Magazine article Clinical Psychiatry News

ADHD Stimulants: No Link to Propensity for Later Drug Abuse

Magazine article Clinical Psychiatry News

ADHD Stimulants: No Link to Propensity for Later Drug Abuse

Article excerpt

YOSEMITE, CALIF. -- Will my child become a dope fiend?

That's a common question Robert S. McKelvey, M.D., fields from parents of children who are prescribed a class II stimulant for attention-deficit hyperactivity disorder (ADHD).

"The answer is 'no,' "Dr. McKelvey said at a pediatric conference sponsored by Symposia Medicus. "The risk of kids who have properly diagnosed ADHD taking stimulants and becoming dope fiends is no different than [it is for] kids who do not have ADHD. The kids at risk are those who have ADHD" and are not on a prescribed drug treatment. "They have three times the likelihood of developing substance abuse problems," he said.

Nonstimulant medications are an option for antisocial teens with ADHD, "although, at least in my view, they're not as effective as stimulants," noted Dr. McKelvey, director of child and adolescent psychiatry at Oregon Health and Science University, Portland. Nonstimulant choices include atomoxetine, bupropion, clonidine, guanfacine, and the tricyclic antidepressants imipramine and nortriptyline.

Another question he commonly fields from parents is the effect of stimulants on children who have a chronic tic disorder such as Tourette's syndrome. "When I was in training, if you had tics, you had a history of tics, or even a family history of tics, we didn't start you on stimulant medication," he said. "Now there are a couple of studies that show that if you have tics and you take stimulants, it's probably OK as long as the tics don't worsen. In many cases, the tics seem to [decrease in severity]."

Drug preparations in the stimulant class are derived from methylphenidate or dextroamphetamine. Methylphenidate is more widely used in the United States, but Dr. McKelvey noted that both agents are equally effective.

"You can't yet predict response, but it's possible that pharmacogenetics studies will give us a hand on that," he said. …

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