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So just how safe is Ritalin? Is
there really a risk?
The millions of people who take
it and other types of stimulant medicines for attention disorders are
likely to ask those kinds of questions for months after a federal
advisory committee recommended Thursday the strongest warning labels be
put on the prescription drugs.
The Food and Drug Administration
had asked the committee to study the drugs following reports of 25
sudden deaths of people taking the stimulants. One may have been
14-year-old Matthew Smith of Clawson.
He died of a heart attack in
2000, collapsing after skateboarding in his aunt's basement. He had
taken Ritalin for eight years.
Oakland County Medical Examiner
Dr. Ljubisa Dragovic, who favors strong warning labels on the drugs,
reported Smith's death to the FDA in 2000. The autopsy found enlarged
heart vessels from longtime stimulant use, Dragovic said.
"Parents and schools should be
aware of these risks," Dragovic said Friday in a telephone interview.
Kelly and Lawrence Smith,
Matthew's parents, have spent the last five years lobbying for stronger
warning labels. The Web site for their National Alliance Against
Mandated Mental Health Screening and Psychiatric Drugging of Children,
www.ritalindeath.com, gets 2,000 visitors a day and has had over four
million visitors, Lawrence Smith said Friday.
"Now all these kids are dying ...
and they still continue to push it," he said. "It's just money, it's all
about the money."
Last year, there were $3.6
billion in sales for attention disorder drugs, according to industry
figures.
Safe for many users
Within psychiatry, the drugs are
viewed as widely safe and effective for as many as 70% of those who take
them, experts say. They help reduce hyperactivity, the hallmark symptom
of Attention-Deficit/Hyperactivity Disorder, and disorganization and
inattentiveness, common symptoms of Attention Deficit Disorder. Possible
side effects include sleep loss, appetite loss and dry mouth, and
sometimes, increased heart rate, though symptoms often wane after
continued use.
They've always generated
controversy, in part because so many people take the drugs -- 2.5
million children and 1.5 million adults.
"I've used these drugs with
thousands of people over the years and I'm unconvinced there's any
reason to be fearful," said Dr. Joel Young, a Rochester Hills
psychiatrist who fielded 10 phone calls by noon Friday from people
asking about the recommendation. A consultant to several stimulant
manufacturers, Young is respected in the area by patients and advocacy
groups.
Dr. David Rosenberg, a professor
of child psychiatry and psychology at the Wayne State University School
of Medicine and Children's Hospital of Michigan in Detroit, called the
drugs some of the safest in medicine. Still, he's happy the news will
call attention to the need for a precise diagnosis and proper evaluation
of a person before drugs are prescribed.
"Not every child who is
hyperactive or who is bored in class" has an attention deficit problem,
he said. "Most don't." Still, most children with the problem are never
diagnosed, he added.
Novartis Pharmaceuticals
Corporation of East Hanover, N.J., which makes Ritalin, released a
statement Friday.
"Based on our review of our
global safety database over 50 years, there does not appear to be an
increase in cardiovascular events ... when viewed in the context of the
expected rates in the general population. We recognize that these are
complex issues and will work with the FDA to do what is in the best
interest of patients with ADHD."
Concerns about side effects, as
well as reticence to take any drug, deter people from getting help,
doctors and ADD experts say. One was Bob Bunnell, 35, a Royal Oak events
producer.
"I really didn't want to take a
pill," he said.
Four years ago, after a relative
told him how much she was helped by a stimulant, he went to Young and
agreed to try a drug for his ADD. "The main thing it's done for me is
give me a consistent level of energy."
He plans to continue taking the
drug.
Other solutions
Drugs aren't the only way to
address attention disorders, but Rosenberg pointed out that comparison
studies showed no improvement in key symptoms in people who received
counseling alone.
Another medicine, Strattera, is a
non-stimulant. But it works best for people who have both anxiety and
attention problems, Rosenberg and Young said.
Others turn to organizational
experts and coaches like Terry Matlen, a Birmingham mother with ADD. Her
Web site,
www.addconsults.com and her book, "Survival Tips for Women with
AD/HD: Beyond Piles, Palms & Post-Its" (Specialty Press, Inc., $17.95)
offer advice for people whose brains are wired a little differently.
"I think most of these strategies
are an adjunct to medications," she said.
Linda O'Brien of Sterling Heights
has sons, 21 and 14, who both have taken Ritalin since age 4. Without
the drug, they struggle to socialize, concentrate or keep still.
"My younger son has very, very
poor short-term memory; you tell him to do something and he'll take
three to four steps and forget," she said.
She expects her sons to use
Ritalin indefinitely even if the strongest warning is added.
"The good far outweighs the
risk," O'Brien said. "Without it, for a lot of kids there's the risk of
dropping out, jail, continued failure as an adult, even suicide."
Contact PATRICIA ANSTETT
at 313-222-5021 or
anstett@freepress.com.
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