Home/Essays Examples/Health/Stimulants for Attention Deficit Hyperactivity Disorder

Stimulants for Attention Deficit Hyperactivity Disorder

Introduction

‘Attention deficit hyperactivity disorder’, ‘minimal brain dysfunction’ ‘attention deficit disorder’, ‘hyper kinesis’ and ‘hyperkinetic disorder’, (Taylor, 1994) are certain terms used for a set of symptoms typified by importunate over impulsivity, movement, and complexities in supporting awareness. (Wender, 1997). The clinicians noticed that adolescents, too, could benefit from stimulant medication while they are generally neglected. Beliefs arise in psychiatry either because many nonscientific clinicians observe the same phenomena over and over again or because scientific studies affirm and demonstrate the clinicians’ observations. Twenty years ago, psychiatrists were conducting careful studies in which they traced the development and outcome of a large group of ADD adolescents.

Approximately 70% of adolescents with ADD find that their symptoms significantly improve after they take medication prescribed by their doctors. (Wilens, 2002) The patient is able to concentrate on difficult and time-consuming tasks, stop impulsive behavior, and tame the restless twitches that have been experienced in the past. Some ADD patient’s psychological and behavioral problems are not solved by medication alone, and are required more therapy or training.

There are two types of drugs that work to balance the neurotransmitters and have been found to be most effective in treating ADD. Stimulants are drugs that stimulate or activate brain activity. Stimulants work by increasing the amount of dopamine either produced in the brain or used by the frontal lobes of the brain. There are several different stimulants that may work to alleviate the symptoms of ADD, including methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert).

Stimulants are by far the most effective medications in the treatment of ADD. Some patients respond well to antidepressants. Antidepressants also stimulate brain activity in the frontal lobes, but they affect the production and use of other chemicals, usually norepinephrine and serotonin. The antidepressants considered most useful for ADD include imipramine (Tofranil), desipramine (Norpramin), bupropion (Wellbutrin), and fluoxetine hydrochloride (Prozac). All stimulants have the same set of side effects. Some patients complain of feeling nauseous or headachy at the outset of treatment, but find that these side effects pass within a few days. (Purdie, 2002)

Many people with ADHD are treated with psychostimulant drugs like Ritalin, Adderall or Concerta, among others. Psychostimulant drugs excite the central nervous system, usually causing increased alertness, focus and feelings of well being, but also sometimes causing a calming effect in hyperactive people. There are naturally occurring and synthetic psychostimulant substances with amphetamines belonging to the latter group. These amphetamines are the most commonly prescribed medications today in the treatment of ADHD. Although scientific research is showing that many sufferers of Attention Deficit Hyperactive Disorder are benefiting from treatment with amphetamines, the use of these drugs is certainly not without its risks.

Scientists are discovering more and more evidence suggesting that ADHD does not stem from home environment, but from biological causes. And over the past few decades, health professionals have come up with possible theories about what causes ADHD. But, they continue to emphasize that no one knows exactly what causes ADHD. There are just too many possibilities for now to be certain about the exact cause. Therefore, it is more important for the person affected and their family to search for ways to get the right help.

A common method for treating ADHD is the use of medications. Drugs known as stimulants seem to have been the most effective with both children and adults who have ADHD. The three which are most often prescribed are: methylphenidate (Ritalin), dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert). (Dommisse, 1984)

For many, these drugs dramatically reduce hyperactivity and improve their ability to focus, work, and learn. (Reid, 1997) Research done by the National Institute of Mental Health (NIMH) also suggests that medications such as these may help children with accompanying conduct disorders control their impulsive, destructive behaviors. Constrained academic condition and coding systems distinguish ADHD from normal and from non ADHD behavior problem children (Milich, Loney, & Landau, 1982) and demonstrate tremendous sensitivity to stimulant drug impacts (Barkley et al., 1988).

There are number of brain functions that can be adversely affected by the use of stimulant drugs. The amphetamines prescribed to treat ADHD can cause significant damage in numerous areas of the brain including the cerebral cortex, frontal lobes, limbic system, basal ganglia, temporal lobe, parietal lobes, cerebellum and reticular activating system. These parts of the brain help control many important functions such as: sensory perception, initiative, autonomy, reason, empathy, insight, regulation of emotions, memory, responsiveness, self awareness, regulation of muscle tone, posture, gait, and skilled coordination. Psychostimulant medications can cause neurological tics including Tourette’s syndrome, atrophy of some portions of the brain, psychosis, mania and depression.

Unfortunately, the brain is not the only part of the body that can be harmed by the use of amphetamines. The Physician’s Desk Reference lists numerous possible side effects that can occur while using Ritalin (methylphenidate hydrochloride), a psychostimulant drug frequently prescribed for the treatment of ADHD. These include, but are not limited to: skin rash, nausea, anorexia, dizziness, headache, high blood pressure, tachycardia, angina, cardiac arrhythmia and significant weight loss. Some studies even link the use of Ritalin to the development of liver cancer. Samuel S. Epstein, M.D. cancer expert has stated “There is no justification for prescribing Ritalin, even by highly qualified pediatricians and psychiatrists, unless parents have been explicitly informed of the drug’s cancer risks.

Otherwise, prescribing Ritalin constitutes inarguable medical malpractice.” The National Toxicology Program conducted a study on Ritalin in 1995. Adult mice were administered doses of the drug that were comparable in amount to the doses normally prescribed to children. After 2 years, the mice were tested and the study found that they “developed a statistically significant incidence of liver abnormalities and tumors, including highly aggressive rare cancers known as hepatoblastomas”. The National Toxicology Program then concluded that Ritalin is a “possible human carcinogen”. (Dugger, 2003)

Another very valid concern when considering treatment with amphetamines is their potential for abuse and addiction. The number of people–especially teenagers and young adults–abusing stimulant medications seems to be growing every day. A news release by the U.S. Drug Enforcement Agency, October 20, 1995, stated that Ritalin ranks in the top 10 most frequently reported controlled pharmaceuticals stolen from licensed handlers. The agency also states that organized drug trafficking groups in a number of states have utilized various schemes to obtain the drug for resale on the illicit market; and that this drug is abused by diverse segments of the population, from health care professions and children to street addicts.

Perhaps the most frightening piece of information in the report was the revelation that a “significant number of children and adolescents are diverting or abusing [their Ritalin] intended for the treatment of ADHD” and that “students are giving and selling their medication to classmates who are crushing and snorting the powder like cocaine. In March of 1995, two deaths in Mississippi and Virginia were associated with this activity.” If this medication did not have such powerful “extra effects”, it certainly would not be in such high demand on the “black market”. (Snider, 2002)

ADHD is a condition most likely based in an inefficiency and inadequacy of Dopamine and Norepinephrine hormone availability, typically occurring when a person with ADHD tries to concentrate. Ritalin improves the efficiency of the hormones Dopamine and Norepinephrine, increasing the resources for memory, focus, concentration and attention (Snider, 2002). Ritalin is the quickest of all oral ADHD stimulant medications in onset of action: it starts to achieve benefit in 20 – 30 minutes after administration, and is most effective during the upward ‘slope’ and peak serum levels. Ritalin’s effect is brief: Most people experience 2-3 hours of benefit, but after 3 hours, benefits drop off rapidly. Some individuals, especially children, may obtain 4 or even 5 hours of positive effect (Snider, 2002).

Ritalin is an effective treatment for people with ADHD. Because it allows them to filter out distractions and improve concentration, some schools and parents force Ritalin on children who may have nothing more than a severe case of childhood. At a popular church preschool, approximately 20 percent of children are on Ritalin. Even a Little League coach urged Ritalin for a 9-year-old catcher to improve his performance. Ritalin’s safety and efficacy is what has turned it into teachers’ and parents’ little helper. It solves, or in some cases masks, children’s behavioral problems (Moyer, 2003).

According to the book Twelve Effective Ways to Help Your ADD/ADHD Child by Laura J. Stevens, every child’s dietary needs are different, so individual prognoses are vital (Moyer, 2003). In some instances ADHD may not be the only problem. Hyperactive behavior could be due to “a blood sugar disturbance, mineral imbalance, toxic metals at the cellular level or other factors” (Greenfield, 1998)

One approach to ADHD is to deny it. Mainly conservative groups often times will not recognize ADHD as a legitimate disorder, and credit its symptoms to childhood, or more often, boyhood (Moyer, 2003). It is not seen as a chemical imbalance, or a neurological disorder, but simply as boredom, restlessness and a lack of parental control. They see ADHD as a “hoax” and medication simply as “the perfect way to explain the inattention, incompetence, and inability of adults to control their kids.” (Epstein, 2002)

While to some this may seem like a valid explanation, the truth of ADHD only become apparent when dealing with children who suffer from the disorder. People without such children have no idea what it’s like. There has been found the difference between boyish high spirits and pathological hyperactivity. These kids bounce off the walls. Their lives are chaos; their rooms are chaos. And nothing replaces the drugs. (McCleary, 2003)

Method

Through further studies, scientists are better understanding the nature of biological disorders. New research is allowing us to better understand how our minds and bodies work, along with new medicines and treatments that continue to be developed. Even though there is no immediate cure for ADHD, research continues to provide information, knowledge, and hope. The most frequent medications used to remedy ADHD are stimulants, which operate by stimulating the areas of the brain in charge of focus, attention, and desire. (Anderson, 2002) The use of stimulants to treat a syndrome often exemplified by hyperactivity is sometimes referred to as a paradoxical effect. The stimulants used include Methylphenidate, or Ritalin; Dextroamphetamine, or Dexedrine; and Adderall. (Zhang, 2001)

Adderall is actually an amphetamine salt that combines amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate, and dextroamphetamine sulfate. That makes adderall potentially highly addictive. Adderall is also used to treat attention deficit disorder and narcolepsy, and also increases attention and decreases restlessness in patients with ADD. Adderall was first prescribed during the 1970s as an appetite suppressant but is rarely used for that now.

Adderall is a manmade combination of the neutral salts dextroamphetamine and amphetamine while cocaine is an alkaloid found in coca leaves. (Willick, 1995) If one were to snort Adderall, it would be as if they were to take methamphetamine, a much more dangerous and addicting drug than coke. Methamphetamine causes heavy visual and auditory hallucinations, increased energy, increased paranoia, panic, anxiousness, aggressiveness, involuntary body movements, severe depression, false sense of confidence and the list goes on. (Mattay et. al. 1996) The idea of snorting Adderall seems quite innocent to some people is in fact very dangerous.

Autoreceptors modulate release of neurotransmitters by responding to the concentration of transmitter in the synapse. Agonists that selectively stimulate autoreceptors attenuate neurotransmitter release, whereas administration of autoreceptor antagonists augments release. Support for the concept of autoreceptor regulation of transmitter release is also provided by electrophysiological studies. Stimulation of the autoreceptor by agonists decreases the firing of the presynaptic neuron. Blockade of the autoreceptor by antagonists increases the firing of the presynaptic neuron.

Binding of the appropriate transmitter to the postsynaptic receptor alters the molecular configuration of the membrane and changes the permeability and subsequent excitability of the membrane. Whether a neurotransmitter produces excitation or inhibition of the postsynpatic neuron is a property of the particular postsynaptic neuron. Stimulation of the postsynaptic receptor may activate transsynaptic feedback mechanisms involving multiple neuronal units.

Stimulation of a transsynaptic feedback loop also may modulate the functioning of the presynaptic neuron by inhibiting the synthesis and release of the transmitter. The excitability of the postsynaptic neuron actually results from the summation of influences of neurotransmitters released from a large number of presynaptic endings that impinge upon the postsynaptic neuron. The model becomes still more complex if it takes into account recent evidence that suggests that neurons may release more than one transmitter.

Conclusion

Students find that their appetites are suppressed and or that they have difficulty in sleeping. If the stimulant dosage is too high the patient may experience feelings of nervousness, agitation, and anxiety, in rare cases, increased heart rate and high blood pressure can result with the use of stimulants, especially if the patient has an underlying predisposition toward hypertension. Ritalin is the most widely prescribed drug used to treat ADD in adolescents. Ritalin appears to work by stimulating the production of the neurotransmitter dopamine. The benefits of Ritalin include improved concentration and reduced distractibility and disorganization.

Dextroamphetamine is another stimulant medication that appears to have a slightly different pharmacological action than Ritalin. Both work to boost the amount of available dopamine. Dextroamphetamine, however, blocks the reuptake of the neurotransmitter while Ritalin increases its production.

All stimulants have the same set of side effects. Some patients complain of feeling nauseous or headachy at the outset of treatment, but find that these side effects pass within a few days. Others find that their appetites are suppressed and or that they have difficulty sleeping. If the stimulant dosage is too high the patient may experience feelings of nervousness, agitation, and anxiety. In rare cases, increased heart rate and high blood pressure can result with the use of stimulants, especially if the patient has an underlying predisposition toward hypertension.

People with ADHD are more liable to indulge themselves in stimulant medication as compared to those who do not have ADHD. People who do not have ADHD are not vulnerable to using psychostimulant medications. On the other hand, there are numerous causes why an individual involves in psychostimulant medications and another does not. No particular reason for addiction subsists; relatively, a permutation of aspects is generally implicated: family history, neurochemistry, genetic predisposition, trauma, life depressions and stress and other material and arousing problems contribute.

Therapy is a source of treatment for ADHD and is even more effective when combined with medication. It is important to work closely with a physician to find what is right for your child. For a lot of people stimulants lessen their impulsivity and hyperactivity and aid in their ability to focus and learn. Some examples of stimulants are Ritalin, metadate, focalin, methlin, concerta, dexedrine, adderall, cylert, pemoline, and clonidine. ADHD is a neurological disorder that should be taken very seriously and can be treated with the right medication. The majority of doctors say that it is caused by genetics although they are still research other possible causes. If a child has ADHD it is best to have him checked out while he is still young and the symptoms are easiest to diagnose.

Many of the drugs that are used as stimulants by Non ADHD individuals can trigger a lifestyle that many wish they didn’t have. It can lead to a life of drug abuse, physical abuse, or personal abuse. They will abuse their body when they think they are doing well towards it. Ritalin, and any other amphetamine, should be a last resort drug. Medication seems to be essential to healthy treatment, but works fully only when combined with behavioral interventions or modifications.

There appears to be some evidence for over-diagnosing ADHD, but overall, it appears that the treatments themselves indicate whether a child suffers from ADHD, or if some other prognosis is warranted. Research and study is being poured into updating the procedures and treatments used in handling ADHD in children, and improvements are being made annually. It seems that there are many useful steps to help parents and physicians approach ADHD and through careful research of treatment options, and the individual makeup of the child being assisted, ADHD can be controlled in the majority of its two million young, American sufferers today.

References

Anderson CM, Polcari A, Lowen SB, Renshaw PF, TeicherMH (2002): Effects of methylphenidate on functional magnetic resonance relaxometry of the cerebellar vermis in boys with ADHD. Am J Psychiatry 159:1322–1328.

Barkley, R. A., Fischer, M., Newby, R. F., & Breen, M. J. ( 1988 ). “Development of a multimethod clinical protocol for assessing stimulant drug response in children with attention deficit disorder”. Journal of Clinical Child Psychology, 17, 1424.

Dommisse CS, Schulz SC, Narasimhachari N, Blackard WG, Hamer RM (1984): The neuroendocrine and behavioral response to dextroamphetamine in normal individuals. Biol Psychiatry 19:1305–1315.

Drevets WC, Price JC, Kupfer DJ, Kinahan PE, Lopresti B, Holt D, Mathis C (1999): PET measures of amphetamine-induced dopamine release in ventral versus dorsal striatum. Neuropsychopharmacology 21:694 –709.

Dugger, D. (2003). Geographic variation in the prevalence of stimulant medications use among children 5 to 14 years old: results from a commercially insured US sample. Pediatrics, 237.

Epstein, Samuel, MD. Health Freedom News, Vol. 20, no. 1. 2002.

Greenfield, Susan A. The Human Brain: A Guided Tour. Basic Books, 1998.

Mattay VS, Berman KF, Ostrem JL, Esposito G, Van Horn JD, Bigelow LB, Weinberger DR (1996): Dextroamphetamine enhances “neural network-specific” physiological signals: a positron-emission tomography rCBF study. J Neurosci 16: 4816–22.

McCleary, L. (2003). Parenting Adolescents with attention deficit hyperactivity disorder: analysis of the literature for social work practice: Health and Social Work, 285.

Milich, R., Loney, J., & Landau, S. ( 1982 ). “The independent dimensions of hyperactivity and aggression: A validation with playroom observation data”. Journal of Abnormal Psychology, 91, 183-198.

Moyer, P. (2003). Will or pill? Kids and parents see ADHD improvement differently. Psychology Today, 18.

Purdie, Nola; Hattie, John; Carroll, Annmarie; A Review of the Research on Interventions for ADD, Review of Educational Research, 2002, Vol. 72 Issue 1, p. 61-99.

Reid MS, Hsu K, Berger SP (1997): Cocaine and amphetamine preferentially stimulate glutamate release in the limbic system: Studies on the involvement of dopamine. Synapse 27: 95–105.

Searight, H. Russell, Adolescent ADD: Evaluation and Treatment in Family Medicine, American Family Physician, 0002838Z, 2000, Vol. 62, Issue 9.

Snider, V. E. Busch, T. Arrowood, L. (2002): Teacher Knowledge of Stimulant Medication and ADHD: Journal of Learning Disabilities, 144-147.

Taylor, E. (1994). Syndromes of attention deficit and over activity. In M. Rutter, E. Taylor and L. Hersov (eds), Child and Adolescent Psychiatry: Modern Approaches (third edition, pp. 285-307). Oxford: Blackwell.

Wender, P. (1997). The Hyperactive Child and Adolescent: Attention Deficit Disorder Through the Lifespan. New York: Oxford University Press.

Wilens, T.E. et al. “Attention Deficit/Hyperactivity Disorder Across the Lifespan,” Annual Review of Medicine (2002): Vol. 53, pp. 113-31.

Willick ML, Kokkinidis L (1995): Cocaine enhances the expression of fear-potentiated startle: evaluation of state-dependent extinction and the shock-sensitization of acoustic startle. Behav Neurosci 109: 929–38.

Zhang J, Xu M (2001): Toward a molecular understanding of psychostimulant actions using genetically engineered dopamine receptor knockout mice as model systems. J Addict Dis 20:7–18.