DAVE TRAXSON - SIDE EFFECTS OF STIMULANT MEDICATION - LONG TERM

Nothing is better than a good nights sleep for a child.

If not you often get this:

The most illogical common side effect of all stimulants , as we all know, is sleep disturbance. How crazy is that? As parents or caring adults we all know the critical importance of sleep for a child. Sleep is natures great restorative and changes brain chemistry positively. A child deprived of good quality sleep for even one night can become fractious and anxious for the next day.So why as a society would we encourage this unscientific and unnatural approach.

So why do we use stimulants that affect sleep and cognition?

         Corrupting Cognition

Amphetamines such as Adderall could alter the mind in other ways. A team led by psychologist Stacy A. Castner of the Yale University School of Medicine has documented long-lasting behavioural oddities, such as hallucinations, and cognitive impairment in rhesus monkeys that received escalating injected doses of amphetamine over either six or 12 weeks. Compared with monkeys given inactive saline, the drug-treated monkeys displayed deficits in working memory - the short-term buffer that allows us to hold several items in mind - which persisted for at least three years after exposure to the drug. The researchers connected these cognitive problems to a significantly lower level of dopamine activity in the frontal cortex of the drug-treated monkeys as compared with that of the monkeys not given amphetamine.

Underlying such cognitive and behavioural effects may be subtle structural changes too small to show up on brain scans. In a 1997 study psychologists Terry E. Robinson and Bryan Kolb of the University of Michigan at Ann Arbor found that high injected doses of amphetamine in rats cause the major output neurons of the nucleus accumbens to sprout longer branches, or dendrites, as well as additional spines on those dendrites. A de­cade later Castner's team linked lower doses of amphetamine to subtle atrophy of neurons in the prefrontal cortex of monkeys.

A report published in 2005 by neurologist George A. Ricaurte and his team at the Johns Hopkins University School of Medicine is even more damning to ADHD meds because the researchers used realistic doses and drug delivery by mouth instead of by injection. Ricaurte's group trained baboons and squirrel monkeys to self-administer an oral formulation of amphetamine similar to Adderall: the animals drank an amphetamine-laced orange cocktail twice a day for four weeks, mimicking the dosing schedule in humans. Two to four weeks later the researchers detected evidence of amphetamine-induced brain damage, encountering lower levels of dopamine and fewer dopamine transporters on nerve endings in the striatum - a trio of brain regions that includes the nucleus accumbens - in amphetamine-treated primates than in untreated animals. The authors believe these observations reflect a drug-related loss of dopamine-releasing nerve fibers that reach the striatum from the brain stem.

One possible consequence of a loss of dopamine and its associated molecules is Parkinson's disease, a movement disorder that can also lead to cognitive deficits. A study in humans published in 2006 hints at a link between Parkinson's and a prolonged exposure to amphetamine in any form (not just that prescribed for ADHD). Before Parkinson's symptoms such as tremors and muscle rigidity appear, however, dopamine's function in the brain must decline by 80 to 90 percent, or by about twice as much as what Ricaurte and his colleagues saw in baboons that were drinking a more moderate dose of the drug. And some studies have found no connection between stimulant use and Parkinson's.

Stimulants do seem to stunt growth in children. Otherwise, however, studies in humans have largely failed to demonstrate any clear indications of harm from taking ADHD medications as prescribed. Whether the drugs alter the human brain in the same way they alter that of certain animals is unknown, because so far little clinical data exist on their long-term neurological effects. Even when the dosing is similar or the animals have something resembling ADHD, different species' brains may have varying sensitivities to stimulant medications.

Nevertheless, in light of the emerging evidence, many doctors and researchers are recommending a more cautious approach to the medical use of stimulants. Some are urging the adoption of strict diagnostic criteria for ADHD and a policy restricting prescriptions for individuals who fit those criteria. Others are advocating behavior modification - which can be as effective as stimulants over the long run - as a first-line approach to combating the disorder. Certain types of mental exercises may also ease ADHD symptoms [see "Train Your Brain," by Ulrich Kraft; Scientific American Mind, February/March 2006]. For patients who require stimulants, some neurologists and psychiatrists have also suggested using the lowest dose needed or monitoring the blood levels of these drugs as a way of keeping concentrations below those shown to be problematic in other mammals. Without these or similar measures, large numbers of people who regularly take stimulants may ultimately struggle with a new set of problems spawned by the treatments themselves.

Growing Problems

Drug toxicity lowers growth rate significantly (2cm average difference over 2 years)

So far the best-documented problem associated with the stimulants used to treat attention-deficit hyperactivity disorder (ADHD) concerns growth. Human growth is controlled at least in part through the hypothalamus and pituitary at the base of the brain. Studies in mice hint that stimulants may increase levels of the neurotransmitter dopamine in the hypothalamus as well as in the striatum (a three-part brain structure that includes part of its reward circuitry) and that the excess dopamine may reach the pituitary by way of the bloodstream and act to retard growth.

Recent work strongly indicates that the drugs can stunt growth in children. In a 2007 analysis of a National Institute of Mental Health study of ADHD treatments involving 579 children, research psychiatrist Nora Volkow, who directs the National Institute of Drug Abuse, and her colleagues compared growth rates of unmedicated seven- to 10-year-olds over three years with those of kids who took stimulants throughout that period. Relative to the unmedicated youths, the drug-treated youths showed a decrease in growth rate, gaining, on average, two fewer centimeters in height and 2.7 kilograms less in weight. Although this growth-stunting effect came to a halt by the third year, the kids on the meds never caught up to their counterparts.
This is a profoundly worrying set of findings which reinforce the view of thousands of concerned child professionals in the U.K. as the the potential for toxic harm to children from 4-16 years old.Clearly this highlights the need for a National review of this increasing lazy practice by medics.