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REPORT TO THE PLENARY SESSION OF THE NIH CONSENSUS CONFERENCE
ON ADHD AND ITS TREATMENT November 18, 1998 presentation by Peter R. Breggin, M.D. Read the full text at: http://www.breggin.com/RitalinNIHSPEECH.html The points I will make today draw largely on published controlled clinical trials. The points are documented with dozens of citations to the literature in my scientific paper. First, the psychostimulants have a dramatic and often irreversible impact on the brain. I asked NIH to deliver to the panel copies of a series of recent scientific papers confirming that two of the clinically used stimulants, amphetamine and methamphetamine, cause permanent, irreversible damage to the brain in the form of biochemical dysfunction, neurotransmitter receptor loss, and brain cell death. The data on methylphenidate indicates similar short-term effects but the research is too sparse and inconclusive on methylphenidate's long-term irreversibility. Potentially neurotoxic drugs should be contraindicated during childhood. Second, even in carefully controlled clinical trials, 8 of which are reviewed in my paper, we know that serious ADRs--adverse drug reactions--occur at least at the rate of 8%. Furthermore, careful examinations of the children reveal ADRs in more than half of them. Looking only at the production of drug-induced obsessive-compulsive reactions, the most careful study from NIH shows a rate of 51% with several very severe reactions. Third, we now know from animal studies that psychostimulants cause a persistent and probably at times irreversible weakening of heart muscle. A dozen or more cases of cardiac arrest have been reported to the FDA due to methylphenidate but these acute crises may have been caused by drug-induced arrhythmias perhaps in combination with hypertension. The weakening of heart muscle probable presents an as yet unstudied longer-term risk. Fourth, psychostimulants inhibit growth, causing abnormally accelerated rebound growth when and if they are stopped. As demonstrated in a large body of literature, this suppression of growth takes place as a result of the disruption of growth hormone cycles. Perhaps unlike appetite suppression--which the drugs also cause--growth hormone disruption will impair the growth of all the organs of the body, including the brain. Since many children remain on methylphenidate throughout the year and for many years at a time, it can no longer be hoped that they will recover their growth during drug holidays. Furthermore, it must emphasized that the accelerated growth during rebound is itself abnormal. Rebound by no means indicates that normal structure and function of bodily organs has been achieved. The potentially negative effects of drug-induced cycles of growth suppression and rebound are beyond our current scientific appreciation but should be of grave concern. Considering the complex structure of the brain and the formative changes occurring in the brain throughout childhood--it is obviously hazardous to suppress growth while bathing the child's brain environment in toxic psychostimulants. In sound medical practice, a drug that causes growth suppression should be contraindicated for children. Fifth, psychostimulants commonly cause a wide variety of psychiatric symptoms, including apathy and depression, obsessive/compulsive disorder, insomnia, agitation, and in the extreme, mania. As the drug wears off between doses, behavior commonly rebounds to a more extreme level of hyperactivity than before taking the drug. Practitioners are frequently unaware of the broad spectrum of CNS adverse reactions, including rebound, withdrawal, and dependence. As a result, many children who take psychostimulants are mistakenly diagnosed with new psychiatric disorders and subjected to additional medication. Frequently they are given antidepressants, antianxiety drugs, sedatives, and even neuroleptics, lately risperidone, when they really need to be withdrawn from psychostimulants. Sixth, a vast number of experimental animal studies--combined with clinical studies of children--demonstrate the mechanism of action of psychostimulants: how they work to control behavior. The drugs make animals--and children--seem better through three closely related toxic mechanisms: (1) Psychostimulants reduce the animal or child's spontaneous, self-generated, autonomous behavior, including socialization. This produces docility, passivity, social isolation and, in the extreme, robotic or zombie-like conformity. Lest the zombie-effect seem like an exaggeration, Drs. Arnold and Jensen in their Comprehensive Textbook of Psychiatry chapter refer to the zombie effect no less than three times. (2) Psychostimulants enforce obsessive-compulsive or perseverative behavior in the animal or child. This produces abnormal concentration or persistence at otherwise boring or frustrating tasks that the child ordinarily avoids or resists. (3) Psychostimulants reduce the animal or child's capacity to respond to nearby distractions, from loud noises and movements to the presence of other people. This makes the child seemingly "less distractible" but in fact the child suffers from drug-induced impairments in awareness and responsiveness to the environment. In effect, the child is made more isolated. In short, the psychostimulants suppress basic spontaneity and sociability while enforcing obsessive behaviors and cutting off the animal or child from external stimuli. These drug-induced impairments, taken together, can produce a docile caged animal who busies itself with obsessive behaviors. These drug-induced adverse effects also make children much easier to manage. This is especially true in structured settings that impose on the child social isolation and boring or frustrating tasks. Psychostimulants allow adults to control children without attending to their genuine basic needs for play and exercise, rational discipline, unconditional love, and in school--engaging, individualized, and developmentally appropriate education. Ritalin & Suicide (affidavit) |
For more information on ADHD contact CHADD (www.chadd.org), a National non-profit organization, at 8181 Professional Place, Suite 201, Landover, Maryland 20785, Tel: (301) 306-7070 (800) 233-4050
Note: "In 1995... an investigative report by journalist J. Merrow aired on PBS which exposed new information on the group. Since 1988 Ciba-Geigy had quietly been giving CH.A.D.D. almost $1 million in grants and services..." (afn.org/~iguana/archives/1997_05/19970503.html)