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Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon

Another reason that physicians don't report their colleagues, researcher Lisa Merlo says, is because medical schools fail to educate them about the disease of addiction. Most medical schools include only a lecture or two on addiction, she says. By contrast, the University of Florida requires all third-year students to complete a 2-week rotation in addiction medicine. "Every physician in the United States has to deliver a baby to graduate, but how many of them are ever going to deliver babies in practice?" she asks. "But every doctor is going to see addicted patients."

Drug Abuse Among Doctors: Easy, Tempting, and Not Uncommon

Access rapidly becomes an addict's top priority, he notes, and self-medicating physicians will do everything in their power to ensure it continues. "They're often described as the best workers in the hospital," he says. "They'll overwork to compensate for other ways in which they may be falling short, and to protect their supply. They'll sign up for extra call and show up for rounds they don't have to do." Physicians are intelligent and skilled at hiding their addictions, he says. Few, no matter how desperate, seek help of their own accord.

Stimulant Use Exceptionally High Among Medical Students

Of 148 medical students, 145 (98%) responded to the survey. The results revealed that 20% of students reported lifetime use of stimulants, with 15% reporting stimulant use during medical school. Compared with Asian students, white students had a 9-fold increase in odds for stimulant use (P = .001). The investigators note that the sample size was not large enough to reliably compare prevalence of stimulant use in black and Hispanic medical students. The researchers report that 13 students (9%) reported a diagnosis of ADHD and had an odds ratio of 37 for stimulant use in medical school compared with those without an ADHD diagnosis (P < .001). The study also revealed that, of those who had taken stimulants, 83% used them specifically to boost cognitive performance, including improving focus while studying and staying awake longer while on clinical duty. There were no differences in stimulant use by age, marital status, or academic achievement. "Indeed, those with high standardized test scores had an almost identical use prevalence compared with those with lower test scores," the investigators report. The majority (83%) of students who reported using stimulants used them specifically to improve cognitive performance.

My Stimulant Use in Med School: The Good, The Bad, The Victory » in-Training, the online magazine for medical students

ADD medications are generally marketed to “unleash the potential of the student,” which is accurate. In my case, I could finally barrel through those lecture notes without stopping five times to look at some shiny thing in order to earn a slightly below average grade on an exam (I’d stop only 2 times, instead). Indeed, there is evidence to suggest that high-functioning students do not benefit from stimulant use the way lower-functioning students do. Of course, “high” and “low” functioning takes on a whole new meaning when we’re now splicing up classes of some of the highest achieving students from their colleges, but this is part of the issue in saying “ADD versus ‘normal.’” It’s really “ADD versus your potential.” The ability to synthesize complex ideas in my head had never been the issue, even through college (i.e. my intellect on its own was plenty strong). My ability to utilize this abstract synthetic ability was the issue, thus the obvious utility of Focalin.

Adderall Concentration Benefits in Doubt: New Study

The last question they asked their subjects was: "How and how much did the pill influence your performance on today's tests?" Those subjects who had been given Adderall were significantly more likely to report that the pill had caused them to do a better job on the tasks they'd been given, even though their performance did not show an improvement over that of those who had taken the placebo.

Adderall, Ritalin, Vyvanse: Do smart pills work if you don’t have ADHD?

What if Adderall turns out to be the new coffee—a ubiquitous, mostly harmless little helper that enables us to spend more time poring over spreadsheets and less time daydreaming or lolling about in bed? For those of us whose natural predilections are to spend far too little time poring and far too much daydreaming, they’re a big improvement over self-medication via caffeine or cigarettes. But those without ADHD might well ask themselves: Don’t I work enough already?

Blood Pressure and Heart Rate in the Multimodal Treatment of Attention Deficit/Hyperactivity Disorder Study Over 10 Years

Disclosures: Dr. Elliott has received research funding from Cephalon, McNeil, Shire, Sigma Tau, and Novartis; has consulted to Cephalon and McNeil; and has been on the speakers’ bureaus of Janssen, Eli Lilly, and McNeil. Dr Swanson has received research support from Alza, Richwood, Shire, Celgene, Novartis, Celltech, Gliatech, Cephalone, Watson, CIBA, Janssen, and Mcneil; has been on the advisory boards of Alza, Richwood, Shire, Celgene, Novartis, Celltech, UCB, Gliatech, Cepahlon, McNeil, and Eli Lilly; has been on the speakers’ bureaus of Alza, Shire, Novartis, Celltech, UCB, Cephalon, CIBA, Janssen, and McNeil; and has consulted to Alza, Richwood, Shire, Celgene, Novartis, Celltech, UCB, Gliatech, Cephalon, Watson,, CIBA, Janssen, McNeil, and Eli Lilly. Dr. Arnold has received research funding from Celgene, Curemark, Shire, Noven, Eli Lilly, Targacepts, Sigma Tau, Novartis, and Neuropharm; has consulted to Shire, Noven, Sigma Tau, Ross, Organon, Targacept, and Neuropharm; and has been speaker for Abbott, Shire, McNeil, Targacept, and Novartis. Dr. Hechtman has received research funding from the National Institute of Mental Health, Eli Lilly, GlaxoSmithKline, Janssen Ortho, Purdue Pharma, and Shire; has been on the speakers’ bureaus of Eli Lilly, Janssen-Ortho, Purdue Pharma, and Shire; and has been on the advisory board of Eli Lilly, Janssen-Ortho, Purdue Pharma, and Shire. Dr. Abikoff has received research funding from McNeil, Shire, Eli Lilly, and Bristol-Myers-Squibb; has consulted to McNeil, Shire, Eli Lilly, Pfizer, Celltech, Cephalon, and Novartis; and has been on the speakers’ bureaus of McNeil, Shire, and Celltech. Dr. Wigal has received research funding from Eli Lilly, Shire, Novartis, and McNeil; and has been on the spearkers’ bureaus of McNeil and Shire. Dr. Jensen has received research funding from McNeil and unrestricted grants from Pfizer; has consulted to Best Practice, Shire, Janssen, Novartis, Otsuka, and UCB; and has participated in speakers’ bureaus for Janssen,-Ortho, Alza, McNeil, UCB, CMED, CME Outfitters, and the Neuroscience Education Institute. Greenhill has received research funding from or has been a consultant to the National institute of Mental Health, National Institute on Drug Abuse, American Academy of Child and Adolescent Psychiatry, Johnson & Johnson, Otsuka, and Rhodes Pharmaceuticals. Dr. Gibbons has consulted to the US Department of Justice, Wyeth, and Pfizer. Ms. Odbert, Ms. Severe, and Drs. Hur, Kaltman, Wells, Molina, and Vitiello report no relevant financial relationships.

Long term heart rate elevation from past stimulant use

The effect on heart rate was in large part driven by current use of medication, although at one time point (8 years) there was a significant effect of cumulative exposure regardless of current use.

The MTA at 8 Years: Prospective Follow-Up of Children Treated for Combined Type ADHD in a Multisite Study

By the next follow up, three years after enrollment (22 months after the end of the randomly assigned treatment), there were no longer significant treatment group differences in ADHD/ODD symptoms or functioning.6 That is, although the improvements over baseline for children in all four groups were maintained, the relative advantage associated with the intensive 14-month medication management in the MedMgt and Comb groups had dissipated.6

Long term ADHD meds worsen school function

Medication use during the past year, measured at each assessment and treated as a time-varying covariate, was associated with outcome over time in a pattern consistent with prior reports.1, 4, 6 It was generally associated with better functioning at 14 and 24 months, when medication use mostly reflected randomized treatment group assignment, but it was associated with worse functioning and more school services (or showed no association with other outcomes) at the later assessments.

Children’s A.D.D. Drugs Don’t Work Long-Term - The New York Times

But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear. The study randomly assigned almost 600 children with attention problems to four treatment conditions. Some received medication alone, some cognitive-behavior therapy alone, some medication plus therapy, and some were in a community-care control group that received no systematic treatment. At first this study suggested that medication, or medication plus therapy, produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits.

Higher heart rate

Using random effects meta-analysis, we found that subjects randomized to CNS stimulant treatment demonstrated a statistically significant increased resting heart rate [+5.7 bpm (3.6, 7.8), p<0.001] and systolic blood pressure findings [+2.0 mmHg (0.8, 3.2), p=0.005] compared with subjects randomized to placebo.

ADHD as a social construct

Researchers looked at ADHD rates for 378,881 children ages 4-17 in Taiwan where the cutoff birthday for school enrollment is Aug. 31, making students born in that month the youngest in their class and those born in September the oldest. They found 1.8% of students born in September received an ADHD diagnosis compared to 2.9% of those born in August. Roughly 1.2% of those born in September received ADHD medication compared to 2.1% of those born in August.

The WHO Adult ADHD Self-Report Scale for DSM-5 | Attention Deficit/Hyperactivity Disorders | JAMA Psychiatry | The JAMA Network

adult attention-deficit/hyperactivity disorder (ADHD) is common, seriously impairing, and usually undiagnosed

Sometimes for six of these and you're ADHD?

How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly? How often do you leave your seat in meetings and other situations in which you are expected to remain seated? How often do you have difficulty unwinding and relaxing when you have time to yourself? When you’re in a conversation, how often do you find yourself finishing the sentences of the people you are talking to before they can finish them themselves? How often do you put things off until the last minute? How often do you depend on others to keep your life in order and attend to details?

Potential Adverse Effects of Amphetamine Treatment on Brain and Behavior: A Review

In 2000, the number of prescriptions for amphetamine exceeded eight million, a 1600% increase over nine years. That same year, US annual manufacture of amphetamine reached 30,000 kg (40 % d-amphetamine, 60% mixed d/l salts). In addition, 1,306 kg of methamphetamine was used primarily for treatment of obesity, although it was also approved for treatment of ADHD 11.

FDA study -- stimulant triggered psychosis, violence sometimes doesn't resolve

FDA Review ADHD Drugs Induce-Psychosis, Mania, Homicide, Suicide http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210B-Index.htm DATE: March 3, 2006 TO: Thomas Laughren, M.D., Director Division of Psychiatric Products (DPP), FDAOffice of Counter-Terrorism and Pediatric Drug Development (OCTAP) Memorandum. FROM: Kate Gelperin, M.D., M.P.H., Medical Epidemiologist Kate Phelan, R.Ph., Safety Evaluator The DDRE ADHD Psychiatric Review Team Office of Drug Safety (ODS) 1 EXECUTIVE SUMMARY / INTRODUCTION A BPCA (Best Pharmaceuticals for Children Act) review of methylphenidate products, prompted by Concerta pediatric exclusivity requirements, identified psychiatric adverse events as a possible concern. The review found some psychiatric adverse events mentioned in labeling, but a need for improved clarity was identified. The Pediatric Advisory Committee1 agreed at the June 2005 meeting at which the methylphenidate reviews were discussed, that the issue of psychiatric adverse events with all drugs indicated to treat ADHD should be examined with the goal of better characterizing these events so that drug labeling could be updated and made consistent between products. Thus, DDRE embarked on reviews of postmarketing and clinical trial reports of psychiatric adverse events associated with drugs used to treat ADHD. This document presents the results of the review of postmarketing reports. A companion document2, from Dr. Andrew Mosholder, presents the results of the review of clinical trial reports.  Information pertaining to selected psychiatric adverse event reports received since January 1, 2000 was requested from the manufacturers of products approved or with pending applications for the treatment of ADHD. Sponsors were asked to provide information regarding four broad categories of psychiatric adverse events: 1) signs and/or symptoms of psychosis or mania; 2) suicidal ideation and behavior; 3) aggression and violent behavior; and, 4) miscellaneous serious adverse psychiatric events. In addition, searches of the FDA AERS safety database were conducted covering the same time period, and the identified cases were assessed by a DDRE Review Team. Duplicates, and reports which were considered to be of poor quality or highly unlikely to be related to the drug of interest were excluded from this analysis.  Cases received from Sponsors, as well as those identified from the FDA AERS safety database, were systematically reviewed and analyzed to assess the probability of adverse drug reactions and to describe characteristics or risk factors observed in these reports. This review focuses on postmarketing safety data from the first three search categories. The miscellaneous category was considered to be beyond the scope of this current analysis due to the large volume of data for review. The most important finding of this review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors, at usual doses of any of the drugs currently used to treat ADHD. Current approved labeling for drug treatments of ADHD does not clearly address the risk of drug induced signs or symptoms of psychosis or mania (such as hallucinations) in patients without identifiable risk factors, and occurring at usual dosages. In addition, current labeling does not clearly state the importance of stopping drug therapy in any patient who develops hallucinations, or other signs or symptoms of psychosis or mania, during drug treatment of ADHD. We recommend that these issues be addressed.  A substantial proportion of psychosis-related cases were reported to occur in children age ten years or less, a population in which hallucinations are not common. The occurrence of such symptoms in young children may be particularly traumatic and undesirable, both to the child and the parents. The predominance in young children of hallucinations, both visual and tactile, involving insects, snakes and worms is striking, and deserves further evaluation. Positive rechallenge (i.e., recurrence of symptoms when drug is re-introduced) is considered a hallmark for causality assessment of adverse events. Cases of psychosisrelated events which included a positive rechallenge were identified in this review for each of the drugs included in this analysis.  In many patients, the events resolved after stopping the drug. In the FDA AERS review, resolution of the events after stopping the drug was reported in 58% of amphetamine /dextroamphetamine cases, 60% of modafinil cases, 33% of atomoxetine cases, and 48% of methylphenidate cases. (Note: Outcome of the psychiatric adverse events was not reported in 21% of amphetamine / dextroamphetamine cases, 9% of modafinil cases, 41% of atomoxetine cases, and 30% of methylphenidate cases.) For drugs currently approved for ADHD treatment, no risk factors were identified which could account for the majority of reports of psychosis-related events. For instance, drug abuse was reported in fewer than 3% of overall cases from the FDA AERS analysis of psychosis-related events. Also of note, in the overwhelming majority of cases (roughly 90% overall), the patient had no prior history of a similar condition. Numerous postmarketing reports of aggression or violent behavior during drug therapy of ADHD have been received, most of which were classified as non-serious, although approximately 20% of cases overall were considered life-threatening or required hospital admission.

Dopamine toggling governs decision making

The voltammetry results showed that fluctuations in brain dopamine level were tightly associated with the animal's decision. The scientists were actually able to accurately predict the animal's upcoming choice of lever based on dopamine concentration alone. Interestingly, other mice that got a treat by pressing either lever (so removing the element of choice) experienced a dopamine increase as trials got under way, but in contrast their levels remained above baseline (didn't fluctuate below baseline) the entire time, indicating dopamine's evolving role when a choice is involved. "We are very excited by these findings because they indicate that dopamine could also be involved in ongoing decision, beyond its well-known role in learning," adds the paper's co-first author, Christopher Howard, a Salk research collaborator. To verify that dopamine level caused the choice change, rather than just being associated with it, the team used genetic engineering and molecular tools -- including activating or inhibiting neurons with light in a technique called optogenetics -- to manipulate the animals' brain dopamine levels in real time. They found they were able to bidirectionally switch mice from one choice of lever to the other by increasing or decreasing dopamine levels. Jin says these results suggest that dynamically changing dopamine levels are associated with the ongoing selection of actions. "We think that if we could restore the appropriate dopamine dynamics -- in Parkinson's disease, OCD and drug addiction -- people might have better control of their behavior. This is an important step in understanding how to accomplish that."

A Test That Finds the Perfect Drug? - The Atlantic

“Psychiatry remains the only discipline of medicine that has no test to predict treatment response,” said Evian Gordon, the founder of one such company, Brain Resource. “This is providing, for the first time, an objective step as to which drug might be responsive.”

Cardiovascular fitness, cortical plasticity, and aging. - PubMed - NCBI

Cardiovascular fitness is thought to offset declines in cognitive performance, but little is known about the cortical mechanisms that underlie these changes in humans. Research using animal models shows that aerobic training increases cortical capillary supplies, the number of synaptic connections, and the development of new neurons. The end result is a brain that is more efficient, plastic, and adaptive, which translates into better performance in aging animals. Here, in two separate experiments, we demonstrate for the first time to our knowledge, in humans that increases in cardiovascular fitness results in increased functioning of key aspects of the attentional network of the brain during a cognitively challenging task. Specifically, highly fit (Study 1) or aerobically trained (Study 2) persons show greater task-related activity in regions of the prefrontal and parietal cortices that are involved in spatial selection and inhibitory functioning, when compared with low-fit (Study 1) or nonaerobic control (Study 2) participants. Additionally, in both studies there exist groupwise differences in activation of the anterior cingulate cortex, which is thought to monitor for conflict in the attentional system, and signal the need for adaptation in the attentional network. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain, and may serve to reduce both biological and cognitive senescence in humans.

How each generation gets the drugs it deserves | Aeon Essays

‘This is a big shift from the old model,’ says Cowles. ‘It used to be: “I am Henry. I am ill in some way. A pill can help me get back to being Henry, and then I’m off it.” Whereas now: “I am only Henry when I’m on my meds.” Between 1980, 2000, and now, the proportion of people on that kind of maintenance pill with no end in sight is just going to keep going up and up.’

How each generation gets the drugs it deserves | Aeon Essays

But, Cowles argues, one might just as easily say that ‘these drugs were created with various sub-populations in mind and they end up making available a new kind of housewife or a new kind of working woman, who is medicated in order to enable this kind of lifestyle’. In short, Cowles says: ‘The very image of the depressed housewife emerges only as a result of the possibility of medicating that.’

Abuse of ADHD drugs following path of opioids

Meanwhile, among those 26 and older, recreational use of Adderall, an amphetamine, rose fourfold, from 345,000 people in 2006 to 1.4 million in 2014, according to the latest available federal data. In emergency departments around the country, the number of cases involving two common ADHD drugs nearly quadrupled over seven years. And at morgues in Florida, a bellwether state for drug abuse problems, overdose deaths involving amphetamines increased more than 450% between 2008 and 2014.

Do ADHD Drugs Take a Toll on the Brain? - Scientific American

Research hints that hidden risks might accompany long-term use of the medicines that treat attention-deficit hyperactivity disorder

Adhd and Temporality: A Desynchronized Way of Being in the World. - PubMed - NCBI

ADHD is, I argue, an impairment in sense of time and a matter of difference in rhythm; it can be understood as a certain being in the world, or more specifically, as a disruption in the experience of time and a state of desynchronization and arrhythmia. Through excerpts of interviews with adults diagnosed with ADHD and observations, I illustrate how impairment in time is manifested in an embodied experience of being out of sync. I suggest that the experience of ADHD is characterized as 1) an inner restlessness and bodily arrhythmia; 2) an intersubjective desynchronization between the individual and its surroundings; and 3) a feeling of lagging behind socially due to difficulties in social skills. In closing, I argue that an increasingly accelerating society is augmenting the experience of being out of sync rather than eliminating it.

Generation Adderall - The New York Times

During the first weeks of finally giving up Adderall, the fatigue was as real as it had been before, the effort required to run even a tiny errand momentous, the gym unthinkable. The cravings were a force of their own: If someone so much as said “Adderall” in my presence, I would instantly begin to scheme about how to get just one more pill. Or maybe two. I was anxious, terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills. I didn’t yet know that it would only be in the amphetamine-free years to follow that my book would finally come together.