Having a bit of a psychopharm debate in pre-allo...

[loveoforganic]

http://forums.studentdoctor.net/showthread.php?t=669935&page=7

I'd appreciate it if one of you could just quickly clear up what the actuality is. It's a 7 page thread, so I'll just put the two points forward

1) Ritalin increases concentration to an equal level of functioning regardless of who the drug is administered to (someone with good concentration and someone with ADHD would be put at an equal level of functioning following medication of both of them).

2) Ritalin increases concenctration in a roughly parallel manner regardless of who the drug is administered to (ADHD patient would be brought to somewhere around population mean following medication, while a person with normal concentration would be put at an increased level of functioning relative to the population mean following medication).

Thanks for your time.

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[kugel]

I've always been taught that stimulants increase the concentration of both groups (ADHD patients and controls), but the increase is much larger for patients than for controls. This does not necessarily mean they reach "normal" level of concentration, though some do.

My clinical experience is that it's clearly not the same magnitude of effect as stimulants have on the quiet, studious, focused, attentive teen/young adult who tries them for the purpose of studying longer.

 

[Sust]

I think this article gets at the issue a little bit, but not with usage of ritalin.
Maybe some need it to get to the "sweet spot" while others might overshoot wildly if taken.

 

[kugel]

I know it wasn't the orig. question, but it's important to remember that response to Ritalin and other stimulants is NOT diagnostic and there is lots of misuse of stimulants for recreational and "enhanced performance" uses.

FROM JOURNAL WATCH - PSYCHIATRY

Misuse of ADHD Meds: Epidemiologic Data
Such misuse is becoming more common and can have severe effects, but clinicians and parents might be able to moderate these trends.

Nonmedical use of ADHD drugs by teenagers is increasing (JW Psychiatry Apr 30 2007). To further examine this phenomenon, researchers analyzed calls in 1998–2005 to the National Poison Data System (NPDS) about ADHD medications in children ages 13 to 19 years. The investigators also obtained data on overall calls about substance abuse made to the NPDS and data on ADHD prescriptions from a national survey of physicians during the 8 study years.

ADHD drug calls to the NPDS increased by 76% from 1998 to 2005, statistically similar to the 86% increase in prescriptions of these drugs to adolescents (ages 10–19) during the same period but significantly higher than the 55% increase in calls to the NPDS about teen drug abuse overall. For mixed amphetamine salts, calls increased 476% and prescriptions increased 141% over the study period. For methylphenidate, calls decreased by 55% while prescriptions increased by 57%. Overall, 58 calls about ADHD misuse (42%) involved moderate or severe impairment, including four deaths; calls regarding moderate or severe effects were significantly more common for mixed amphetamine salts than for methylphenidate (45% vs. 37%). Forty percent of calls concerned girls (whereas ADHD is diagnosed at a 3:1 ratio in boys and girls).

Comment: These data underscore the need for parental education about the progressively increasing risks for misuse of ADHD medications. Clinicians can encourage parents to become the dispenser in the home, especially because these drugs are now formulated as long-acting preparations that can be given in the morning before school. Observing the teenager swallow the medication and keeping the ADHD drugs in home lock-boxes might also be useful.

— Barbara Geller, MD

Published in Journal Watch Psychiatry October 5, 2009

Citation(s):
Setlik J et al. Adolescent prescription ADHD medication abuse is rising along with prescriptions for these medications. Pediatrics 2009 Sep; 124:875.

 

[loveoforganic]

Thank you both for the replies

I think this article gets at the issue a little bit, but not with usage of ritalin.
Maybe some need it to get to the "sweet spot" while others might overshoot wildly if taken.

Does the article make a link between the genotype and the presence of disorder? Or is there a link? If not, could you explain how this relates to amphetamine effects for one with disorder vs one without disorder? Or was the study just to show the variable response?

 

[Sust]

The group that wrote the paper works mostly on imaging genetics and schizophrenia with no overt investigations into ADHD because I believe ADHD is NICHD's domain at the moment.

However, working memory is a prominent part of Danny Weinberger's lab and I think this paper suggests a variable response to amphetamines in working memory performance(as reflected in fMRI DLPFC activation + task accuracy, neuropsych test results) based on COMT genotype modulation of prefrontal dopamine turnover in normal adult volunteers.
That is, amphetamines could be improving dopaminergic tone in val/val COMT carriers such that brain activation in the DLPFC is placed back into (what I call) "the sweet spot" of the inverted U-shaped curve(fig.4) which would be reflected in better working memory task performance. Likewise for the met/met COMT carriers, amphetamines could be pushing their place on the inverted U shaped curve past the sweet spot and thus diminishing working memory performance.
At least that's my simplistic view of their work which I encourage you to read... others can correct me if I'm wrong.

I wouldnt want to generalize their findings beyond the normal adult realm esp. since we dont really even know exactly where and what ADHD pathology is. ADHD is an active area of investigation that has a fairly good update here.

Sorta referring to what Kugel said, I dont think "performance enhancement" with stimulants is that simple. This article suggests that there's more at play in attention/cognition than simply blasting your brain with more dopamine so any such thoughts of performance boosting through stimulants are thoroughly discouraged especially in light of the fact that you could be counter-productively making performance worse depending on what COMT val158met haplotype you carry.

 

[whopper]

This is an interesting issue.

ADHD IMHO has never really been explained too well in terms of how it works on a psychopharm basis. The treatments are usually amphetamines that can cause abuse, and there is data showing it can cause improvements in concentration in those without ADHD.

Its certainly an issue that should be openly debated.