The “Logic” of Researchers in ADHD

 

About 15-20 years ago or so, when I was still Director of Psychiatric Residency Training at the University of Tennessee Medical School, I went to a grand rounds (a teaching conference involving the whole department) to hear a talk by a doctor about adult ADHD. It turned out to be more of a drug commercial for some or other stimulant the sponsor of the talk was selling.

The guy basically said that this pseudo-diagnosis was in fact incredibly common – up to 14% of the adult population – and all of them should be taking significant doses of one of the most dangerous and addictive class of drugs that are available by prescription – classified by the FDA in the same category of abuse potential as opiates like morphine. Wow.

During the Q&A at the end of the talk, the subject of ADHD in children came up. Someone asked him why so many kids diagnosed with the disorder could go to a video game arcade (which had at the time only recently gone the way of the dinosaurs) and concentrate with tremendous focus on the game they were playing despite all sorts of buzzers and bells going off, flashing lights everywhere, and scores of people milling all around talking to each other. The speaker opined that this was “not concentration.” I’ve heard that sentiment many times before and since from Pharma shills. Well if it isn't concentration, I wondered, then WFT is it?

Another skeptic in the audience from child psychiatry asked him about the high incidence of alcoholism in the parents of ADHD patients. His response: “If you had a kid like that, you’d probably drink too!” Oh, I see. Alcoholism is caused by having rambunctious children.

I should have gotten up and cussed the dude out for saying heinous stuff like this, but my boss in the department might have frowned on it.

All this reminds me of another talk I once heard from someone from the National Institute for Drug Abuse during an outside medical meeting. He was going on and on about how cocaine, another stimulant BTW, depletes a chemical in the brain called Dopamine, which makes it nearly impossible for abusers to enjoy anything but the drug. Someone (again, not me) got up and asked, “But aren’t we doing that when we prescribe stimulants to our kids?” The speaker’s answer, “But the drugs work so well.”

So I’m guessing that the answer to the question that was actually asked, which the speaker completely avoided, was, “Yes.”

Drug Abuse and Drug Companies

As most readers will know, opiate abuse and overdoses have increased dramatically in recent years, and it’s all over the news. Some of the public may even be aware of the role of drug companies and drug distributors in the process – the latter being recently profiled on an episode of Sixty Minutes. Let’s look at the role of the drug companies.

A Pharma executive, a billionaire, was arrested in October on charges of bribing doctors to prescribe opioid painkillers. (http://fortune.com/2017/10/26/john-kapoor-insys-therapeutics-arrested-net-worth/). The Department of Justice arrested Insys Therapeutics founder John Kapoor, 74, in Phoenix. Kapoor was charged with using bribes and fraud to prop up sales of a pain medication called Subsys, a fentanyl spray typically used to treat cancer patients suffering excruciating pain. Fentanyl is 50 to 100 stronger than morphine, and contributed to the overdose deaths of pop stars Prince and Tom Petty.

When it comes to drugs of abuse, the lunatics seem to have taken over the asylum in medicine these days. In their push towards huge profits, dangerous drugs are being hawked when cheaper, less toxic, and less addictive alternatives are available for treating some conditions. And as discussed in this blog, whole diseases such as “adult adhd” have been invented out of whole cloth.

For those readers who may not know, potentially addictive drugs are referred to by the Drug Enforcement Agency (DEA)  as “scheduled” drugs. Schedule I drugs are the illegal ones. Schedule II drugs are those with the highest abuse potential: narcotics and stimulants. Schedule  IV drugs are those considered to be of low potential for abuse. If you didn’t know how the drugs were scheduled, you certainly would never know it from listening to presentations by doctors working with Pharma.

Pharma hires doctors to do research on as well as give talks to other doctors about their products, totally with the goal of increasing sales – if patients do happen to benefit in some way, all the better – but that is hardly a requirement. The slides that are presented during the talks are furnished entirely by the drug company after being approved internally; the doctors giving the talks are not allowed in most instances to use their own slides.

Pharma is particularly known for employing what they call “Key Opinion Leaders” (KOLs) to give promotional talks to doctors around the country. The more academic credibility they seem to have the better – that is one source of determining who might be a KOL. But it is not the only one.

Pharma can actually get any given doctor’s prescribing records from the pharmacy industry (unless the doctor “opts out” of allowing his or her data to be mined in this way. Most docs are not even aware of this option—and having the information publically available is the default position). Pharma then uses this data to see if prescriptions for their products increase after one of their KOLs makes a presentation. 

Those doctors that make the best salesmen are hired again and again, while those who do not measure up are dropped.

A colleague of mine has taken a course required in Tennessee for licensure that discusses the “proper way” to  prescribe drugs of abuse. The course was sponsored by our malpractice carrier. According to him, one year the leader of the course scolded the doctors present for not prescribing enough opiates to people with chronic pain. 

The doctors were told how much suffering they were causing these patients by withholding these medications. Just one year later, after the “opioid crisis” hit the news, the same course was given. Only this time, the doctors were scolded because they were prescribing these “suddenly” dangerous and highly addictive substances to their patients with chronic pain!

I have discussed in previous posts how the risks of that class of medication (Schedule IV) have been wildly overblown in the medical literature and in public news stories. As well as being classified as “low abuse potential” by the DEA, they do not cause intoxication, and have next to no side effects compared to just about any other class of meds in most patients. I am not saying they are never abused, but usually only by people that mix them with opiates and alcohol. 

And of course any individual can have a bad reaction to any drug. It seems benzo’s are never discussed without the admonition that the “are addictive,” or have a few side effects in (some) patients – while drugs like amphetamines (Schedule II) that are abused far more often, and have more potential adverse or toxic side effects, are enthusiastically pushed.

And I do mean pushed, as in supplied by pushers masquerading as drug companies. I recall a “grand rounds” (a major lecture at an academic department in a medical school) from maybe 18-20 years ago in which the KOL was saying that about 18% of all adults should be on high doses of speed, that the reason that many of the parents of kids diagnosed with ADHD were substance abusers was because, "If you had a kid with ADHD, you'd drink too," and that kids who had ADHD could concentrate intensely on video games in an arcade despite multiple and pervasive loud distractions all about because that is "not concentrating." (I always wondered what the heck it supposedly was). I kid you not.

As another amazing example of drug pushing, one news service for psychiatry called MDLinx devotes a whole e-mail newsletter to articles extolling the use and virtues of drugs like Adderall and Concerta. Some recent examples:

MDLinx Psychiatry 3/13/18 - Ranked, sorted, and summarized by MDLinx editors from the latest literature.

IN THE NEWS SHP465 mixed amphetamine salts effective, safe for ADHD in adults Liz Meszaros, MDLinx, 03/08/2018

Researchers investigate the link between ADHD and risk of self-harm Paul Basilio, MDLinx, 02/23/2018

Study of 23,000 people links ADHD with genetic signature for delay discounting. Paul Basilio, MDLinx, 12/11/2017

They also have a section of their more general psychiatric newsletters also devoted to this goal that is called the ADHD Resource Center: A collection of articles and features related to ADHD with articles like:

AAP Experience - American Academy of Pediatrics              National Conference & Exhib Conference Of course, none of these Pharma sales mechanisms would matter that much if there were not already a ready market for abusable medications. That market is growing, and adverse childhood experiences and family dysfunction are a huge part of that problem. Still, as Steppenwolf used to sing, “G-d damn the pusher man.”

Marketing Methamphetamine Clones for Fun and Profit

From 2010 (when I first started this blog) until 2013, I published several posts about the United States Department of Justice assessing huge fines against several large pharmaceutical company for off-label marketing and false advertising about several different psychiatric drugs. Somehow in September of 2014, I missed  a big one. 

That time, a large fine was assessed against my least favorite of all the drug companies, Shire Pharmaceuticals - the maker of the methamphetamine clones Adderall and Vyvanse. They also make a version of Ritalin called Daytrana.

As far as I'm concerned, this company is nothing but a dope dealer that cares only for profits and not a whit for their victims - er, I mean consumers. The company does its best to convince doctors to dope up kids who have various behavior problems - which in reality are mostly due to problematic parenting and/or chaotic home environments - with highly abuseable and dangerous stimulants. 

I have written several posts on the huge increase in prescriptions for these medications in children over the last twenty years or so. Now, we are seeing a huge increase in prescriptions of these drugs to adults for the adult version of "ADHD." While there may be both adults and children with minimal brain dysfunction who have a real disorder that requires this medication, most people who are given this diagnosis present with symptoms which are caused by other factors. The biggest ones: the effects of bad environments mentioned above which create anxiety and low moods, and amphetamine abuse. The later patients lie to their physicians in order to get the drugs. 

The drugs not only get people high, but are also used as performance-enhancing drugs for mental activities—much like steroids are used to enhance performance for physical activities.

Currently, medications to treat ADHD are one of the most lucrative sectors of the US drug market, totaling more than $10 billion in sales - 83 million prescriptions in 2014, according to data from IMS Health, ”with adults using more of these medications..." The “2013 edition of the Diagnostic and Statistical Manual of Mental Disorders... relaxed the definition for” ADHD in adults."

ADHD symptoms are easily faked. A 2010 study found that 22% of adults tested for ADHD exaggerated their symptoms. And that was probably only those subjects who would admit to it! Such exaggeration has been made much easier by the wide availability of online symptom checklists. 

Getting back to the matter at hand, Shire Pharmaceuticals LLC  paid a $56.5 million fine to resolve civil allegations that it violated the False Claims Act as a result of its marketing and promotion of these drugs. As one can easily see from the above figures, that's actually a very small cost of doing business. Among other things, they marketed Adderall XR based on unsupported claims that Adderall XR would prevent poor academic performance, loss of employment, criminal behavior, traffic accidents and sexually transmitted diseases. 

Shire medical science liaison allegedly told a state formulary board that Vyvanse “provides less abuse liability” than “every other long-acting release mechanism” on the market.  However, the government contended that no study Shire conducted had concluded that Vyvanse was not abuseable, and, as an amphetamine product, the Vyvanse label included an FDA-mandated black box warning for its potential for misuse and abuse. Shire also made allegedly unsupported claims that treatment with Vyvanse would prevent car accidents, divorce, arrests and unemployment. 

Interestingly, the Justice Department was alerted to these marketing practicing by whistleblowers. The allegations arose from a lawsuit filed by Dr. Gerardo Torres, a former Shire executive, and a separate lawsuit filed by Anita Hsieh, Kara Harris and Ian Clark, former Shire sales representatives. The lawsuits were filed under the False Claims Act’s whistleblower provisions, which permit private parties to sue for false claims on behalf of the government and to share in any recovery. 

The marketing of stimulants for "adult ADHD" is as heinous as the marketing to children and teens. According to an article published by Medscape, "... the prevalence of [supposed] ADHD in adults these days is about half that in children. For years, the legitimacy of the adult ADHD was based on the belief that it was a condition that started in childhood and, for some, persisted into adulthood. 

But last year that hypothesis was shaken by the publication of a provocative, long-term study that followed more than 1,000 New Zealand children until age 38. In that study Terrie Moffitt, PhD, a psychologist at Duke University, and her colleagues found that in childhood, 6% of those in the study had ADHD. At age 38, that number had dropped to 3%.

And the biggest surprise was the lack of evidence of significant overlap between the two groups. Only 5% of those with ADHD in childhood still met the criteria at age 38. And only 10% of those who met the definition at age 38 were among those with the supposed condition in childhood.

The Medscape news article concluded from this data that "Studies suggest people diagnosed with ADHD as adults may have a condition that differs from ADHD seen in children." Wow. I would come to a different conclusion. Namely, that most of these patients did not have "ADHD" at all, but something else entirely.

And in yet more marketing-of-dope-to-children news (without a peep out of the pesky National Institute for Drug Abuse or the FDA), there’s a new, candy-flavored amphetamine on the market. Adzenys is chewable and fruity! Dr. Alexander Papp, affiliated with University of California, San Diego, asked, “What’s next? Gummy bears?”

When Anecdotal Evidence is Sufficient Proof

Printed by Publish Any Damn Thing or Perish Press. Research funded by the Keep Unimaginative Academics Employed Foundation.

As I did on my posts of November 30, 2011,  October 2, 2012, September 17, 2013, June 3, 2014, and February 24, 2015, it’s time once again to look over the highlights of the latest issue of one of my two favorite psychiatry journals, Duh! and No Sh*t, Sherlock. We'll take a look at the unsurprising findings published in the latest issue of Duh! My comments in bronze.

As I pointed out in those earlier posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already known to be true but have yet to be "proven"? Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

May 7, 2105. Study: Bisexual And Gay Children More Likely To Be Bullied As They Grow Up

The AP (5/7, Stobbe) reports that a research letter published May 7 in the New England Journal of Medicine suggests that bisexual and gay children “are more likely to be bullied as they’re growing up – even at an early age.” Researchers found that “many of the nearly 4,300 students surveyed said they were bullied, especially at younger ages,” but 13 percent of the 630 bisexual and gay youngsters reported being bullied “on a weekly basis,” compared to just eight percent of the other children.

        HealthDay (5/7, Haelle) reports that “consequences of bullying can include physical injury, anxiety, low self-esteem, depression, suicidal thoughts, post-traumatic stress and negative school performance...said” the study’s lead author. 

This is just more propaganda from people advancing the gay agenda.

6/15/15. Small Study: Lisdexamfetamine May Improve Memory, Concentration Problems Associated With Menopause.

HealthDay (6/13, Haelle) reported that the stimulant medication lisdexamfetamine, which is “marketed for attention-deficit/hyperactivity disorder, might improve memory and concentration problems associated with menopause,” according to a study of 32 menopausal women published online June 11 in Psychopharmacology. The study, which received support from the NIH and Shire, the maker of lisdexamfetamine, revealed that “brain activities such as memory, reasoning, multitasking, planning and problem-solving,” improved while women were taking the medicine.

Hate to break this to the Pharma shills, but stimulants will do that for ANYBODY.

8/4/15. Pediatric brain injuries may be associated with attention issues

The Washington Post (8/4, Cha) “To Your Health” blog reports that youngsters who suffer a brain injury, even one considered minor, may be “more likely to experience attention issues,” according to a study published online Aug. 3 in Pediatrics. For the study, investigators included “113 children, ages six to 13, who suffered from traumatic brain injuries (TBIs) ranging from a concussion that gave them a headache or caused them to vomit, to losing consciousness for more than 30 minutes, and compared them with a group of 53 children who experienced a trauma that was not head-related.” HealthDay (8/4, Doheny) reports that the study found that “attention lapses” suffered by the kids with TBIs “led to lower behavior and intelligence ratings by their parents and teachers.” What’s more, the “loss of focus was apparent even when scans showed no obvious brain damage, the researchers said.”

Because injuries to the brain always improve its performance.

8/18/15. Family Problems Early In Life May Raise Boys’ Risk Of Depression, Anxiety.

HealthDay (8/18, Preidt) reports, “Family problems early in life might raise boys’ risk of depression and anxiety, which is also tied to altered brain structure in their late teens and” into early adulthood, according to a study published online Aug. 17 in JAMA Pediatrics. The study, which “included nearly 500 males, ages 18 to 21,” found that “those boys who faced family problems during” the years from birth to age six “were more likely to have depression and anxiety at ages seven, 10 and 13.” Such boys “were more likely to have lower volume of...’gray matter’ in the brain by the time they reached ages 18 to 21.”

What was Freud even THINKING?

8/31/15. Risky Behaviors May Be Signs Of High Suicide Risk In People With Depression.

 

HealthDay (8/30, Preidt) reported, “Risky behaviors such as reckless driving or sudden promiscuity, or nervous behaviors such as agitation, hand-wringing or pacing, can be signs that suicide risk may be high in depressed people,” research presented at the European College of Neuropsychopharmacology’s Congress suggests. The study, which involved some 2,800 people with depression, also revealed that “other warning signs may include doing things on impulse with little thought about the consequences.” People with depression “with any of these symptoms are at least 50 percent more likely to attempt suicide, the new study found.” 

This is just silly. We all know that people who are keen to die are risk averse.

10/7/15. Small Study: Older Adults Appear To Recover More Slowly From Concussion Than Younger Patients.

HealthDay (10/7, Preidt) reports that “older adults recover more slowly from concussion than younger patients,” according to a study published online Oct. 6 in the journal Radiology. Included in the study were “13 older adults, aged 51 to 68, and 13 young adults, aged 21 to 30.” All participants were evaluated at the four-week and 10-week mark following their concussions. While “a significant decline in concussion symptoms – such as problems with working memory – was seen among young patients between the first and second assessment,” researchers found “no such decrease in symptoms...in older patients.”

Aw come on. The body always improves with advanced age.

10/14/15.  Psychological Distress May Be Highly Prevalent In Caregivers Of Patients With Advanced Cancer.

Medscape (10/14, O'Rourke) reports that “psychological distress is highly prevalent in caregivers of patients with advanced cancer and is associated with both caregiver and patient factors, researchers said...at the Palliative Care in Oncology Symposium (PCOS) 2015.” Lead study author Ryan David Nipp, MD, said, “Caregiver characteristics that were significantly associated with caregiver depression were being female and having anxiety.” Dr. Nipp added, “Patient factors that were associated with caregiver depression included patients reporting depression, that the goal of their care was to cure their cancer, and using emotional support coping.”

The impending death of loved ones is always such a high!

10/21/15. Parental Involvement May Optimize Therapy For Kids With Disruptive Behavior Disorders.

Reuters (10/21, Rapaport) reports that having parents participate in therapy for youngsters with disruptive behavior disorders may help the children respond optimally to that treatment, according to a meta-analysis of 66 studies published online Oct. 19 in the journal Pediatrics.

Nonsense. We all know that being rude is genetic.

10/28/15. Cancer diagnosis may lead to loss of income, study indicates

The Washington Post (10/28, Blakemore) “To Your Health” blog reports that research indicates that cancer “can take a heavy toll on patients’ pocketbooks, even long after they recover.” The Los Angeles Times (10/28, Kaplan) reports in “Science Now” that researchers found that “in the second year after being diagnosed with cancer, survivors were earning up to 40% less than they had been before they became sick, on average.” The data indicated that “even in the fifth year after diagnosis, annual earnings still had not recovered to their precancer levels.”The findings were published in Cancer.

Because, thanks to the demise of unions, fewer and fewer folks get paid sick days from their job any more. (I'm not being funny).

11/10/15.  Study Supports Raising SSRI Doses in Patients Who Do Not Respond to Low-Dose Treatment

Using a higher dose of selective serotonin reuptake inhibitors (SSRIs) for major depressive disorder appears to be associated with an increased likelihood of response, according to a meta-analysis published today in AJP in Advance. This benefit, which is somewhat offset by decreased tolerability of SSRIs at high doses, appears to plateau at about 50 mg of fluoxetine (250 mg imipramine-equivalent dose). A team of researchers in the United States and London searched PubMed for randomized, placebo-controlled trials that examined the efficacy of SSRIs for treating adults with major depressive disorder and assessed improvement in depression severity at multiple time points.
       

Er- the first lesson in psychopharmacology 101, I believe.

11/20/15.  Opioid Addiction In Women May Often Start With Physician-Prescribed Medications.

Medscape (11/20, Brooks) reports that new research suggests that the upsurge in the number of women with opioid addiction may be attributed to prescription medicines. Researchers evaluated “sex differences in substance use, health, and social functioning among 266 men and 226 women receiving methadone treatment for opioid use disorder in Ontario.” The researchers found that over half of women (52%) and a third of men (38%) “reported physician-prescribed opioids as their first contact with the” medications. The findings were published online Nov. 9 in the journal of Biology of Sex Differences.

This can't be right. Addiction can only be caused by that evil weed gateway drug, marijuana. Or was that beer?

Conventional Wisdom that Seems Obvious Once Again Found to be Actually True

As I did on my posts of November 30, 2011,  October 2, 2012, September 17, 2013, and June 3, 2014, it’s time once again to look over the highlights of the latest issue of one of my two favorite psychiatry journals, Duh! and No Sh*t, Sherlock. We'll take a look at the unsurprising findings published in the latest issue of No Sh*t Sherlock. My comments in bronze.

As I pointed out in those earlier posts, research dollars are very limited and therefore precious. Why waste good money trying to study new, cutting edge or controversial ideas that might turn out to be wrong, when we can study things that that are already known to be true but have yet to be "proven"? Such an approach increases the success rate of studies almost astronomically. And studies with positive results are far more likely to be published than those that come up negative.

 

5/28/14.  Physical activity program may reduce mobility disability in seniors.

USA Today (5/28, Painter) reports that for seniors, “losing the ability to walk a short distance often means losing independence.” Now, “researchers say they have found a treatment that, for some, can prevent that loss of mobility,” and that is “a moderate exercise program.” The Washington Post (5/28, Bahrampour) reports that the study, “called the Lifestyle Interventions and Independence for Elders and funded by the National Institute on Aging and the National Heart, Lung, and Blood Institute, was the first of its kind to test a specific regimen of regular physical activity for sedentary older people.” The Boston Globe (5/28, Kotz) “Daily Dose” blog reports that the study, published online May 27 in the Journal of the American Medical Association, “found that elderly people who walked and did basic strengthening exercises on a daily basis were less likely to become physically disabled compared to those who did not exercise regularly.” The study control group consisted of people who were instructed to take health education classes. 

I guess it's still OK for seniors to sit very, very still while posing as nude models for art students.

6/17/14. Study Shows Association Between Mental Illness Severity and Employment and Income.

More severe mental illness appears to be associated with lower employment rates in recent years, and people with serious mental illness are less likely than people with no, mild, or moderate mental illness to be employed after age 49, according to the report, “Employment Status of People With Mental Illness: National Survey Data From 2009 and 2010,” published in Psychiatric Services in Advance.

We now know for sure that employers are not always hot to hire people who are too mentally impaired to perform the work.

6/20/14. Brain Injuries Linked To Higher Risk For Headaches.

HealthDay (6/20) reports that research scheduled to be presented at the American Headache Society meeting suggests that “U.S. veterans of the Iraq and Afghanistan wars who suffered brain injuries are at a much higher risk for headaches, especially migraines.” This “study included 53 veterans who had suffered a traumatic brain injury during deployment and...53 veterans without brain injuries.” Investigators found “that all of the veterans in the brain injury group said they experienced headaches, compared with about 76 percent of those in the control group.” Eighty-nine percent of the headaches in those with brain injuries were migraines, while just 40 percent of the headaches in the control group were migraines.

Now just a minute. Bodily injuries produce pain?? Since when?

9/1/14. The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa. 

European Child and Adolescent Psychiatry, 09/03/2014: Focker M, et al.  In this study, the relationship between pre-morbid body mass index (BMI) percentile and BMI at admission was solidly confirmed. In addition to pre-morbid BMI percentile, BMI at admission and age were significant predictors of BMI percentile at discharge. BMI percentile at discharge significantly predicted BMI percentile at 1–year follow–up. An additional analysis that merely included variables available upon referral revealed that premorbid BMI percentile predicts the 1–year follow–up BMI percentile.

Oh, I did not see it before, but I get it now. More severe disorders have a worse prognosis.

11/25/14. Talk Therapy May Prevent Suicide in High-Risk Patients

Talk therapy may decrease risk for future suicide attempts and completions in patients who have already made a previous attempt, new research suggests. 

God, I should hope so, or I'm in the wrong business!!

1/13/15. Self-injurers experience greater negative emotionality, particularly self-dissatisfaction, compared to individuals with no NSSI history.

Self-injurers also reported less positive emotion, but these effects were smaller. The pattern of results was similar when controlling for Axis I psychopathology and borderline personality disorder.

And here I thought cutters and burners did so because their joy was just soooo unbearable.

1/30/15. Repeated Blows To Head In Boxing, Martial Arts May Damage Brain.

HealthDay (1/30, Preidt) reports that research published in the British Journal of Sports Medicine “supports the notion that repeated blows to the head in boxing or the martial arts can damage the brain.” Investigators studied “93 boxers and 131 mixed martial arts experts,” as well as 22 individuals who had never suffered a head injury. “MRI brain scans and tests of memory, reaction time and other intellectual abilities showed that the fighters who had suffered repeated blows to the head had smaller brain volume and slower processing speeds, compared to non-fighters.”

So I guess I should quit beating my head against the wall trying to get researchers to actually look into things we actually do NOT already know.

1/30/15.  The US Food and Drug Administration (FDA) has approved lisdexamfetamine dimesylate (Vyvanse, Shire) to treat binge eating disorder (BED) in adults.

The drug is the first FDA-approved medication to treat this condition. "Binge eating can cause serious health problems and difficulties with work, home, and social life," said Mitchell Mathis, MD, director of the Division of Psychiatry Products in the FDA's Center for Drug Evaluation and Research. "The approval of Vyvanse provides physicians and patients with an effective option to help curb episodes of binge eating." The efficacy of Vyvanse in treating BED was shown in two clinical studies that included 724 adults with moderate to severe BED, as reported by Medscape Medical News. In the studies, participants taking Vyvanse experienced a decrease in the number of binge eating days per week and had fewer obsessive-compulsive binge eating behaviors compared with patients in a placebo group.

Shocking new finding: appetite suppressants reduce eating.

January 2015.  Alcohol, Depression potent risk factors for suicide.

BERLIN– Alcohol dependence and major depressive disorder are similarly potent yet independent risk factors for suicidal behavior, according to Dr. Philip Gorwood. Although alcohol use disorder and major depression are extremely common and often comorbid, the mechanisms by which they boost the risk for suicidal behavior are very different, he said at the annual congress of the European College of Neuropsychopharmacology.

Insert your own joke here. No prize will be awarded for best gag, but let's see what you got!

And yes, it is OK to joke even about suicide. Black humor often helps us all to squarely face up to very serious issues, and is therefore to be encouraged. 

Schizophrenic Attitudes towards Legal versus Illegal Stimulants

The United States has always had a peculiar and highly inconsistent attitude towards amphetamines, and it seems to become more and more schizophrenic about them with each passing day. The government, the National Institute of Drug Abuse (NIDA), and the media systematically overstate the dangers of the illegal variety, while systematically understating the dangers of the legal varieties. 

In actuality, as neuroscientist Carl Hart points out in his book High Price, there is really no significant difference between these two. 

Why aren’t kids who are given daily doses of Adderall getting “meth mouth?” Again according to Dr. Hart, because meth mouth is not actually caused by methamphetamines per se. A media-generated old wive's tale.

In my past writing on this subject, I have brought up a couple of interesting stories about stimulants that bear repeating. (If you’ve seen them, skip this paragraph and the next). When I was a freshman in college from 1966-1967, I was going to school in Berkeley. I got to personally witness the hippie scene in the Haight Ashbury in San Francisco months before the media even knew it was there. As you may know, the hippies were all in favor of experimenting with getting high on a variety of drugs. But even they used to say, “speed kills.”

Then much later in my life there was a talk I attended given by a representative at NIDA, who went on and on about how illegal stimulants deplete the brain of dopamine and thereby destroy the ability of addicts to have pleasurable experiences with anything besides maybe the drug itself. This of course is another one of those grossly exaggerated scare stories. Taking it at face value, however, someone in the audience got up and asked, “So aren’t we doing that to our kids with ADHD?” The non-answer from the NIDA man, “But the drugs work so well!”

Interestingly, the Federal Government's drug regulatory agencies seem to think that stimulants are far more dangerous and prone to abuse than benzodiazepines. Benzo’s are demonized by almost everyone in both their legal and its non-prescription uses. Stimulants are classified as Schedule II, which means they have a high potential for abuse. Opiates like oxycontin are also Schedule II.

Benzo’s, on the other hand, are classified in schedule IV, which consists of drugs considered as low risk for abuse and dependence. That is correct. When was the last time you ever read in the newspaper or online about a big bust of an illegal valium dealer?

I came across a really interesting history of America's attitudes towards amphetamines on line at http://motherboard.vice.com/read/the-speed-of-hypocrisy-how-america-got-hooked-on-legal-meth?utm_source=digg&utm_medium=email.

A sample of the subtopics covered:

In the sixties, stimulants were hawked by the drug industry as diet pills, resulting in an epidemic of stimulant abuse among housewives. (This was dramatized in the movie The Divine Secrets of the Ya-Ya Sisterhood - DA). According to the above story:

"By 1970, nearly 10 percent of American women regularly used or were dependent on some form of amphetamine, most prescribed for weight loss. In his book Speed-Speed-Speedfreak, Mick Warren reminds us that hooked housewives and twenty-something women were established cultural tropes….” 

To make up for ground lost from this scandal, Pharma and its surrogates are now in the midst of making a huge and concerted effort to market to women both the drugs and the condition known as “Adult ADHD.” 

There’s a lot more interesting history in the web story. I would recommend the whole piece to anyone interested in this subject. The pictures of old advertisements are particularly awesome.