Ritalin’s Side Effects
Psychiatrists often say that Ritalin is safe, having few side effects, and none that are severe. This is just not true. Here’s a rating scale listing possible side effects that parents and teachers are supposed to fill out—answering “no problem,” “mild,” “moderate,” or “severe”—as a child begins to take stimulant medication. It’s included in a book written by medical professionals for parents of so-called ADD children:[xxxvi]
Decreased appetite
Problem getting to sleep
Problem staying asleep
Anxious or fearful
Irritable
Looks like a zombie (staring)
Decreased spontaneity
Depressed (even crying)
Headache
Stomachache
Tics (e.g., twitches, jerks, blinks, squints)
Vocal tics (e.g., throat clearing, sniffing, grunting)
Skin rash
Embarrassment because taking medication
Psychosis (irrational thinking, hallucinations, extreme anxiety or inappropriateness
Rebound effect as drug wears off: increased symptoms, hyperactivity and/or depression
If these were rare side effects, there would be no need for such a questionnaire.
The Potential for Psychosis. There is no getting away from the fact that Ritalin is a stimulant, classified as an amphetamine-like drug because of its properties. As Prozac Nation author Elizabeth Wurtzel put it, writing in The New York Times,[xxxvii] “Whatever good Ritalin can do to help center those with attention problems, it does so for a simple reason: It is an amphetamine. In fact, Ritalin is more or less the same as what is sold as speed on the streets.”
The reality is that 10 mg of Ritalin is equivalent to 5 mg of amphetamine. And like amphetamines, Ritalin can cause psychotic behavior. This information is in fact included in the warnings of the drug-packaging information. And psychiatrists, although they may not be forthcoming with facts when they are pulling out their prescription pads, do know that stimulants can make children psychotic. In a 1999 Canadian Journal of Psychiatry report study,[xxxviii] 98 children received stimulant drugs for ADHD and were on them for almost two years. Six of the children developed psychotic symptoms during treatment. The journal concluded that physicians should have “…an awareness of the potential of psychotic side effects from stimulant medication when prescribing for children.”
What’s frightening is that this study documented a better than 6- percent rate of psychotic behavior in children taking stimulants at a time when 5 to 7 million children are now taking the stimulant Ritalin. Psychiatrists have known for decades that Ritalin can cause psychotic behavior. In 1975, psychiatrist Daniel Friedman wrote that Ritalin was one of five drugs that “produced psychotic reactions.” Even at low doses amphetamine-like drugs “may occasionally produce psychotic states, and such psychosis may be prolonged, resembling paranoid psychosis.” In fact, in 1973, psychiatrists were giving amphetamines to volunteers in order to observe their reactions. The reactions frightened researchers, who noted that several of the subjects expressed “a desire to kill” or to do something “bad or destructive.”[xxxix] Researchers concluded that there was a potential danger of impulsive murderous violence caused by amphetamine-induced psychosis.
Dyskinesia and Other Problems. Many children taking Ritalin will develop involuntary muscle contractions and limb movements known as tics, or dyskinesia. A study published in the Archives of Pediatric and Adolescent Medicine[xl] showed that this can happen to up to 9 percent of children taking stimulants. Other studies in the peer-reviewed medical literature bear out this association,[xli] [xlii] [xliii] as well as the Ritalin-psychosis connection. Also, Ritalin has also been shown to have an adverse effect on heart tissue and has been linked to cancer. In the mid-90s, the FDA forced Ritalin’s maker to send letters to 100,000 doctors, warning them of a possible link between the drug and liver cancer. Researchers reported to the FDA that their studies show “clear evidence” that link the drug to cancer. The FDA changed the warning to “some evidence,” a change that was protested by one of the main researchers. A formal proposal to keep the wording “clear evidence” was presented to an FDA panel, but this was defeated by a vote of 4 to 3. “Clear evidence” became “some evidence,” and ultimately the FDA publicly announced that there was “a weak link” between Ritalin and cancer and that doctors should not be concerned about continuing to prescribe the drug.
A problem that some children and teenagers experience with Ritalin is called rebound. When the drug is metabolized and the level in the bloodstream goes down, these children seem to go back to a hyperactive state “and then some.” They may get excitable or impulsive, or develop insomnia.[xliv] In fact, as many as half the so-called ADHD children on medications report some presleep agitation, called P-A.[xlv] Physicians try to handle this problem by decreasing the last dose of the day, or, alternatively, adding another dose, so that the child sleeps with a new supply of Ritalin in his blood. Sometimes this works, but one has to wonder about the advisability of children taking a sleep-pattern-altering drug over the long term.
Yet another Ritalin side effect is the stunting of growth that occurs in some children taking moderate to high stimulant dosages over a period of years. This happens not just because stimulants can diminish appetite, but also because they may alter the body’s natural balance of growth hormones.[xlvi] The growth-stunting phenomenon doesn’t seem to have alarmed the medical establishment as much as it should. Consider the advice given by clinical psychologist Dr. John Taylor in his book Helping Your Hyperactive/Attention Deficit Child.[xlvii] The author notes, first, that some physicians recommend taking the child off medication during vacation periods, so that he can catch up in height and weight. Then Taylor counsels: “The crucial question is whether your child’s behavior can be tolerated if he or she is unmedicated (or undermedicated) during the summer months. Several adjustments are available. Your child can play outdoors more, attend camps, participate in athletic programs or other vigorous play activities, or even be sent to live with a relative. There is little or no requirement for intense academic pursuits, there is no need to sit still for hours as is required in school, and summer entertainments can take advantage of your child’s interests to prevent boredom….Among those who are not given any medication-free periods and who experience the stunting effect, the average amount is less than two inches. If stunting occurs and becomes an important psychological issue, choice of hair style and footwear can compensate.”
At least three questions arise. First, if it’s possible to give a child a stimulating and active life in the summer, at camp or with relatives, why can’t this be done in the winter, in school and with the nuclear family? Surely arranging for more outdoor playtime, and more interesting activities, is preferable to putting a child on drugs. Second, do parents and doctors have the right to stunt a child’s growth for any reason other than, perhaps, to save his life? And third, even if “choice of hair style and footwear can compensate,” for decreased height, how is the child going to feel about this later, when he understands what’s been done to him?
In addition to all the potentially damaging effects of Ritalin one has to factor in the reality that it doesn’t work. Yes, it does make some children better behaved at certain times. But there are no studies showing improved academic performance or social behavior over the long term.[xlviii] What has been shown over the long term is that the side effects can become quite serious.
The Deadly Consequences of Long-Term Stimulant Use
Most people assume that drugs are proven safe before they are marketed. But this is not always the case, especially when you consider the long-term picture. Science knows very little about the long-term effects of medicating children. In effect, children have been guinea pigs. The results of this grand experiment are only now becoming evident, and sometimes the consequences are deadly.
Consider the case of Stephanie Hall, a first grader placed on Ritalin because her teacher felt she was “just a little bit too antsy,” according to her mother. “[The teacher] suggested that Stephanie go for testing, so we went the route of a neurologist who said she could throw a ball and read a book and a psychologist who said she had average intelligence but, yes, she was a little easily distracted. So now she qualifies to be medicated.” When she turned 12, the prescription was increased; that very day, Stephanie died from cardiac arrest in her sleep. Says her mom, “Her death was caused by cardiac arrhythmia with no family history of any type of heart problem whatsoever, and she died a day after her medicine had been increased. It kind of adds up.” [xlix]
A double tragedy struck the Hall family when Stephanie’s sister Jenny, also a long-term Ritalin user, started to have seizures. Subsequent medical tests revealed a brain tumor. Mrs. Hall believes that Jenny was misdiagnosed; as a result proper medical attention was delayed. She states, “There’s Jenny’s ADHD, it’s a brain tumor. I’m not saying everyone that is labeled ADHD has a brain tumor….But there’s the possibility that a child could have an underlying neurological disease that really needs treatment.” Mrs. Hall also wonders whether the medication could have precipitated or exacerbated Jenny’s condition: “It probably made her condition worse because prior to being on medication she never had seizures. I later read that if you have a low threshold to seizures you should never take Ritalin to begin with.”[l] She and her husband are suing Novartis, the maker of Ritalin, for producing a defective product and concealing adverse reactions and deaths related to its use.[li]
The once trusting mother advises parents to learn from her mistakes: “Don’t trust your doctor. Question him over and over. If you are not happy with what he says, if you have an intuitive feeling that something doesn’t seem right, it’s not. Get second and third opinions. It may not seem reasonable to have to go to that extent, but if it’s at the price of your child, it is. I hope others can learn from my tragedy and realize that a doctor’s word is not God’s law.”[lii]
In a more publicized story, Matthew Smith, a 14-year-old from Michigan, had also, like Stephanie Hall, been taking Ritalin from the time he was in first grade. After eight years of ingesting the drug daily, Matthew suddenly became pulseless and died while riding his scooter. An autopsy performed by the county medical examiner, a Dr. Dragovic, found that Matthew’s heart muscle was diffusely replaced with scar tissue, as were the muscular walls of the coronary vessels. Much to the displeasure of the psychiatric and pharmaceutical industry, the doctor publicly stated that Matthew’s death was undoubtedly due to heart damage akin to that regularly seen in deaths among amphetamine addicts, and that his death was clearly due to the Ritalin.
Yet another incident occurred in a psychiatric facility near San Antonio, Texas, where young Randy Steele was being restrained when he suddenly died. Randy was on several psychiatric drugs at the time. But his first psychiatric diagnosis, his entry into a life of psychiatry, had been ADHD, and his first drug was Dexedrine or dextroamphetamine. At death he had an enlarged heart.
It should surprise no one to learn that Ritalin and other amphetamines can lead to death. The dangers are well known to doctors who study the adverse effects of these substances as medical students. Dr. Dragovic explains: “Methylphenidate—that’s [Ritalin’s] chemical name—is classified as an adrenergic agonist. This is a type of drug that boosts the adrenergic system. It affects everything that has as its chemical pathway adrenalin, noradrenaline, dopamine, those types of mediators and transmitters. Drugs in the category of stimulants also include Ritalin’s cousins–amphetamines, methamphetamines, and even cocaine. If they are repetitively used, these drugs stimulate the adrenergic system in the human body. Over a period of time…many months to many years—the enhancement of the adrenergic system will produce changes in small blood vessels. Some cells will be lost, and in an attempt to repair the area there will be scarring….The blood vessels will narrow. The changes that we’re seeing in kids who have been on Ritalin for about eight years are basically the same as the changes in someone that has been abusing cocaine regularly over a period of years.”[liii]
Dragovic adds that irreversible damage to the vascular system could also result in cardiovascular problems down the road, including high blood pressure. By medicating vast numbers of children today, we could be creating an army of future patients with other conditions that need to be treated. “Do we need that?” asks Dr. Dragovic. His answer is certainly no, but as he explains, “That’s the peril of chronic Ritalin use, or of any stimulant for that matter. It’s paying the due to long-term use.”[liv]
There are few if any statistics on how many people experience adverse effects. What we do know is that, according to FDA adverse reaction reports—which are notoriously incomplete—there were 160 Ritalin-related deaths between 1990 and 1997, most of them cardiovascular-related. We know that Ritalin is a vasoactive (blood-vessel-altering) substance that decreases cerebral blood flow.[lv] And we know that children’s brains are undergoing dramatic development through the teen years, not just in early childhood, as had been previously thought.[lvi] We also know that Ritalin can have persistent, cumulative effects on the myocardium, the muscle cells that form most of the heart wall.[lvii] With all these facts in mind, one has to wonder about the implications for the millions of American children being dosed over the long term with stimulants. As Dr. Fred Baughman points out, “There is no way of knowing the actual frequency of… any medical side effects of these drugs, because there is no required reporting system. There is only a voluntary system whereby physicians would call the FDA, and, needless to say, they don’t often report their own complications.”[lviii] Ritalin’s vast growth—its legal and illegal use–could mean that a multitude of tragedies are on the horizon.
The Problem of Learned Helplessness
In addition to physical devastation, an ADD label can cause psychological harm. According to Dr. David Stein, “ADD is a stigma, and probably an unnecessary stigma to have to live with….Current treatment programs are designed with the idea that [the ADD child is] diseased and handicapped. They treat the child in such a way as to help him, coax him, warn him, assist him excessively, post rules, sit with him when he does homework.” The result, concludes Stein, is that children labeled as having attention deficit disorder begin to develop four types of dependencies:
1. Task dependency—the belief that they can’t initiate and complete a task without someone helping them;
2. Cognitive behavioral dependency—a constant need to be reminded about how to behave in different environments;
3. Emotional dependency—the belief that they have to have someone help them all the time; and
4. Medication dependency—the belief that they can’t function unless they take the drugs, even if a physical dependency on the drug does not exist.[lix]
Such dependencies are counterproductive to normal, healthy development, Stein points out. Children should be encouraged to become confident and independent, but limiting beliefs about the capabilities of “diseased” children can keep them handicapped well into their teenage and adult years. For instance, once a child receives an ADD or ADHD label, down the road he or she may be perceived as unstable and thus banned from certain types of employment, such as security jobs in the federal government.
Could Attention Deficits Be Culturally Induced?
There are those who believe that what we perceive as ADHD is simply children’s natural reaction to the sped-up quality of much of American life today. One of these people is psychologist Dr. Richard DeGrandpre, fellow of the National Institute on Drug Abuse and author of Ritalin Nation.[lx] “As society goes faster, so do the rhythms of our own consciousness,” DeGrandpre writes in this insightful book.[lxi] “This is especially true for children, who grow up in concert with the latest speed.” DeGrandpre points out that young people who have known nothing but a hurried, perpetually wired environment, will tend to get restless when the stimulation level lags—in a classroom, for instance. And he says that Ritalin, being itself a stimulant, does not so much erase the need for excitement but rather fulfill it, in a prosthetic way. Indeed, he coins the phrase “prosthetic pharmacology” to refer to the way modern psychiatry uses drugs as crutches, rather than cures. And while a real crutch may help a person’s injured leg heal, psychiatric crutches often mask underlying problems, resulting in no effort being made to deal with them.
A noteworthy point made by DeGrandpre is that, while years ago, the condition then known as hyperactivity tended to disappear when childhood ended, today’s ADHD seems to linger into adolescence and adulthood for a lot of its “victims.” But why would a bona fide disorder suddenly afflict a whole new age group? There has to be a cultural component at play.
Our Shifting Values. We don’t seem to want to face any cultural concerns, though. We’d rather diagnose a large segment of the population as mentally impaired, thereby shifting responsibility for our mental well-being away from society and toward the medical profession. When people are identified as “sick,” their issues are seen as the result of a diseased mind, rather than as a reaction to an unhealthy family dynamic or social environment. But one need only compare the world of today to that of 50 years ago to appreciate the magnitude of the additional stresses in contemporary times that could result in maladaptive behavior. Many children practically grow up in day care centers, for example, their parents being too busy and hassled to raise them, and dinner is usually eaten in front of the TV. Family members don’t interact with each other. School demands more academic work from children at an earlier age. The extended family is practically nonexistent, with grandparents, aunts, and uncles living many states away. As a result, values are not taught to children. The divorce rate is approaching 67 percent, and 50 percent of children are being raised by single parents. These statements about modern life are almost cliché, but the fact remains that the environment they describe does have an impact on children.
I believe you have to look deeply at the values of a society to really understand what ails its people. In today’s America, it never occurs to anyone that it’s okay to just be by being. In our society we hate the idea of being without purpose. Baby boomers, in particular, feel that we’re always supposed to have a purpose, a goal, a motivation to get there, discipline to keep the motivation going, and passion to fuel it all. We’re supposed to have a higher ideal, and to value success and competition. But in the process of doing all that we frequently lose our sense of identity. We have to consider that when today’s kids take a careful look at their parents, they may not want to duplicate what they see. They—or at least some of them—may be turned off by the high stress levels, the judgmental attitudes, the lack of quality of life, the lack of unconditional love, the absence of peace of mind, and the inability to feel comfortable with what is. So kids may say, “I’m just going to kind of hang out in the moment.” And we think, “No, you can’t. You’ve got to get in there. You’ve got to achieve. You’ve got to prove yourself. You’re up against competition. There’s a shortage of everything.” And then we put them in a situation where they can’t win and can only be labeled as having some kind of deficit.
The Question of Parental Compliance
The successful campaign to medicate the young could not happen without the consent of willing parents. Or could it? What happens if you, as a parent, concerned that your child may be having side effects from a medication that you weren’t even sure he needed to begin with, want to take the child off the drug? Your child might be refused entry to school, or worse. You could lose your child because the authorities do not believe you have the right to decide whether or not he or she should be on Ritalin. Schools are now using heavy-handed tactics with parents who refuse to give the drug. Parents are accused of child abuse, violence, or neglect. Child protective services are called in to force the parents to medicate their children, sometimes under the threat of removing the child from the parent’s home. One example of the abuse of power by schools and family courts is the experience of Tammy Maria Kabiak, a mom who conscientiously gave Ritalin to her son for eight years after being told the boy had ADHD, but who decided to stop after researching the facts.
Tammy Kabiak’s decision to stop came about gradually, after several years of doubt. After Ritalin was begun, Kabiak noticed the development of side effects in her son—memory loss, shaking, bad headaches, sleep disturbances, and loss of appetite. Years later, she researched the drug and became increasingly concerned. Tammy learned that her son was taking a Schedule-II controlled substance, meaning the drug was in the same category as cocaine and methamphetamines. Due to their highly addictive nature, these substances are under continual surveillance by the U.S. Drug Enforcement Administration; they’re overseen as well by a United Nations body called the International Narcotics Control Board. So this was not a harmless medicine, as her son’s school had led her to believe, but an addictive substance. Even more disturbing, Kabiak learned that Ritalin could be fatal when given to children with heart problems, and her son had a heart condition. In light of these new insights, the choice seemed obvious. She would wean her son off the medication. Interestingly, once the Ritalin was stopped, many of the disturbing symptoms she had observed over the years also ceased.
Kabiak informed the school of her decision. She showed them medical records documenting the severe consequences that the child had suffered with the drug. And she showed them how, when he was taken off the drug, those conditions improved. The school challenged her, though, and charged her with being an unfit parent, and now threatened to take her other two children away. They did take her son away, putting him into a boy’s home where psychiatric drugs were forcibly given to him. “The school took my son to a hospital without [first notifying] me,” Kabiak remembers. “When I got there, they refused to let me take him home and said if I didn’t sign papers they would call child protection and have my rights as a mother severed.”[lxii]
Currently a resident at a home for children with problems, Kabiak’s son demonstrates anger and depression. As a result, he now takes more drugs, including the antidepressant Zoloft. What those in charge don’t seem to consider is that the new symptoms may well be a response to the sudden, traumatic uprooting or even an effect of Ritalin. Unfortunately, Tammy Kabiak is a poor person, and does not have the financial wherewithal to challenge what has been done to her family.
The Carroll family is another one that got into trouble with the psychiatric establishment because of problems with a son. When seven-year old Kyle Carroll, a first-grader, was prescribed Ritalin after a diagnosis of ADHD, his parents, Michael and Jill Carroll, worried about the drug’s side effects. But when they decided to stop the drug, school administrators alleged child abuse, and the Carrolls found themselves on a New York statewide list of alleged child abusers. They were thrust into a family court battle to clear their name and prevent their child from being removed from their home.
“I told the school I wanted to take him off the Ritalin to see how he does the first couple of weeks,” recounts Michael Carroll. “A week after that, Child Protection came knocking on the door. They basically said that by not giving him the drug we’d be charged with neglect for not following doctor’s orders.” The Carrolls were taken to court, where they were ordered to administer all drugs prescribed by the physician. They were fortunate in that their pediatrician stopped writing the prescription; therefore, their not medicating their son was no longer going against the court order. But their reputation as parents has been tarnished, and the Carrolls are still in the process of trying to clear their name.
In yet another upstate New York case, parents had agreed to try Ritalin on their seven-year-old boy but changed their minds after witnessing serious side effects. The school district objected and said that taking the child off Ritalin constituted child abuse. Unconscionably, Child Protective Services hauled this family into court. The judge said that not giving the child Ritalin put the parents at risk of having the boy taken away.
Richard Wexler is executive director for the National Coalition for Child Protection Reform in Alexandria, Virginia, author of Wounded Innocence: The Real Victims in the War Against Child Abuse,[lxiii] and a writer on the child welfare system for the New York Times and the Chicago Tribune. Discussing the above case and ones like it, he explains his belief that the school district and Child Protective Services are interfering in medical decisions that should be between the child, the parents, and their doctors, and, in the process, doing enormous harm to children. “Imagine the specter, being a small child, seven-years-old. Suddenly strangers are questioning you about the most intimate details of your life. The child may be pulled out of his class to the principal’s office and suddenly asked all sorts of very difficult questions like ‘Do you think your parents really love you?’ ‘How do they discipline you?’ ‘How do they treat you?’ That’s terribly scary. The younger the child, the scarier it is.
“And hanging over everything is the specter that you might suddenly be taken away, not only from your parents but from everything loving and familiar…. In a situation where the child is actually removed, if a child is very young he or she may experience it as akin to a kidnapping. I recall one case in which a child was dragged away, literally kicking and screaming, and the child kept yelling, ‘I’m sorry. I’m sorry. I’m sorry.’ She thought that she must have done something wrong for which she was being punished.”[lxiv]
Child protective workers have complete power over parents, which is sometimes necessary for rescuing children from real and serious abuse. But sometimes workers get carried away; they can get into the mindset of assuming that every case put before them is one of serious abuse. Dr. Wexler points out that for a child protection agency to automatically call parents negligent for not administering a controversial psychiatric drug to their child, and, irrespective of the circumstances, to subject them to the same rules as someone who just beat their child, is grossly unfair to those parents. “We know that these cases have arisen,” states Wexler, although often cases of alleged negligence are complicated by a variety of factors.[lxv]
Successfully Challenging the Courts. One parent who successfully challenged a court order regarding forced medication is Nestor Sosa, a divorced father, who, upon opening his door one day, was handed a court order to give his son Ritalin. This was how Sosa learned that his son had been given psychological tests, found to have ADHD, and put on medication. All this had occurred without Sosa’s knowledge or consent; therefore, it was a violation of his joint custody agreement, he reasoned, and he would challenge the order.
Sosa took his case to court, deposing the pediatrician who made the original recommendation, and asking to see medically objective tests performed on his son. No such tests were available, although the doctor tried skirting the issue by talking about a psychological assessment that had been performed at UCLA. This psychological evaluation, however, said nothing about actual medical tests proving a brain abnormality. Sosa remembers how the deposed pediatrician could not even define ADD: “I asked him three times, and he changed his answer three times. The third time we came into the deposition he picked up a magazine and, reading it slowly, said, “It’s a neurobiological condition. Yeah, that’s what it is.”[lxvi]
In the end, the doctor had to admit that there was no validity to the diagnosis. Sosa states, “I went there with letters from UCLA admitting that currently there are no tests to diagnose ADHD. Even the pediatrician that I deposed said that there are no tests, and that he was not qualified to validate ADHD. I went back to court demanding valid tests and saying that if I do not see those tests then this is a violation of informed consent. ‘I need to be able to see the marker, the biological marker, that you’re using to diagnose these kids as being ADHD or not.’ They could not turn it over. Never during my time in court did I get to see a medical test that confirmed he had ADD or some other condition that justified their giving him a Schedule-II controlled substance. By my last court date they concluded that he didn’t have the condition, and they ordered him off the drug.”
Sosa concludes, “This whole thing is a pure scam,”[lxvii] and advises other parents fighting the system to enter the arena well informed. Parents must take an active stance, and can do so in the following way:
1- Document everything. Write down who said what and when they said it.
2- Ask the school to tell you, in writing, how they diagnosed ADD, the qualifications of the teachers making the diagnosis, and what objective medical tests were used to confirm the diagnosis. Have them sign the documents under penalty of perjury.
3- Let the school know that under federal law (United States Code Title 20, Section 1232H) you are allowed to obtain all records and that you are able to refuse any participation by your child in psychological surveys, analyses, or evaluations.
4- Obtain all medical records from any doctor prescribing drugs. Have the physician tell you (also in writing) how he or she confirms an abnormality in a child and how that abnormality justifies the use of a toxic, controlled substance such as Ritalin. Make sure that any tests given were made prior to exposure to any psychotropic medication, so that what is diagnosed is not an iatrogenic condition (a condition caused by medical treatment). You are entitled to all medical records and should obtain the entire set.
5- If Child Services gets involved, have them provide you with the tests they used to confirm that your child has a disease. If they respond with defamatory remarks about your character—for example, if they say that you’re an unfit parent for not giving your child a controlled substance—you have the right to sue them for slander.
6- If the tests you have requested are not given to you by your court date, ask the court to produce the tests. Inform the court that without a valid test you and your child have been deprived of proper informed consent. Let the court know how upset you are that your rights have been violated.
A Parent’s Right Not to Medicate
A number of schools require children labeled with ADHD and ADD to take Ritalin. Parents refusing to comply are told to keep their youngsters home. Recently, though, such abuse of authority has been challenged in some states. A leader in this reform has been Patty Johnson, a former member of the Colorado State Board of Education, who spearheaded the landmark state school board resolution to protect children from being refused an education if a parent chooses not to administer Ritalin.
As a school board member, Johnson received numerous disturbing complaints from parents being pressured to place their children on Ritalin. She gives several examples: “A police officer in Denver was given three choices. She was told either to put her son on Ritalin, pull him from the public schools, or sit with him in class all day. She decided to leave the police force and home-school her son, saying there was no way was she going to put her bright son on drugs (he was a straight-A student). He was very active, and she just wanted them to discipline him and set boundaries. Another parent just wanted special reading help for his daughter and was told, ‘You cannot get the reading help unless you put her on the drug.’ There are also parents in Jefferson County that are in court fighting for custody because they put their happy-go-lucky little boy on Ritalin and saw a drastic change in his behavior overnight. They found steak knives in his bedroom. He had slashed his mattress and all his teddy bears. They said he was walking around like a zombie. Then when they took him off the drug and told the school that they would rather try other solutions the principal called Social Services and reported them for medical neglect. So they are now in court fighting for custody of their child because they refused to keep him on Ritalin.”[lxviii]
Johnson decided to try to do something about the situation by showing other board members research on Ritalin and eventually proposing a new school board resolution. The title of the resolution was “Promoting the Use of Academic Solutions to Resolve Problems with Behavior, Attention, and Learning.” “It basically reminded teachers that their role was to teach,” explains Johnson. “They are not medical doctors. They can’t practice medicine without a license. And it was up to the parent whether or not to medicate their child.”[lxix]
The pro-medication tide is turning in other states as well, particularly Connecticut. That state was the first in the nation to legislate against teachers or other school officials recommending psychiatric drugs for individual children. School personnel can recommend that parents take their child to a doctor for evaluation, but suggesting that Ritalin is needed is no longer allowed.
The new law’s chief sponsor, a state representative who is also an emergency room nurse, is quoted in an Associated Press article as saying, “’I cannot believe how many young kids are on Prozac, Thorazine, Haldol—you name it….It blows my mind.”[lxx] Apparently other Connecticut lawmakers were equally incensed about the increasing drugging of children, because the law was approved unanimously by the legislature. Other states moving legally to limit the advocacy of drugs by school personnel include New York, New Jersey, Arizona, Utah, and Wisconsin. As The New York Times explains, “The legislative push is a reaction to what its advocates call overprescription of the drugs. They say an excessive reliance on Ritalin and several competing drugs is driving parents away from traditional forms of discipline and has created a growing, illegal traffic in what are potent and dangerous speed-like stimulants.”[lxxi]
Overcoming Behavioral Problems Without Drugs
Children manifest behavioral disorders for a number of reasons, including physical ones such as dietary factors and lack of exercise. Doctors taking a proactive approach believe that children can and should be helped without drugs, as drugs only mask the problem without getting to the root of it. Moreover, drugs do not teach a child anything. The advantage of a drug-free approach is that children can learn how to actively think and how to monitor their behavior. Improvements are long-term, with no reliance on dangerous substances.
Psychologist Dr. Thomas Armstrong is a former special education teacher who has had a lot of experience working with children with attention and behavior problems. In his book The Myth of the A.D.D. Child[lxxii] Armstrong describes 50 techniques that parents and teachers can use to mold the behavior of children who are habitually inattentive or hyperactive. His suggested strategies range from dietary and physical techniques to new ways of communicating with your child and interacting as a family. Here are a few of the ideas Armstrong elaborates on:
Provide a balanced breakfast that includes complex carbohydrates, protein, and fruit.
Limit TV and video games.
Have your child study a martial art.
Use color to highlight information.
Include physical movement in your child’s learning environment.
Find your child’s best times of alertness, and then utilize that knowledge.
Provide appropriate, uncrowded, spaces for learning.
Give your child immediate feedback.
Have the child do real-life tasks, including teaching a younger child.
Hold family meetings, at which parents and children can function as equals.
While not totally against the use of drugs, Armstrong feels they are overemphasized, and that “the more parents focus on drugs as solutions for their children’s behavior problems, the less likely it will be that they’ll look at important non-drug interventions.”[lxxiii] It’s easier to focus on whether a child has taken his daily pill rather than on the development of new communications strategies or the need to revise a school curriculum.
The Dark Side of Antidepressants
In the past several years a whole new vocabulary of disturbed behavior has entered the English language, with terms such as “going postal,” “road rage,” “air rage,” and “sports rage.” The types of events these terms refer to used to be practically nonexistent. Now, unfortunately, such happenings are commonplace, and one reason is the widespread use of antidepressants.
Nearly a decade has passed since Prozac was introduced to the market and quickly proclaimed a wonder drug. During that time, the drug has indeed helped many people who suffer from severe depression. But the early claims that Prozac would alleviate depression without causing harmful side effects have not been realized. Indeed, just the opposite has proven true. Prozac has produced serious side effects in some users, prompting a host of lawsuits against Eli Lilly & Company, the drug’s manufacturer. These adverse effects include akathisia, a condition in which a person feels compelled to move about, as well as permanent neurological damage, obsession with suicide, and acts of violence.
In 1990, the Citizens Commission on Human Rights, an organization that investigates psychiatric violations of human rights, wrote a letter to the House of Representatives that stated, “The wide use of Prozac has been largely generated by Lilly’s false claim that Prozac has fewer side effects than other antidepressant drugs. This is a serious misrepresentation to the public which is destroying lives.” (The letter notes that Eli Lilly had in fact changed its advertisements to remove the statement that Prozac causes “fewer side effects.” In one ad, for example, the manufacturer said instead that the drug produces “fewer tricyclic-like side effects.”) The letter concludes, “The drug should be immediately recalled as a serious health hazard and kept off the market until the manufacturer can guarantee the drug will not kill more people.”
What is particularly disturbing is that, right now, children are one of Prozac’s primary targets. And while psychiatrists claim such drug treatment is safe, they rarely, if ever, talk about the harm this practice has been proven to cause. A 1994 investigation into Prozac’s adverse effects on children, which looked at 659 children between the ages of 1 and 18, showed 1332 adverse reactions suffered by those children. These reactions included 34 deaths and 83 attempted suicides. Two five-year-old children committed suicide in 1992 while taking Prozac, and two four-year-old children attempted suicide while taking just 10 mg a day of the drug. It should be noted that Eli Lilly has stated that the drug was never intended for young children, but for those 18 and older.[lxxiv]
Overlooking Prozac’s Drawbacks
In our rush to find the mental “magic bullet,” we have neglected to notice the side effects of Prozac. First and foremost, there is overstimulation. Prozac acts like a stimulant, and some of the side effects are thus the same as those of amphetamines. The major adverse reactions to the amphetamines, like those of Prozac, are exaggerations of the desired effects, specifically excessive stimulation of the central nervous system manifested as insomnia, anxiety, or hyperactivity. Other symptoms of this problem include agitation, nervousness, increased headaches, sweating, nightmares, loss of appetite, and weight loss. A common manifestation is akathisia, the need to keep moving around. So now, just as sedatives were often prescribed along with amphetamines to counter overstimulation, Ritalin may be prescribed as a way of modulating the effects of Prozac.
Consider how this can affect a child. Let’s say there is a child—more often than not it’s a boy—between the ages of 8 and 14, who’s not performing well in school. And his parents have decided, based upon some behavior that they’re not happy with, possibly a lack of respect for what they want for their son, that he needs psychiatric help. Prozac is recommended. But there are side effects. Now, when they boy goes to school, while before he may have been bored with the teacher, bored with the class, and perhaps smarter than the teacher and the class, now he has agitation, anxiety, and nervousness. So now the teacher thinks he has attention deficit hyperactivity disorder. And now he’s going to be given Ritalin along with the Prozac.
This is not a rare scenario. Research shows that almost a third of the children on Prozac or a similar antidepressant also take Ritalin or a similar stimulant.[lxxv] And studies have reported that 40 percent of people on Prozac experience akathisia. With this condition a person may feel driven to shuffle his feet or to stand up and walk around. At the same time, there’s an inner sense of anxiety and irritability, something like you feel when you hear chalk going down a chalkboard. The feeling could be mild or torturous. Imagine having to sit in classrooms hour after hour while experiencing that.
The picture gets nightmarish when we consider that both akathisia and agitation are associated with violence and suicide because they are related to a breakdown of impulse control. Sometimes, when overstimulation becomes extreme, people become psychotic. Then they may do outlandish and even violent things, such as shooting up schools.
The possibility of Prozac’s inducing psychosis was noted in FDA-controlled studies that were only four to six weeks long. Out of the 286 people who finished these studies, 1 percent became psychotic. Actually the true rate of induced psychosis may be higher than 1 percent, since these were such short-term studies and the population of people studied was narrow. It should be noted that the people chosen for this research were carefully screened to exclude those with a history of being manic-depressive, schizophrenic, or suicidal. As a result, one can see that the craziness people experienced was strongly associated with the drug.
Psychiatrist Peter Breggin, in Talking Back to Prozac, illustrates how Prozac-induced mania can affect a child, as he summarizes a case reported in a psychiatric journal:[lxxvi] [lxxvii]
“A ten-year-old boy became depressed when his family moved to a new neighborhood, and he was placed on 20 mgs. of Prozac by his family physician. The youngster immediately became ‘hyperactive, agitated,’ and ‘irritable,’ and his speech was pressured. He was less tired and required less sleep, and he developed a ‘somewhat grandiose assessment of his own abilities.’ Then he began to make a number of anonymous phone calls, threatening to kill a stranger in the neighborhood. When the telephone calls were traced back to him, the Prozac was discontinued and all of the hypomanic symptoms resolved within two weeks. Mania and hostility frequently go together and suggest one of the mechanisms for Prozac-induced violence, as well as for ‘crashing’ and suicide.”
Another side effect that sometimes occurs with Prozac is the very condition it’s supposed to cure—depression. This is not as illogical as it sounds because depression is an after-effect of overstimulation, and Prozac acts like a stimulant. A look at FDA materials on Prozac shows that Eli Lilly knew Prozac caused depression and, in fact, the company initially reported it. Then, this information just disappeared from the label. This is a serious omission, and certainly places patients in jeopardy.
This is what may happen to certain patients: They start taking the drug, and in the beginning they feel better, perhaps because they feel they’ve finally done something for themselves. Or maybe the drug gives them a burst of energy; stimulants will do that. But then they get more depressed. They get suicidal feelings. But they—or in children’s cases, their parents—don’t know the drug hasn’t been tested on suicidal patients. And they aren’t aware that Eli Lilly once listed depression as a possible effect of the drug. And so they end up thinking they should take more Prozac—to fight the depression. When that fails to work, resulting instead in more depression, they could eventually end up receiving shock treatment, never knowing that if they hadn’t started on Prozac, they may never have gotten so severely depressed. Subjecting children to this possibility does not seem like a wise idea.
A trend that has to be factored into this situation is that, while SSRI’s were initially drugs prescribed by psychiatrists for serious clinical depression, they’re increasingly used in a more casual way—prescribed by general practitioners for mild depression. So now we have a lot of people taking a drug that they don’t actually need—a drug that research shows will make a small percentage of those taking it suicidal, even if they’ve never been suicidal before. According to researcher Dr. David Healy, director of the North Wales Department of Psychological Medicine, “Generally the findings would indicate that women and children and those who are least ill may be most at risk.”[lxxviii] Healy believes that the research that preceded the initial approval of SSRI’s was flawed, so that now they’re being given out without heed being paid to their dangers.
Many other doctors would agree. For example, pediatrician Dr. Jerry L. Rushton, of the University of North Carolina at Chapel Hill, reports on the widespread practice of prescribing SSRI’s to youngsters for reasons such as mild to moderate depression, and ADHD. Says Rushton: “Despite a paucity of safety and effectiveness data more than 500,000 prescriptions for SSRI’s are written for children and adolescents each year.[lxxix]
Other possible side effects of Prozac are tardive dystonia, a condition in which muscles tense up involuntarily, and tardive dyskinesia, in which there is involuntary movement. Many psychiatric drugs, such as Haldol and Thorazine, are recognized as causing tardive dyskinesia in roughly one out of five long-term users. Current medical knowledge holds that the permanent damage of tardive dyskinesia is not expected to develop until a person has been on a psychiatric drug for a year or more. Hence the name “tardive,” meaning late developing. With Prozac, however, the scientific literature shows that it can develop rapidly and without warning early on. Tardive dystonia and dyskinesia are conditions that should not be taken lightly because they can be stigmatizing. The movements and postures associated with these conditions can look bizarre. They may make a person seem quite mentally ill when, in fact, their movements are simply side effects of medications intended to alleviate mental illness. And these symptoms can persist long after the person has come off the drug. In some cases they never remit at all because parts of the brain that control muscle function have been destroyed by the drug.
Another possible side effect is a rash, and there are several kinds of rashes associated with Prozac use. At the most serious extreme, rashes that appear reflect serious immunological disorders, such as lupus erythmatosis or serum sickness, which is accompanied by fever, chills, and abnormal high white blood cell count. A few deaths have been associated with Prozac-induced skin rashes.
Cancer is yet another possibility. Animal studies show that Prozac, as well as a number of other antidepressants, enhance tumor growth. And yet these drugs are commonly given to people suffering from cancer because it’s thought they will help with depression.
Withdrawal Problems. When people abruptly stop taking Prozac or other SSRI antidepressants, after taking them for several months, there are usually problems. Up to 78 percent of the people who do this experience physical and psychological symptoms such as changes in mood, appetite, and sleep; dizziness; fatigue; anxiety; agitation; nausea; headaches; and sensory disturbance. The symptoms are so typical that the clinical entity “SSRI discontinuation syndrome” is now widely accepted—after its existence had been denied for several years following the introduction of SSRI’s on the market. Symptoms are usually mild and short-term but occasionally can be severe and long lasting.
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