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Consumers Union: ADHD Drugs Overprescribed

Most Stimulants Equal in Effectiveness, Group Says
By
WebMD Health News
Reviewed by Louise Chang, MD

Sept. 27, 2005 -- Stimulant drugs used to treat attention deficit hyperactivity disorder in millions of American children are effective but are probably being prescribed to many youths who do not have the disorder, concludes a report by Consumers Union, the publisher of Consumer Reports magazine.

The study names several different stimulant drugs as "Best Buys," noting that evidence points to most of the drugs being equally effective for ADHD.

Consumer Reports names several forms of the stimulant methylphenidate as a best buy, including Metadate, Methylin, and generic forms of the drug. Methylphenidate is also contained in the well-known brand-name drug Ritalin, which was left off the best-buy list because it is more expensive than the other forms.

Generic forms of dextroamphetamine are also named, which cost $10 to $48 per month, depending on dosage.

"Our analysis found no evidence that any one stimulant drug is more effective than any other," the report states, adding that stimulant drugs are "generally effective and safe."

Consumer Reports conducted a review of available scientific studies to evaluate different drugs used to treat ADHD and then applied average pricing data to come up with its picks. Its publishers have conducted similar reviews of antihistamines and nonsteroidal anti-inflammatory pain drugs.

CDC data show that 4 million American children aged 3 to 17 have been diagnosed with ADD, comprising about 6.5% of the population. Boys are much more likely than girls to have the disorder.

Close to 65% of diagnosed children take stimulant drugs as treatment, though many others without an official diagnosis may also use it, according to federal figures.

Diagnosis Complex

Tuesday's report warns that diagnosis of ADHD is complex, requiring extensive interviews and evaluation of potential learning problems, school performance, and emotional issues. Many American children are likely to be taking stimulants for only mild disorders or even in the absence of ADHD, it states.

"You should be skeptical if a doctor or a therapist diagnoses ADHD in the first visit and immediately prescribes a drug," the report states.

"I don't think it's a one-person call," says Marvin M. Lipman, a professor of medicine at New York Medical College and the chief medical advisor to Consumers Union.

The report also advises parents to seek a second opinion if they have doubts about an ADHD diagnosis or stimulant prescriptions from a doctor.

"The evaluation can't be done in the 15-minute office visit," says Mary Solanto, PhD, a researcher and head of the ADHD program at Mount Sinai School of Medicine in New York.

"At the same time, a lot of kids who need it are not getting it," adds Solanto, who says she has consulted for three ADHD drug manufacturers and conducted industry-funded research.

Sleeplessness, appetite loss, stomach pain, and headaches are the most common side effects with the use of stimulants. The FDA is also conducting a review of reports of psychotic episodes and suicidal thoughts in patients taking Concerta, a brand-name form of methylphenidate.

The agency declined several months ago to alter the drug's label to warn of the risks but is withholding a final decision until its review is complete.

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