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Monday, April 24, 2017

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Are ADHD Stimulant Drugs Bad for your Heart

Potential Cardiovascular Risks of ADHD Medications

Given the rapid rise in prescription stimulant medications for ADHD, potential concerns surrounding the side effects of these medications has been a hot topic of recent interest. News alerts like to mention the potential dangers of these drugs, and "natural health" websites are often even quicker to point out these flaws (often to the point of exaggeration).

While it is a medical fact that stimulant medications do carry certain health risks, I believe that the big question we should be asking ourselves surrounding this issue is not whether amphetamine or amphetamine-like medications are dangerous for us, but rather how can we minimize these negative effects of these substances and keep their usage as safe as possible? After all, untreated ADHD can cause enough problems in and of itself (I will describe some of these lesser known consequences in a later post).

There was a relatively recent article (2006) in the New England Journal of Medicine titled ADHD Drugs and Cardiovascular Risk sought to investigate the overall safety of these stimulant medications for treating ADHD. This article was in the Perspective section of the journal, meaning that this was an opinionated piece. We should always be careful about drawing conclusions based on opinionated sources, but I believe that the author, Steven E. Nissen of the Cardiovascular Medicine division of the Cleveland Clinic and member of the FDA Advisory Committee on ADHD drugs, makes some very important points that are at least worth mentioning.

Some of the key points of the article are summarized as follows:

The administration of mixed amphetamines (Adderall) and the amphetamine-like compound methylphenidate (Ritalin, Concerta) both raised systolic blood pressure (the higher number) by about 5 mm Hg. Based on other reviews, elevated blood pressure, even of this magnitude can pose as a major cardiovascular threat.

Taking medications of this class (called sympathomimetic agents) results in a long-term increase in heart rate at potentially dangerous levels.

Several drugs which are chemically similar to ADHD stimulant medications have been either pulled from the market or are subject to strong medical lobbying efforts for removal. Drugs such as ephedra and phenylpropanolamine (PPA) are both chemically similar to ADHD stimulants and have similar overlapping modes of action. Ephedra has been linked to the deaths of several professional and amateur athletes and a warning has been issued surrounding PPA and increased risks of hemorrhaging and stroke.

The Adverse Event Reporting System (AERS), which is a database used by the FDA to detect potential risks surrounding medications and other treatments, turned up multiple reports of sudden deaths associated with ADHD stimulant drugs, several which involved individuals with pre-existing cardiovascular defects and conditions. Additionally, a significant number of non-fatal heart difficulties such as heart attacks, irregular heart beats and stroke were observed.

Many of these reports were "without proper documentation", so the FDA could not make any definitive conclusions from this data. Based on this bloggers opinion, the phrase "without proper documentation" could refer to either data which is not complete to the point of being statistically significant to warrant further action, or information that was disregarded due to minor "technicalities" intrinsic to a bureacratic system. It is neither my place nor my intention to villainize the FDA, but it is important to at least consider this information and keep it tucked away in the backs of our heads.

If the information and conclusions of the article appear bleak to you, that is because they are. Nevertheless, it is important to note that this is one persons opinion, which, although echoed by many, is by no means unanimous. Having said that, I believe that the following steps should be taken for anyone considering stimulant medications for ADHD or a related disorder:

A thorough screen of both an individuals background and their family history should be done before starting any type of ADHD stimulant medication.
Numerical measurements such as blood pressure and heart rates should be taken frequently and passed on to the individuals physician. Keep in mind that even moderate increases in either of these can pose serious cardiovascular risks over time.
For individuals with pre-existing heart problems, these medications should only be taken in cases of severe levels of ADHD (where the risks of non-treatment would be potentially more injurious to the individual than the elevated cardiovascular risks associated with these drugs).
Even minor changes and symptoms need to be reported immediately and communicated to a supervising physician.

I believe that, in spite of the information presented in this, as well as other articles, ADHD medications can still be administered safely. However, I also believe that a more stringent set of conditions should be met, especially with regards to an individuals overall cardiovascular health. For those who believe that they fall into the "cardiovascular risk" category, I will soon be outlining some useful strategies to help reduce the potential risks and improve the overall safety of these ADHD medications.

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Bad Science Emergency Chat Thread

Shit, so Ben at Bad Science is having problem with his site - as we continue to not help him out fiscally (bad us). Still if it helps anyone from the forum, please feel free to use this thread as a chat thread till we get the forum back - or at least a more suitable alternative. It allows anon comments so your shouldnt have problems.

Ill keep this post updated with whats happening - or wherever else we may have gone (if somewhere more suitable is found).

EDIT: Incase the site goes down again heres the update on the status of badscience.net

Forum temporarily disabled, bandwidth exceeded, website dying, er, “help?”

July 3rd, 2007 by Ben Goldacre in bad science |

Sorry about the very long outage, my host suddenly and without any announcement simply pulled the plug on all CGI (geek stuff) because I was apparently putting too great a strain on their servers, and I’ve had to switch the forum off (at the very least) until I get it sorted. It turns out that I was the hog making everything run slowly: who’d have thought? This blog is back online but only on borrowed time now I’m afraid, to give me a chance to upgrade to Wordpress 2.2.1 and see if that will help reduce the CGI load for a bit. I’ve barely got time to do even that right now.

If anyone could offer help that would be amazing, I need to upgrade Wordpress and phpBB. I really can’t pay for web skills at the moment - must start vitamin pill company instead of giving talks for free in schools and losing train ticket receipts - but I can give love, kudos/publicity, and I know some pretty girls. Might be better to email instead of posting below as the site will probably go down again soon, maybe for quite a while, so ben@badscience.net is the best.

Also unfortunately - with the best will in the world - I guess I maybe now ought to move to a bigger host to speed everything up, and most importantly remove any chance of this kind of thing happening again (the hours wasted already…) so it would be good to get opinions on what hosting can handle a min of 12,000 visitors a day to a mySQL intensive Wordpress and phpBB installation, and run really quickly? Ideally somewhere a step up from my current ten dollar arrangement but a bit short of the proper big money for a dedicated server?

Anyway thanks and sorry for the outage, hopefully going to sort it all out for good this time. Thank god nobody ever goes here or here eh. Look ma, no adverts. No evil drug company funding. Just a broken website. Looks like the web2.0 cashless volunteer ideas economy may not work if you lack time and 3L33t webskillz.

Sticks in my throat. “Help.” Can’t someone please just become my best mate and hold my hand for the web stuff? I really love this website being here, but I just can’t spend hours sorting it out at the moment.

Want to help?
Buy some merchandise
Buy Amazon stuff through here for Badscience to get 5% of the cost.
(Ive just checked the paypal donation button doesnt like being hotlinked to - so youll have to go to the site to make a direct donatation).

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5.7/10IMDb24%Rotten Tomatoes38%Metacritic

Fueled by cheap whiskey, greed and hatred, Willie Soke (Billy Bob Thornton) teams up with his angry little sidekick, Marcus, to knock off a Chicago charity on Christmas Eve. Along for the ride is chubby and cheery Thurman Merman, a 250-pound ray of sunshine who brings out Willies sliver of humanity. Mommy issues arise when the pair are joined by Willies horror story of a mother, Sunny Soke, who raises the bar for the gangs ambitions, while somehow lowering the standards of criminal behavior.

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Casting In Movie -: Sean Astin, Gina Gershon, Sammi Hanratty | See full cast & crew »
Released -: 13 January 2017 (USA)
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Plot: DETENTION SUCKS BUT ITS KILLER FUN: Its four years later, and a new group of students has been placed in Saturday detention at the infamous and prestigious Crestview Academy. When Siouxsie, sophomore undercrust, crashes the party to avenge her sisters death, a Saturday detention reserved for the privileged seniors of Crestview Academy turns into a date in hell. Its not long before a naïve pussycat lover, gay drug dealer, smokin hot preachers daughter, squeaky-clean senators son, and the uninvited younger outsider find themselves locked-up in school with no way out, wondering who (or what) has set them up. Hilarity and suspense ensue while each bad kid pits one against the other, and one by one each falls victim to absurdly gruesome accidents while trying to escape. (Based on the best-selling graphic novel sequel Bad Kids Go 2 Hell.)

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In this new comedy from the grateful husbands and devoted fathers who wrote The Hangover, Amy has a seemingly perfect life--a great marriage, over-achieving kids, beautiful home and a career. However shes over-worked, over-committed and exhausted to the point that shes about to snap. Fed up, she joins forces with two other over-stressed moms on a quest to liberate themselves from conventional responsibilities--going on a wild, un-mom-like binge of long overdue freedom, fun and self-indulgence--putting them on a collision course with PTA Queen Bee Gwendolyn and her clique of devoted perfect moms.

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It seems like my school is teeming with student-athletes and just about anything is considered a sport in this joint. Ive become accustomed to notification from the athletics department about whos going to be absent and requests to be as accomodating as I can, and Ive heard from students that Im more sympathetic to the plights of student athletes than most.

That was then, and this is now.

A couple weeks back that all went to crap when one of my student-athletes lied to me about missing class for a badminton tournament. He asked to make up the in-class assignment, and I told him Id check with the athletics office because I hadnt heard about the badminton tournament. Well, when I checked, the coordinator told me that there werent any excused absences for the badminton team that day. I emailed the student her reply, and suggested he have his coach talk to me if there was some sort of error. I heard nothing, until today.

Today, when he emailed me about his grade thats stuck somewhere between a B+ and an A-. Today, when he who lied to me and I probably could have pursued it as academic dihonesty, told me that it wasnt fair because I hadnt offered enough opportunities for him to make up the work he missed (I dropped the three scores, but he wanted more). Today, when he played the poor-pitiful-student-athlete card. Today, when the semester is already over and all that remains is his final exam.

I am afraid that my view of student athletes is eternally tarnished - all because of the one bad-minton player.

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