September 04, 2009

Study Links ADHD Stimulants To Risk Of Sudden Death

A new study out in the American Journal of Psychiatry asserts that there is a risk, however small, of sudden death associated with the use of ADHD stimulants in youths. The study examined state vital statistics from across the country for the years 1985 through 1996 and, according to the authors, was mostly looking for methylphenidate (Ritalin) use. That time frame would largely exclude the years that Adderall has been on the market, so it'd be interesting to know what kind of results they would've gotten through 2006 or so.

Anyway, what researchers found was that in 564 cases of unexplained sudden death that 10 of the cases--or 1.8 percent--involved ADHD stimulant use. They compared this group with a control group of youths who had died in auto accidents and concluded:

"This case-control study provides support for an association between the use of stimulants and sudden unexplained death among children and adolescents. Although sudden unexplained death is a rare event, this finding should be considered in the context of other data about the risk and benefit of stimulants in medical treatment."

Interestingly, the journal published an accompanying editorial by Benedetto Vitiello who's one of NIMH's big shots on ADHD and Kenneth Towbin, also of NIMH. The pair pretty much try to pooh-pooh the study--while praising its methodology!--while offering this takeaway:

"However, it is equally clear that 1) sudden unexplained death is a rare event, 2) this is only the first such study, 3) it relies on small numbers, and 4) it is not possible to quantify the risk beyond estimating that it is very small. A full estimate of the risk-benefit ratio of ADHD treatment cannot be properly conducted at the population level because sudden unexplained death is so rare and we lack controlled long-term data on the effectiveness of these medications for reducing the risk for other adverse health outcomes, such as accidents, medical hospitalizations, unsafe sex practices, antisocial behavior, and substance abuse, which have been associated with ADHD."

It's fine for them to point out the rarity of sudden unexplained deaths and so on, but given that the average age in the study group was 15.76 years and ages ranged from about 13 to 17 years of age, it's kind of weird--at least to me--that they would try to use a backdoor justification of ADHD stimulant use related to accidents, unsafe sex, anti-social behavior and so on. Who the hell do these guys think Americans with ADHD are anyway? Is that what they really think of America's teens? That's some nice stigmatization there.

Posted by Philip Dawdy at September 4, 2009 12:03 AM
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A friend of mine stumbled into a ramshackle hospital in one of Brooklyn's poorest neighborhoods two years ago. She was agitated, complaining of problems, feeling uneasy, knowing something was wrong. She was scared.

The hospital staff thought she was on drugs, and took their time with her admission. It was only when she began to have seizures on the waiting room floor that she was seen by some doctors.

It was too late. After being forced to wait for approximately six hours, she suffered from respiratory failure and fell into a coma. Her brain began to swell. Her brain stem and cortex showed no activity. She was taken off life support two days after entering the hospital.

The results of her blood tests were negative for illegal drugs. What was found was the presence of the ADHD drug Focalin. The blood level wasn't excessive or abusive. It was the normal, suggested dose. And it killed her.

Like many other college students, she had attained these drugs illegally, through a friend of hers who gave them away to people when they needed help to study. Kids in college know that they can finally concentrate when they take these things and they know what to commonly expect after taking these drugs: the jitteriness, insomnia, loss of appetite. But, the side effects are minor so long as the paper gets finished, so long as the chapter info gets crammed.

But would they take them if they knew that the possibility of death was possible? Would they take them if they understood philosophically that they were cheating themselves, that they were cutting corners? Those questions really don't matter. Voices of pharmaceutical, psychiatric dissent are suppressed just like other voices for political and social causes.


We need serious oversight and scrutiny of these drugs so that no innocent people die inexplicably for their intake of government approved substances. A sober investigation of these issues is necessary and needs to be POPULARIZED and as many readers of this site know, much of that essential, pioneering work is being done by Philip Dawdy.

It is deplorable and unethical that the medical community overlooks the grave consequences of taking these drugs; it is equally problematic that the users of these drugs so unwittingly ingest potentially life-threatening, life-altering substances without much consideration.

The reasons for taking these drugs is embedded deep in our own society, and in order to free ourselves of this out-of-control system, our culture needs to take a long hard look at itself. Well see if that happens in this Brave New World we're all very much a part of.

My friend was just like many other college students who face self-imposed pressure and turn to psychiatric medications for help, instead of looking inwards first. A major cause of this rampant rise in prescription drug use is that people overlook the philosophical, psychological, and spiritual reasons for their troubles, and turn instead to the easy push button solution in a pill a day treatment.

Posted by: Jeremy at September 4, 2009 04:59 PM

The NIMH doctor asserts the small risks of killing children with stimulants must be balanced with the reduction in high risk unsafe behaviors those with ADHD manifest and that stimulants reduce. Where is the data that children are being saved from themselves by stimulants to support such an assertion?

Posted by: John Sorboro MD at September 5, 2009 04:01 AM

Seems like what the adhd doc is asserting is that an untreated "adhd" child is better off dead, sort of what the worst of the zyprexa litigation says about "schizophrenics." In fact all harm with psych drugs is defended by the idea that an untreated "mentally ill" person is better of dead. It's all bogus and scary. We doubt the drugs and that's good but until the random dsm number diagnoses are debunked as diseases, there's always going to tragedy.

Posted by: Sally at September 5, 2009 06:56 PM

Let's not forget that stimulants, the most prescribed medications for "ADHD" are Schedule II drugs, which places them in the same class as cocaine, morphine, etc. In fact, Desoxyn which is touted as an effective drug for treatment resistant ADHD, is methamphetamine hydrochloride!, the same drug which is quickly becoming public enemy #1. We understand the science very well behind these drugs but not of the syndrome which they purport to treat; ie, ADHD. And what's the end point of stimulant treatment for a diagnosis, which is typically made based on results of a subjective rating scale, without regard for other causes of nonspecific symptoms such as inattention, hyperactivity and impulsivity? Imagine going to a physician with a complaint of fever and cough and completing a check off list rating severity of such symptoms, only to be diagnosed with "FCD"; ie, fever-cough disorder. You'd brand that doctor as a quack and so would his/her community. Yet, it seems to be a cultural norm for Americans to blindly accept ADHD as a legitimate medical illness,while the rest of the world must be shaking their collective heads in amuzement. The fact is, there are no reliable neurophysiological markers for ADHD, yet we understand the neurophysiological underpinnings of these drugs very well and their propensity for addiction and the problems that ensue as a result. Consider these statistics...Americans are often criticized for consuming 25% of the world's oil supply, while only constituting 5% of the population. But we also consume 70% of its stimulant drugs. Now, if you scour the internet, you'll find opposite opinions as to the long term risk of stimulants regarding addiction, but check the sources of these articles. This link provides a critical summary to the ongoing debate...http://www.abcmedsfree.com/debate.htm

Posted by: Scott Zentner at September 6, 2009 05:24 AM

Mr JS M.D.,

Scientific data is made by the winners just like history.
Guess who are the winners when we are dealing with mental health?
Not the patients, that's for sure.

Posted by: Ana at September 6, 2009 02:17 PM

Dropping dead without warning is in the fine print of just about ALL psych meds, what's shocking is that no one seems to F-ing care when all they are focused on is making someone fit into the "normal box".

Posted by: Stephany at September 7, 2009 08:03 AM
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