All drugs cause harm (we just hope the benefits outweigh the risks)
The choice is yours, but wait until you have ALL the facts.
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Navigating the world of medical treatment is no easy task.
Big Pharma buries research that doesn’t paint their products in a positive light. And they create marketing that distorts the truth.
It's so common that there’s a name for it: Publication bias.
Publication bias leads to an overestimation of a drug's effectiveness. This impacts clinical decision-making.
Your average doctor has little knowledge of ADHD medications and their risks. Publication bias is (partly) responsible.
A study by Naci et al. (2015) titled "Industry sponsorship bias in research findings: A network meta-analysis of ADHD treatment in children," found that industry-funded studies were more likely to report favourable results compared to non-industry-funded studies. The authors suggest that the relationship between industry sponsorship and favourable results may be due to selective reporting or publication bias.
A study, in The New England Journal of Medicine, on anti-depressants went further, finding – via FDA registration records for antidepressant drugs – that the majority of trials with negative or questionable results were either not published or were published in a way that presented the results as positive.
Hundreds of similar studies prove that the pharmaceutical industry bullshit you, me, and most concerning, our doctors and healthcare experts into believing drugs are safe, without giving us the full picture.
Ben Goldacre wrote an entire book on it called Bad Pharma — worth a read, but not for the faint of heart.
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Back in 2016, after suffering 5 major seizures, I decided to learn how to read scientific research studies. My ADHD brain made it hard. But it was worth the effort.
I now wince when someone sends me standalone studies that “prove” one thing or another.
Let’s put a solid line in the sand now.
Single standalone studies DO NOT prove anything.
When one study is conducted it must be repeated again and again and again to ensure the first and second and third studies had reliable findings. Most studies don’t. Especially in psychology where 8/10 studies NEVER replicate.
Just because it’s labelled science doesn’t mean it’s true, trustworthy, or hasn’t been manipulated by those with financial interests.
The only studies we can trust are called Meta-analysis or Systematic Review. They collate all studies on a specific subject, put all the data together, and analyse that data to find the truth.
But, in a field like ADHD, even they cannot give you 100% rock-solid truth. This is not physics.
If I ever mention a study, I make sure it’s both a meta-analysis AND massive. Meaning it has the most amount of data possible. More data, across as many studies as possible, means we can iron out the bullshit.
It’s the wild west out there.
Where does that leave us, the people with ADHD trying to find the best way to manage our condition?
I’ll now explore informed consent and seek a better understanding of how to make ethical and well-informed decisions about taking (or not taking) medication to treat our ADHD.
What is informed consent and why does it matter?
Imagine you're hosting a dinner party, and one of your guests is allergic to peanuts. Before serving a dish containing peanuts, you'd make sure to inform them about the ingredients and ask for their consent to serve it.
Informed consent is the process of providing essential information and seeking approval, so people can make well-informed decisions about their own well-being.
Informed consent requires you to obtain permission from someone before involving them in a particular activity, typically in the context of research or medical procedures.
It is a fundamental ethical principle that ensures individuals are well-informed about the potential risks and benefits, and voluntarily agree to participate.
Think back to when you or your kid was diagnosed with ADHD. Do you feel you were adequately informed about all risks of the medication?
Therapeutic and Harmful Effects of ADHD Medications:
ADHD medications, such as stimulants (e.g., methylphenidate and amphetamines) and non-stimulants (e.g., atomoxetine and guanfacine), are designed to help manage the core symptoms of ADHD.
They work by affecting certain neurotransmitters, such as dopamine and norepinephrine, which are involved in attention and impulse control.
While these medications can significantly improve the quality of life for individuals with ADHD, they also have side effects. Common side effects of stimulant medications include appetite suppression, insomnia, irritability, and increased heart rate.
Non-stimulant medications may cause side effects such as drowsiness, upset stomach, and dizziness. In some cases, more severe side effects, such as elevated blood pressure, heart problems, or psychiatric symptoms, may occur.
Some doctors even recommend regular heart and blood pressure checkups for people using ADHD medications.
The severity and occurrence of side effects can vary among individuals, depending on factors like dosage, the specific medication used, and the individual's genetic makeup.
The point is this: we should be supplied with ALL the facts. And then we should be given the chance to decide if the risks of a medication are worth the benefits.
All drugs cause harm, we just hope the benefits outweigh the risks
When prescribing ADHD medications, healthcare professionals must weigh the potential benefits against the possible risks associated with their use. This process, known as a risk-benefit analysis, is essential for determining the most appropriate treatment plan for an individual with ADHD.
In conducting a risk-benefit analysis, healthcare professionals consider factors such as the severity of the individual's ADHD symptoms, the impact of those symptoms on daily functioning, the likelihood and severity of side effects, and the availability of alternative treatments (e.g., behavioural therapy).
For example, if an individual with ADHD is struggling significantly with daily tasks and is not responding well to behavioural interventions, the potential benefits of medication may outweigh the risks associated with side effects.
On the other hand, if an individual has only mild ADHD symptoms and experiences severe side effects from medication, the risk-benefit analysis might indicate that alternative treatments should be pursued.
But it’s not a hard rule. It’s a spectrum (like ADHD). And we need to be given ALL the correct information AND have self-awareness about how ADHD affects our lives before making a decision.
Ultimately, the decision is yours. But do you have ALL of the important information?
Now let’s look at some research on the efficacy of ADHD medication.
The Multimodal Treatment Study of Children with ADHD (MTA Study) is a well-known study on the efficacy of ADHD medication.
It’s quoted wildly in ADHD circles.
This large-scale, longitudinal study was conducted by the National Institute of Mental Health (NIMH) and is one of the most influential studies on the long-term effectiveness of ADHD medications. The MTA Study compared four treatment groups: medication management, behavioural treatment, combined medication and behavioural treatment, and community care (treatment as usual).
The study initially showed that medication alone or in combination with behavioural treatment was more effective than behavioural treatment alone or community care in managing ADHD symptoms.
Ok, this study shows that ADHD medication is better than anything other treatment, right?
And you thought everything I wrote about was against medication.
I’m not against ADHD medication for shits and giggles. I’m against it based on data.
And the data in this study has one fatal flaw — it only ran for 14 months.
Thankfully, there are two follow-up studies. Although you rarely hear about them in those ADHD circles (I wonder why?).
The follow-up studies at 3 years (Jensen et al., 2007) and 8 years (Molina et al., 2009) found that the initial advantages of medication over other treatments had dissipated over time.
By the 3-year follow-up, there were no significant differences in ADHD symptom outcomes between the four treatment groups.
This is a prime example of publication bias.
Big Pharma, and the doctors in Big Pharma’s pocket, don’t want you to see the truth of long-term ADHD meds use, so they do everything they can to hide it.
We’re on our own here people.
If drugs don’t work long-term, what does?
This meta-analysis examined the long-term effectiveness of psychological interventions for children and adolescents with ADHD.
The researchers found that over time, psychological interventions, such as behavioural therapy and parent training, showed sustained improvements in ADHD symptoms, while medication effects tended to decrease.
These studies, along with others, suggest that while ADHD medications can be effective in the short term, their long-term effectiveness may not be significantly better than alternative treatments, such as behavioural interventions. This evidence emphasises the importance of considering the potential long-term ineffectiveness and side effects of ADHD medications when making treatment decisions.
When you combine this with the enormous, 20-year study in Utah, on ADHD medications that found prolonged use of prescribed stimulants could lead to as much as an 8.6x increase in the change of Basal Ganglia disease, including Parkinson’s and seizures (like I suffered), the argument for ADHD meds is looking flakey at best.
This is an enormous amount of data.
Yet there are people out there still spouting nonsense that these drugs are safe and effective to use over the long-term.
I’m often accused of creating medication hesitancy.
What I’m actually doing is looking at the truth. Not burying my head in the sand and trying to force the narrative towards one that suits me personally.
I’m also saddened by the lack of empathy in the people who fail to realise that by uncovering the truth on ADHD medications, we’re giving the people who continue to take meds, in spite of their effectiveness, a way out – people who are stigmatised by those who say I’m creating hesitancy.
In the end we return to informed consent. Which I boil down into this short sentence: all drugs cause harm, we just hope the benefits outweigh the negatives.
You’ve seen the research. Now it’s up to you to make a personal choice. Not me, not the vocal majority on social media, and definitely not your doctor.