Ritalin Bugs

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"Stimulants like Ritalin lead a small number of children to suffer hallucinations that usually feature insects, snakes or worms," The New York Times reports, citing FDA officials. One doctor "described the case of a 12-year-old girl who said that insects were crawling under her skin. Another child was found by his parents crawling on the ground and complaining that he was surrounded by cockroaches." And just last month, an FDA advisory panel urged the agency to warn the public that prescription stimulants can have dangerous cardiovascular effects.

Both kinds of reactions are rare, and the FDA is rightly concerned about stirring up excessive alarm among doctors and patients. But it's striking that Ritalin has been on the market for half a century, and it's only now that regulators are starting to worry that it might have side effects similar to those commonly attributed to illicit stimulants. Moreover, in the case of good, "medical" stimulants, the government is careful not to overreact, while in the case of bad, "recreational" stimulants, it implies that hallucinations and heart attacks are typical outcomes. The contrast is especially puzzling when you consider that the uses to which prescribed stimulants and black market stimulants are put–such as staying awake and staying alert–are often indistinguishable.

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  1. The Christina Aguilera monsters are the worst, man.

  2. I think Meth addicts have the same bug problem. That’s why a lot of them pick at their skin.

  3. This is weird. Now why would the hallucinations tend to feature insects, snakes or worms?

  4. Hopefully this will cut down on the use of Ritalin, and the habit to keep “disruptive” children sedated (It is much easier to diagnose a misbehaving child as “in need of Ritalin” than to correct him).

  5. “This is weird. Now why would the hallucinations tend to feature insects, snakes or worms?”

    Don’t humans have a fear of snakes hard-wired into our brains? I heard Steven Pinker mention a study that dealed with infants who had a toy snake dropped in their play pen. Even though they were too young to even know what a snake was their behavior indicated that they were afraid and anxious once they saw the toy snake. Dropping a toy gun in the play pen had no effect on the children at all.

  6. Next in the playpen…Spiders! Lots and lots of spiders!

  7. Adriana-No, it won’t.

  8. I have been on Ritalin since I was 12, I am now 21. It is a very useful drug for me, I am definitely ADHD as I took a battery of tests before I was prescribed the drug.

    What they are doing is stigmatizing medical treatment of ADHD. Despire all the alarming moral panic about kids being over-prescribed ADHD drugs, no more than 4% of kids are on stimulant drugs.

  9. “Dropping a toy gun in the play pen had no effect on the children at all.”

    On the contrary it turned them into blood thirsty whiney little tots who later grew up to be conservative Republicans.

  10. emme,

    That’s interesting. So I guess the implication is that a fear of snakes was selected for in our evolution.

  11. Ah, the blurring of distinctions between prescription and recreational drugs. I would have thought Reason was better than that. Usually, this magazine is one of the only places to go for health coverage that doesn’t uncritically accept the fear of pharmacology that most of the media seems to have.

    You seem to be able to condemn both the war on prescription painkillers and the war on illegal drugs without needlessly conflating smack addicts and patients suffering from chronc pain. ADHD is just as real.

  12. No, we’re afraid of snakes because the fall of man, as portrayed in the Bible, is the God’s unvarnished truth! Duh!

  13. “That’s interesting. So I guess the implication is that a fear of snakes was selected for in our evolution.”

    That’s the theory. It’s also mentioned in a book titled Mean Genes. I forgot the author’s name.

  14. Adriana,

    Thank you for trotting out the standard, O’Reilly-style diagnosis. Here are some useful facts for you:

    Ritalin is not a sedative. It does not act by stunning, numbing or tranquilizing the child (or the adult) with ADHD.

    ADHD, crudely put, is a condition in which the capacity of the brain for self-regulation is impaired. In layman’s terms, it is very much like being drunk and/or stoned all the time (without any of the good parts). A child with ADHD does not choose to behave badly, any more than an adult with ADHD chooses to space out during meetings. Lack of control over the direction of one’s own thought processes and behavior is an extremely unpleasant, somewhat frightening condition to suffer from, as I do. It seems to be difficult for non-sufferers to imagine this kind of impairment, perhaps because it involves a capacity that they are not conscious they have in the first place.

    Some people are prone to becoming agitated, reckless or violent while drunk, even though we know that alcohol is a depressant drug. This is because alcohol impairs self-regulation and inhibition. For people with ADHD, Ritalin and other stimulants can have the obverse effect: they enhance self-regulation, which allows the sufferer to choose to behave appropriately, and choose to pay attention to and carry out relatively simple tasks. Again, it seems to be difficult for people to understand how life-changing these drugs can be, because they don’t seem to understand how the problems they address could exist in the first place.

  15. All i know is i took ritalin during law school. And when I was on it I raced through my con law book like a freakin demon.

  16. A more mundane hypothesis: stimulants trigger oscillatory patterns in the tactile and visual cortices, interpreted as bugs crawling. If the nature of these hallucinations are anything like those on psychedelics, you don’t actually see insects, but your visual space is partially or completely “Escherized”, like in Metamorphosis, and a naive belief is that you’re seeing insects.

  17. Of course. Because some people have a real problem, it must be the case that the drug is:
    1) The drug is never overprescribed
    2) Bright kids who the teacher finds annoying are never misdiagnosed.
    3) The drug can never, ever be harmful.

  18. A more mundane hypothesis: stimulants trigger oscillatory patterns in the tactile and visual cortices, interpreted as bugs crawling. If the nature of these hallucinations are anything like those on psychedelics, you don’t actually see insects, but your visual space is partially or completely “Escherized”, like in Metamorphosis, and a naive belief is that you’re seeing insects.

  19. I doubt any kid that experienced hallucinations by taking ADD medication was on an appropriate dose. Their parents probably gave them more than they were supposed to. I’m taking ritalin and i can barely feel the effects except for being more productive. Also, i ate some cubensis last weekend and i now know what hallucinations really are and i can’t imagine ritalin doing that to my brain.

  20. Number 6,

    Kids who choose to cause problems of their own free will won’t stop because they’re on Ritalin. They’re likely to become more disruptive.

    It’s not clear who your comment is addressed to, since no one seems to have made any of your three itemized claims.

  21. ADHD is just as real.

    The fact that some people are less attentive or more active than the norm does not qualify those people as having a disorder. That’s the biggest beef I have with ADHD…it attempts to set a standard for normalacy and considers anyone who deviates from that to be abnormal.

    Once classified as a disorder, it becomes a common belief that the failure to treat this disorder is a form of abuse. This is a significant factor in the uprise against ADHD medications.

    Remove the last D from ADHD and much of the controversy goes away.

  22. daksya’s correct. And it’s not even so much the stimulants themselves in many cases, it’s the sleep deprivation on top of it. You’re seeing these squiggling, squirming types of visuals, and it seems like bugs. They seem to be under your skin because you can’t interact with them.

  23. T-Rev: My comment was directed to the people lambasting anyone who has the gall to question the prevailing wisdom that ADD is epidemic and that drugs for it are a universal good. Read a few posts up from mine, and you’ll find them.

  24. Number 6,

    The closest sentiments to what you describe appear to be ESB:

    What they are doing is stigmatizing medical treatment of ADHD. Despire all the alarming moral panic about kids being over-prescribed ADHD drugs, no more than 4% of kids are on stimulant drugs.

    and the 15th:

    You seem to be able to condemn both the war on prescription painkillers and the war on illegal drugs without needlessly conflating smack addicts and patients suffering from chronc pain. ADHD is just as real.

    While “moral panic” may or may not be overstrong a description, neither comment seems to me to put forth any of your three statements:

    1) The drug is never overprescribed
    2) Bright kids who the teacher finds annoying are never misdiagnosed.
    3) The drug can never, ever be harmful.

    In particular, statement 3 seems bizarre. Ritalin and Dexedrine are powerful stimulant drugs with a high risk of abuse, and I don’t think you’re likely to find anyone denying that. the15th’s statement in fact acknowledges that by the comparison with and between “smack addicts and patients suffering from chronc pain”.

    Stating that ADHD is a real condition and that Ritalin is a legitimate treatment for it is not equivalent to any of the following assertions:

    1) The drug is never overprescribed
    2) Bright kids who the teacher finds annoying are never misdiagnosed.
    3) The drug can never, ever be harmful.
    4) Everyone has ADHD
    5) Everyone with ADHD will benefit from Ritalin
    6) Schools are happy places, and a sane, healthy child would never, ever misbehave
    7) A sane, healthy child would never, ever rebel or misbehave, anywhere
    8) We all have AIDS! AIDS AIDS AIDS!

    I believe all these statements to be false, and I suspect ESB and the15th would agree with me. I do, however, assert that:

    1) Some people do suffer from ADHD to the extent that it causes them significant impairment (‘significant impairment’ is part of the definition of a disorder.)
    2) Some people suffering from this disorder can obtain significant relief from the use of drugs like Ritalin
    3) For these people, the benefits of Ritalin frequently outweigh the drawbacks.

  25. I was legal guardian of a teen that was diagnosed as ADHD. The effects of Ritalin on this teen were staggering. From completely uncontrollable to reading the morning newspaper and providing interesting commentary on current events over a civilized breakfast 😉

    The push-back against ADHD treatments stem from several problems. The normal treatment program is to analyze the problem, diagnose ADHD, prescribe a treatment program, and evaluate.

    This process has become reversed in many instances today. If the kid has problem, give him/her Ritalin. if the problems go away, then diagnose the kid as ADHD.

    As bogus as this is, there is some logic to it. ADHD, as I recall, is caused by key centers in the brain being under-stimulated. If you give a stimulant to a person with ADHD, they calm down. If you give a stimulant to a normal person, they get hyped up. So the response to stimulants is sort of an indicator of ADHD kinds of problems.

    However, none of this justifies the current pressures the school system puts on parents to medicate any child the teacher finds to be problematic.

  26. carrick,

    Yeah, the backward logic with Ritalin administration is at the very least highly problematic. If you give anyone a low-to-moderate dose of Ritalin, they’re probably going to experience a significant improvement in concentration and task performance. Difficult tasks become less difficult. The euphoric buzz can also result in a sort of cheerful, non-sedated calm–although it can also cause hyperactive, hypomanic behavior in some. It’s dangerous stuff.

    (The main difference for people with ADHD is that the person’s starting point is so poor; the quantitative improvement (in cases where a stimulant is effective) is great enough to constitute a qualitative improvement. Instead of difficult to less-difficult, tasks go from impossible to possible.)

    A teacher can and should recommend evaluation for a student if the student is troubled, disrupting class, or having difficulty functioning. (In about ten years of university teaching, I did so exactly twice–directly to the student in each case, although that’s not really an option when you’re teaching elementary school.)

    That’s a vital part of the job, but that’s also the limit of the job. A teacher has absolutely no business diagnosing ADHD or any other disorder, let alone prescribing medication.

  27. I’ve had ADD my entire life, but was only diagnosed — by chance — in my mid 30’s. Currently I’m taking 40mg of Long Acting (LA) Ritalin and it does make a big improvement. The biggest issue with ADHD/ADD is a lack of solid medical education — most doctors are not versed in the current work, especially in regards to Dr. Amen. So while a stimulate will calm and help me to focus, for others it can be detrimental.

    My best advice, before beginning drug therapy, is to consult a doctor/psychologist who specializes in ADHD/ADD and who has examined & treated hundreds of patients. In this case, the family doctor just isn’t good enough.

  28. *1) The drug is never overprescribed*

    I wouldn’t agree with that, many doctors do not put kids through the proper battery of tests required to properly diagnose ADHD. It is true that there are some parents who say to their family doc, “my kid is a pain put him on meds”. But I do believe the media and politicians over-state this problem.

    *2) Bright kids who the teacher finds annoying are never misdiagnosed.*

    See 1.

    *3) The drug can never, ever be harmful.*

    ANY drug can be harmful when abused. Take too much tylenol and watch your liver go into shock. Take too much Asprin and watch the stomach ulcers appear.

    Thats not to equate Ritalian with Asprin or Tylenol. It is indeed a powerful stimulant with the potential for abuse. *When used incorrectly* it is dangerous. But this should be common sense to most doctors and parents–I really don’t think they need the FDA to tell them that, thank you.

    *4) Everyone has ADHD*

    Its impossible for everyone, or even a substantial part of the population, to have ADHD. Becaues once that happens, its no longer a disorder.

    *5) Everyone with ADHD will benefit from Ritalin*

    Many don’t. Some respond to other drugs, some respond to therapy, though most pshychiatrists would recommend a combination of both.

    *6) Schools are happy places, and a sane, healthy child would never, ever misbehave*

    Ahahah, sure whatever you say. Public schools need serious fixing, no amount of drugs for kids is going to fix that.

  29. There is a war on unpatented drugs.

    Disguised as “protection from addiction”.

  30. BTW the war on unpatented drugs is just a subset of the general war on self medicators.

  31. MP has got it right. ADHD is nothing more than a term used to describe someone with a short attention span, relative to his/her peers. There are vast differences in attention spans between people. So what. There are also vast differences in physical stature. We don’t say that a woman who is 5’2″ has height deficit disorder, or that a man who is 6’4″ has excessive height disorder. We just say she is short, or he is tall. What about psychologists, they label almost everyone as having a psychological disorder. Perhaps they have ELDD, Excessive Labeling of Disorders Disorder.
    Stimulant drugs, such as ritalin, can be very beneficial to certain people, and everyone should be free to use stimulants if they choose to. In fact, just about everyone does use some form of stimulant, if you include nicotine and caffeine. The extent to which a drug is beneficial to the user has no bearing on whether the user has a disorder, though. Barry Bonds benefitted greatly from steroids, but he clearly did not have any physical disorders before he started taking them.

  32. Ritalin, so much easier than parenting.

  33. We don’t say that a woman who is 5’2″ has height deficit disorder, or that a man who is 6’4″ has excessive height disorder.

    Yes & No. Those with extreme height deviance (<4ft & >7ft) are treated as abnormal, but their prevalence is much less than those purportedly with ADHD. Secondly, height is an easily recognised single-variable trait, and its variance is readily tolerated because barring few select occupations like basketball, it does not affect (or rather, hasn’t been shown to robustly correlate with) performance. Strong differences in something fundamental as attention span will affect most spheres of your life. Moreover, there are “vast differences” in attention span, but it’s their distribution, which is important. Consider IQ (ignore its utility for now) distribution, 50% are between 90-110. 85% between 75-120. Those left out are double of those supposedly with ADHD (5 to 8%).

    Labelling a ‘disorder’ is a social value judgement, but since one has to function within society, it is simply a message that your attributes are beyond a fuzzy threshold, hence considered maladapted. This is all probabilistic. You may have severe untreated ADHD and be a billionaire, but we are talking likelihood here. If your typical ADHD can fit in better, via medication, then so be it.

    The extent to which a drug is beneficial to the user has no bearing on whether the user has a disorder, though.

    Sure, no fixed bearing to those labelled with a ‘disorder’, but certainly with a bearing to your individual biochemistry. To the extent that disorder diagnosis is rigorous, then there is a bearing with having a disorder. In the case of ADHD specifically, drugs alter the activity profile of catecholamine neurotransmitters, notably dopamine, the same chemical implicated in parsing reward value of the euphoria of these drugs. There are various hypothesis that diagnose ADHD to be a result of some dopaminergic malfunction (since, surprise, getting distracted may be a result of not being attracted enough to a task i.e. reward value), so it’s not unreasonable that the benefit of these drugs is related to the state of your brain.

  34. Litmus Paper,

    Er, but we do. We do say that an adult under 4’10” in height suffers from dwarfism, and we know that in many cases it is associated with abnormal bone structures, degenerative joint disease, glandular disorders, etc.

    We also identify people with blood pressure or cholesterol levels outside a certain range as having a disorder. Damn those cardiologists and their need to label everything! Who are they to dictate to you what’s “normal”?

  35. The extent to which a drug is beneficial to the user has no bearing on whether the user has a disorder, though.

    This is easily seen to be false. If you aren’t in pain, drugs like Tylenol and Advil will do nothing for you. If you don’t have a bacterial infection, antibiotics will have absolutely no beneficial effect. If you don’t have cancer, chemotherapy drugs will have absolutely no beneficial effect and many harmful effects, possibly including death.

  36. t.rev. is correct.

    Which is why some find pot useful and some don’t.

  37. This is weird. Now why would the hallucinations tend to feature insects, snakes or worms?

    Delusional Parasitosis and Formication

  38. ADHD is just as real.

    Real or not, if you like taking ritalin (or whatever), go for it: the “Vice Guide to Sex and Drugs and Rock and Roll” has a handy chart indicating what to tell a doctor to get him prescribe whatever you want.

    FWIW, I’ve noticed that a high proportion of crack smokers are hyper, and are more hyper before they smoke.

  39. Sleeping pills will make you sleep, even if you don’t suffer from insomnia. Steroids will make you stronger even if you do not have any physical ailments. Stimulants will make you more alert and focused, even if you don’t have a short attention span.
    If, for any given person, the benefits of stimulant use outweigh the costs, then they should use them. There is nothing fundamentally wrong with using performance enhancing drugs.

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