It is with some real concern that once again we enter a phase where a therapeutic class shows all the promise of being well tolerated, non addictive, non carcinogenic bla-de-blah, while in fact we are going forward with yet another on-going drug trial for the antagonist medications now the first line approach to treating ADHD.
There are a good number of biochemical and population-genetic arguments and of course presidents from Thalidomide to Valium but what about the ethics of long term prescribing in ADHD ?
My point of view is that psychiatrists now have a new, powerful tool.... to go and conduct a 20 year drug trial with. Ritalin and the other preparations are now established as very successful treatments for many with classical symptoms of ADHD or ADD. However the treatment is not like an anitbiotic: you do not get better from a course of it, you are on it indefinetly.
With any drug on "chronic management of xx disease", physicians are conducting a wider scale trial: it probably kills less people than those who would continue with ADHD/ADD would, including suicides. That we know from the ADEMTOX and full phase clinical trials. What we dont know is the very long term effects from management over many years or decades.
Another issue is that the medication over stimulates a central neural pathway, and we may miss the needle in the haystack by burning the whole barn down. The accurate ætiology of ADHD/ADD is not fully established by any means, nor is that for non-reactive depression for a very good parallel example to take.
It could be like this analogy;: the car over heats because it leaks water, but instead of finding the leak in the radiator, we come upon using a bigger water pump and have a header tank to feed the system. In fact we then treat the whole system and get the desired "cure" while actually walking over the root-cause of the disease.
Currently from what clinicians say, Ritalin and the other preparations are in fact in an area of prescribing where it is UNETHICAL not to utilise them when clear signs and symptoms of ADHD/ADD present.
The problem is that the alternatives are a bit lame: dietry alterations work, but not as comprehensively as the drugs; exercise and comprehensive regimes work, but take time and investment which can be disproportionate to benefit and affect the economic activity of the subjects enough to make them inpractial; psychological and cognitive approaches, once again more vairable results and also there is far lower compliance in self "medicating" to these regimes over longer time.
So pill-popping it is then for the time being, being the best treatment based on the best biological information avaialb....to drug comapnies 10-15 years ago.
I think we are still missing the point;: Why ADHD ?