The U.S. Food and Drug Administration staff did not say the drugs were responsible for the fatalities, but they urged close monitoring for “the rare occurrence of pediatric sudden death during stimulant therapy.”” (Yahoo! News)
Compare this situation to that of antidepressants. On the basis of histrionics and flawed research design, the FDA urged that they not be used in children and mandated the dreaded ‘black box warning’ on the drugs’ prescribing information. I am not sure, but I fear these actions have had a discernible chilling effect on antidepressant prescribing rates, because doctors will be skittish about prescribing them to even urgently depressed patients, some whose lives are in jeopardy from their mental state.
Stimulants, on the other hand, are superfluously prescribed for a condition that is vastly, epidemically, overdiagnosed in a loosey-goosey, unsystematic, irresponsible way. Unlike antidepressants, anyone almost anyone prescribed a stimulant like Ritalin or Adderall, ADHD or not, will feel better and the shoddy diagnosis becomes a self-fulfilling prophecy because a medication is seen to have caused improvement. Again, unlike antidepressants, the drugs have enormous potential for abuse, diversion to the street trade, and addictiveness, because they feel so good to use. Tolerance accelerates use and creates escalating need for higher and higher doses over time. And the cardiovascular consequences, including sudden death, are far from trivial risks.
So one class of drugs with serious dangers prescribed for too little reason to far too many people, for which a ‘black box warning’ would almost surely be a public policy step in the right direction, and have the desireable effect of diminishing the volume of prescriptions, is given a free pass, while the applicability and acceptability of another urgently needed class of drugs for a life-threatening illness is hobbled needlessly. No matter how large the denominator, 51 deaths from stimulants certainly represents a much higher rate of morbidity/mortality than attributable to the antidepressants, and an effect magnified by the diminished necessity for and benefit of stimulants as compared to antidepressants.
Update: FDA Panel Recommends Warning on ADHD Drugs (New York Times )
