ADHD (attention deficit/hyperactivity disorder) with completing homework.

Researchers enrolled 75 children with ADHD who took part in an 8-week summer school session. The children ranged in age from 5 to 12 years old. The students were given either a long-acting stimulant or a behavioral intervention that included both report cards for kids and training for parents on how to help their kids with homework.

In the stimulant group, physicians took about 2 weeks to determine the correct drug dose to give them. After that, for another 3 weeks, those students were given either a stimulant or placebo. For the last 3 weeks, those who were on a stimulant switched to a placebo, and vice versa. The stimulant given was methylphenidate, which is known under the brand names Ritalin, Daytrana and Concerta.

In the behavioral therapy group, students took part in six 2-hour group sessions for the first 2 weeks, and then individual sessions lasting 30 minutes over the following 2 weeks.

Children who received behavioral treatment were able to finish between 10% and 13% more homework and assignments, and the work was also 8% more accurate than that of the children who received a stimulant only, the researchers reported in the Journal of Consulting and Clinical Psychology. Medication had no significant impact on homework performance.

The authors note this translates to children who received behavioral treatment getting an average grade of C compared to an average grade of F for those who didn’t get the intervention.

Need To Know: Nootropics

Nootropics is an umbrella term that can refer to anything from a prescription drug, supplement or other substances that enhances a substance that enhances cognition function, particularly memory. They are often referred to as “brain drugs.” They are most often used by students, as well as business professionals and athletes. More than 130 substances are considered nootropics.

While they may seem like a sort of “fountain of youth,” they could be more of a “Pandora’s Box” due to potential risks and side effects.

Common Names

Racetams: Nootropil (piracetam), Ampamet, Draganon (aniracetam) and (oxiracetam); choline; ampakines; Vitamin B derivatives; amphetamines: Adderall (dextroampetamine/amphetamine) Ritalin, Concerta (methlphenidate) Vyvanse (lisdexamfetamine); wakefulness promoting drugs: Provigil (modafinil); Nuvigil (armodafinil); caffeine; ginseng; ginko biloba.

Side Effects and What to Do About Them

Because many products that are considered nootropics are available over the counter, people sometimes incorrectly assume they are safe to take. In addition, any nootropics are passed off as dietary supplements, which are largely unregulated and often don’t have clinical testing to demonstrate their efficacy and safety.

Common side effects of using nootropics can include migraines, headaches and skin rashes. In some cases, such as when too much of a nootropic is taken or different kinds of nootropics are mixed, the results can be life-threatening.

Some people can also experience major sleep problems (especially with amphetamines and wakefulness-promoting drugs as they are stimulants), even after they stop taking nootropics. This can diminish overall sleep quality, which can negatively impact the quality of ones’ daily life.

Withdrawal symptoms are also an issue for some users of nootropics. For example, some people who took Provigil and then quit the drug showed signs of low energy, depression, concentration problems and overall fatigue.

Amphetamine-based drugs used as nootropics are normally prescribed for ADHD (attention-deficit/hyperactivity disorder). They also lead to spikes in dopamine and epinephrine in the brain, which can lead to tolerance to the drugs and possible habit formation. They can also have impact appetite, mood swings, irritability and sleep.

Drug Interactions

While some people might take a single nootropic at a time, others like to mix them for more powerful results, a practice known as “stacking.” The problem with “stacking” nootropics is that mixing them can actually lead to potentially dangerous reactions within the body. Using a “stack” can potentially lead to heightened side effects or create new side effects and therefore make the use of nootropics that much more risky.

Effectiveness and Considerations

One thing to consider is that not all nootropics will work the way they are advertised on the label. In fact, some nootropics may have little to no effect at all since, with the exception of prescription drugs that are nootropics, they have not been subject to rigorous testing for efficacy. Much of the evidence supporting the use of nootropics has been based on anecdotal reports.

Brain scans have indicated that certain nootropics can cause alterations to brain chemistry and the way the brain works. Some research even indicates that the brain can shrink or expand depending on nootropic use. There is also no research available to determine what happens to the brain after a person takes nootropics over the long term, and then stops.

There is also a lack of research right now about the potential long-term risks of using nootropics.

Alternatives to Nootropics

If you really feel you need a boost in the area of cognitive ability, you may want to examine and adjust your existing routine and make lifestyle changes. Perhaps you are not getting enough sleep or your diet is not sufficient in providing your brain with the proper nutrition.

There is some evidence to suggest that B vitamins may help with brain cognition. Low levels of B vitamins have been associated with poor memory function and slow information processing. B vitamins are known to be crucial in converting food to fuel for cellular energy.

Many herbal supplements are also considered brain boosters. For example, turmeric, the active ingredient in the herb curcumin used in curries, works to improve blood flow to the brain, which helps improve memory and learning. It also increases levels of serotonin and dopamine in the brain. Some studies have also indicated ginkgo biloba improves short-term memory and sharpens attention.

There has been an explosion in recent years of “brain games” or “brain training” apps that supporters say are a great to increase one’s cognitive abilities and memory. The scientific results, however, have been mixed. In 2014, a group of 70 cognitive psychologists and neuroscientists released a letter expressing concerns over claims made by brain training program.

How They Work (Method of Action)

Nootropics can alter the way the brain works. Some sections of the brain may increase or decrease in physical size due to use of certain nootropics. One thing that is not yet fully understood is the long term effect on the body after a person stops taking one or more nootropics. This can pose a potentially serious health risk to the user.

The conclusion is that until there is sufficient evidence to show that nootropics are not only effective, but safe, you are likely gambling with your potentially permanent changes to your brain. Making various lifestyle changes can positively impact not only the quality of your life but also your overall mental performance.

What Worked for You?

Share your experience with nootropics in the Disqus box below.

Further Reading

Nootropic Effects and Method of Action

Drug Classifications, Schedule I, II, III, IV, V

The FDA has been overseeing drugs in the US since the beginning of the 20th century. In 1970 the FDA released the following drug classifications, or drug schedules, under the Controlled Substance Act (CSA). The drug classificaton schedules organize drugs into groups based on risk of abuse or harm. Those drugs with high risk and no counterbalancing benefit are banned from medical practice and are Schedule I drugs.

From the Drug Enforcement Administration Office of Diversion Control:

Definition of Controlled Substance Schedules

Drugs and other substances that are considered controlled substances under the Controlled Substances Act (CSA) are divided into five schedules.  An updated and complete list of the schedules is published annually in Title 21 Code of Federal Regulations (C.F.R.) §§ 1308.11 through 1308.15.  Substances are placed in their respective schedules based on whether they have a currently accepted medical use in treatment in the United States, their relative abuse potential, and likelihood of causing dependence when abused.  Some examples of the drugs in each schedule are listed below.

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine (“Ecstasy”).

Schedule II/IIN Controlled Substances (2/2N)

Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.

Examples of Schedule II narcotics include: hydromorphone (Dilaudid), methadone (Dolophine), meperidine (Demerol), oxycodone (OxyContin, Percocet), and fentanyl (Sublimaze, Duragesic).  Other Schedule II narcotics include: morphine, opium, and codeine.

Examples of Schedule IIN stimulants include: amphetamine (Dexedrine, Adderall), methamphetamine (Desoxyn), and methylphenidate (Ritalin).

Other Schedule II substances include: amobarbital, glutethimide, and pentobarbital.

Schedule III/IIIN Controlled Substances (3/3N)

Substances in this schedule have a potential for abuse less than substances in Schedules I or II and abuse may lead to moderate or low physical dependence or high psychological dependence.

Examples of Schedule III narcotics include: combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin), products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine), and buprenorphine (Suboxone).

Examples of Schedule IIIN non-narcotics include: benzphetamine (Didrex), phendimetrazine, ketamine, and anabolic steroids such as Depo-Testosterone.

Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances in Schedule III.

Examples of Schedule IV substances include: alprazolam (Xanax), carisoprodol (Soma), clonazepam (Klonopin), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam (Halcion).

Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances listed in Schedule IV and consist primarily of preparations containing limited quantities of certain narcotics.

Examples of Schedule V substances include: cough preparations containing not more than 200 milligrams of codeine per 100 milliliters or per 100 grams (Robitussin AC, Phenergan with Codeine), and ezogabine.

 

5 Ways to Minimize Side Effects of Your Child’s ADHD Meds

While there is a relatively scant amount of research examining the benefits or the risks of stimulant medication -– the most common type of drug used to treat ADHD –- over the long term, many parents and doctors may decide that a stimulant (along with continuing cognitive therapy) might be the most effective way to treat your child.

But addressing ADHD first through non-medical means is best practices and in many cases makes using drugs unnecessary. Here is an article on how children can be treated for ADHD through non-pharmaceutical interventions. However, there are times when medication is part of an appropriate treatment plan.

Although stimulants have benefits, they also have a wide array of side effects. However, these side effects can potentially be minimized with a few pieces of helpful information.

1. Find the Right Medication

There are 2 basic lines of stimulant medication: those derived from methylphenidate (e.g, Ritalin) and those derived from dextroamphetamine (e.g., Adderall). Although they are very similar medications, they are not the same, and any given child may do much better on one than the other. There is no reliable way to predict whether your child would do better on one than the other. There is new genetic testing that may help predict your child’s reaction to stimulants, but so far it cannot distinguish between the 2 lines.

The absolute key to successful treatment with minimal side effects is communication, communication, communication!

Even within a given line, there can be significant differences between how your child reacts to one or another. As an example, Focalin (dexmethylphenidate) can be effective when there are unacceptable reactions to Concerta (methylphenidate), or vice versa, despite the fact that both are derived from methylphenidate.

2. Find the Right Dosage

Like most psychotropic medication, there is no single dose that will be effective for each patient. The expected dose is generally based on a child’s size, but there are dramatic differences in how children metabolize these medications. There are college students in my practice doing very well on the minimal possible dose of Concerta, for example, while there are 10-year-olds who need twice that much.

The correct dose is the smallest dose that produces the desired effect without causing unacceptable side effects. In some cases, no such dose exists. In other words, even the smallest dose that is effective causes side effects that cannot be tolerated. Then another medication must be tried. Most clinicians would suggest that an acceptable side effect is appetite loss at lunchtime only. An unacceptable one is depression or irritability. However, it is the patient and patient’s parents who are the final determiners of what is an acceptable side effect and what side effects make the drug benefits not worth it.

3. Nutrition and Lifestyle

If you are not taking care of all the nutritional and lifestyle factors that can influence ADHD, then I recommend doing so before trying drugs. These include proper nutrition, adequate sleep and adequate exercise. Continue to make sure school accommodations (as outlined in a 504 plan in any public school) are up to date and being carried out. If you feel that you might need help in parenting your child effectively, seek the proper guidance.

4. Non-pharmaceutical Interventions

There are some other non-pharmaceutical interventions that should be continued even while taking medication. Some of these would include taking fish oil, zinc and iron when indicated, as I discussed in a prior article for MedShadow. Continuing these interventions can reduce the amount of medication necessary to be effective and thus make the difference between successful and unsuccessful treatment.

5. Communication

Over and above these factors, the absolute key to successful treatment with minimal side effects is communication, communication, communication! As parents you are the hub of a network that is crucial to your child’s success.

You and your child must talk to each other to be as clear as possible about positive and negative effects. This communication will be as much by observation of behavior as by what your child is actually telling you.

You and his or her teachers must be in constant touch to be as clear as possible about the effects of the treatment while the child is at school. For the majority of parents, this is the major time that the medication is active, so this is crucial.

You must give your medical provider as much feedback as possible to help determining changes in dosage or medications. Beware the health care provider who gives you a prescription and tells you to come back in 4 to 6 months without any interim contact. This is unlikely to lead to a positive result.

Although I believe many children with ADHD can do well without stimulant or other medication, there are some children for whom it is truly necessary. Following the above guidelines will help increase the chances of successful treatment.