Chapter 5 – Drug Therapy – for Lay People
It’s important to distinguish between which one of the triad of symptoms of ADHD (inattention, impulsivity, hyperactivity) is predominant in a child & decide if drugs will help. A rule of thumb is – if impulsivity is major child will deteriorate with drugs. 20% of children with inattention & moderate hyperactivity will respond to a morning dose for school hours only. A dose frequency more than that will cause down regulation of receptors needing a higher dose of methyl phenidate. That causes undesirable side effects. Give a drug holiday. Don’t give the drug daily. Give only the minimum dose once a day.
Unwarranted Drug Therapy
As the drug companies and organized psychiatry have sought larger markets for pharmaceutical products, children have come under extensive abuse from the psychopharmaceutical complex. The first great assault took place in the form of diagnosing children with ADHD and then medicating them with stimulant drugs. Soon millions of children were defined as mentally dysfunctional or defective and were submitted to brain-damaging psychoactive medications.
A new pattern emerged as doctors began to treat the adverse drug reactions to stimulants—including over-stimulation, insomnia, agitation, behavioral abnormalities, depression, suicidality and violence, mania and psychosis—with increased numbers of additional psychiatric drugs. They usually did this without explaining to the parents that the drugs were causing the newly developed symptoms.
Millions of children are growing up with drug-intoxicated brains. They are given no hope that they can learn to control their own behavior and grow up to be effective adults—goals they will never achieve with medication-drenched brains. Many drug-treated children will suffer from irreversible brain changes that hamper their mental life. In the case of stimulants, many will have their growth stunted and become prone to cocaine addiction in young adulthood. As a result of neuroleptics like Zyprexa, Risperdal and Abilify, many will suffer from development delays and from tardive dyskinesia with its irreversible abnormal movements that impair and stigmatize them.
| Taken together, the evidence indicates that high levels of catecholamine release initiated by the amygdala during stress switch the brain from thoughtful, reflective regulation by the PFC to more rapid reflexive regulation by the amygdala and other subcortical structures. These mechanisms might save our life when we are in danger and need to react rapidly, but they can be detrimental when we need to make choices that require thoughtful analysis and inhibitory control. | Child is wired up for reflexive behaviour rather than creative play & thoughtful action |
Amygdala
| Stress to children come thru excess digital stimulation | |
| The amygdala plays a key part in changing the neurochemical environment of the PFC during stress. Lesions to the amygdala prevent the increase in dopamine and noradrenaline release that occurs in the PFC in response to a psychological stressor81. As shown in BOX 1, under stress conditions the amygdala projections to the brain-stem and to the hypothalamus stimulate the release of catecholamines and glucocorticoids throughout the neuraxis. These high levels of catecholamines and glucocorticoids strengthen amygdala functions, such as fear conditioning and consolidation of emotionally relevant information79,80, but weaken PFC functioning; thus they shift the orchestration of brain responses from the PFC to the amygdala... | Digital Stress makes children to act out the input from Amygdala on ventero-medial PFC while dorso- lateral PFC is subdued. Undesirable Option occurs. Non-preferred direction on the ODR. This is the problem with ADHD. |
| High levels of catecholamines also strengthen the functioning of other subcortical brain regions and posterior cortical areas. For example, high levels of noradrenaline acting at α1– and β-receptors enhance memory consolidation processes in the hippo-campus82,83 and increase the signal/noise ratio in primary sensory cortices84–86 | This explains why ADHD children are very sensitive to visual & auditory input. Too over wired for in this area craving more colour, more sound, more screech, more cartoons. |
| Higher levels of dopamine release also promote habit formation in the basal ganglia87. It is possible that high levels of dopamine release in corticobasal ganglia circuits during stress serve to capture whatever successful behaviour has just rescued subjects from danger and engrain this pattern as a habit. But this same evolutionary solution could make humans vulnerable to maladaptive behaviours (for example, motor tics, drug addiction and auditory hallucinations) when an inappropriate behavioural pattern is ‘captured’ by high dopamine levels | Habit of risk taking. This is why ADHD children get addicted to dangerous power play games. Later they attempt risk & peril |
| Taken together, the evidence indicates that high levels of catecholamine release initiated by the amygdala during stress switch the brain from thoughtful, reflective regulation by the PFC to more rapid reflexive regulation by the amygdala and other subcortical structures (BOX 1). These mechanisms might save our life when we are in danger and need to react rapidly, but they can be detrimental when we need to make choices that require thoughtful analysis and inhibitory control. | Child is wired up for reflexive behaviour rather than creative play & thoughtful action
Top down regulation by PFC to subcortical structures is deficient. Down to top regulation by amygdala over firing has taken over. |
Benefit of Methyl phenidate comes from stimulating post synaptic α2a in the over aroused Reticular formation. When MP is given once a day minimal dose during school hours. No MP for weekends. Minimal dose of MP acts on α2a but with increasing dose, the receptor specificity is lost & side effects increase.