Recent quotes:

Abysmally primitive

as Dr. Sophia Vinogradov, Chief of Psychiatry at the University of Minnesota Medical School, recently wrote in Nature Human Behavior, “There's a secret that we psychiatrists do not like to talk about: the abysmally primitive state of how we assess, understand, and treat mental illness.”

Why Are There No Biological Tests in Psychiatry? - Scientific American Blog Network

we must also not minimize the grave practical problems and limitations associated with not having biological tests to identify psychiatric disorders. Most troubling is the fact that the overwhelming majority of prescriptions for psychotropic medicines are written by primary care physicians who often have little training in psychiatry; little time to perform an adequate diagnostic evaluation; a tendency to depend on tests rather than talking to patients; and too great a susceptibility to quick trigger diagnosis and poorly chosen pill solutions (fostered by aggressive and misleading drug company marketing). The lack of precise and easily available biological tests in psychiatry permits much loose diagnosing and cowboy prescribing.

Why Are There No Biological Tests in Psychiatry? - Scientific American Blog Network

The problem of teasing out heterogeneous clinical presentations in psychiatry is compounded by the fact that they also have heterogeneous underlying mechanisms. There will not be one pathway to schizophrenia; there may be dozens, perhaps hundreds. Biological tests that appear to be associated with schizophrenia are never useful for making the diagnosis because they always show more variability within the category than between categories. And seemingly intriguing findings usually don't replicate.

Dr. Nestler is dean for academic and scientific affairs and director of the Friedman Brain Institute at the Icahn School of Medicine at Mount Sinai. Dr. Hyman is a past director of the National Institute of Mental Health.

Virtually all of today’s treatments are based on serendipitous discoveries made six decades ago.

Highest odds for stimulants: male, US, upper year medical student

Psychostimulant use was significantly correlated with use of other drugs (Table 1). Lifetime use of psychostimulants was significantly associated with male gender (21 % male (519/1,087) versus 15 % female (568/1,087), Chi squared p = 0.007, 28 no response). Students who mainly grew up outside the U.S. were significantly less likely to report any lifetime psychostimulant use than their U.S.-reared counterparts (outside of U.S. psychostimulant use prevalence = 4 % vs. 20 % U.S. reared; Chi squared p = 0.013). Overall prevalence of psychostimulant use while in medical school was significantly associated with current year in medical school, with first year students being least likely to report use compared to their second, third, fourth and fifth-year colleagues (41 % first year (n = 42/196), 66 % second year (n = 59/196), 60 % third year (n = 52/196), 71 % fourth year (n = 41/196), 50 % fifth year or beyond (n = 2/196); Chi squared p = 0.048, two no response). Students who self-reported attending a school that determined class rank were significantly more likely to respond that they had used psychostimulants while in medical school (class rank assessed 68 % versus no class rank 51 %, Chi squared p = 0.018). Items not significantly correlated with psychostimulant use included age, marital status, estimated class rank (split by quartiles), tobacco use, caffeine intake, or weight loss supplementation.

Cognitive Enhancement Drug Use Among Future Physicians: Findings from a Multi-Institutional Census of Medical Students

Of these, 11 % (117/1,115) of students reported use during medical school (range 7–16 % among schools). Psychostimulant use was significantly correlated with use of barbiturates, ecstasy, and tranquilizers (Pearson’s correlation r > 0.5, Student’s t-test p < 0.01); male gender (21 % male versus 15 % female, Chi squared p = 0.007); and training at a medical school which by student self-report determined class rank (68 % versus 51 %, Chi-squared p = 0.018). Non-users were more likely to be first year students (Chi-squared p = 0.048) or to have grown up outside of the United States (Chi-squared p = 0.013).

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, 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?

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

“The evidence is pretty clear that these are potent stimulants,” says Craig Rush, a professor of behavioral science at Kentucky. "They produce euphoria, and they have significant abuse potential.” Nora Volkow, director of the National Institute on Drug Abuse, told 60 Minutes in 2010 that she believes even casual use can lead to addiction. “It’s not worth the risk to be playing with a drug that has potentially very adverse affects.”

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.

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

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.