Category Archives: pharmacotherapy

Adderall vs Risperdal.

Why it’s important to optimize stimulant treatment for ADHD before adding other medicationspic-boy-sitting-laptop

As a child, adolescent, and adult psychiatrist seeing people with ADHD, I’m stunned by how many of them arrive in my office already taking medications that no one (including the FDA) ever intended to  be used for this condition.

Stimulants such as Ritalin (methylphenidate) have been used in children to treat symptoms of ADHD since the 1960’s. We have decades of experience as well as substantial research evidence  supporting their effectiveness.  Although stimulants are by no means free of side effects, today we have more sophisticated formulations of these medications that are quite well tolerated by most people.

But it’s surprising how many people bring their ADHD kids to see me, and I find out that someone has prescribed Risperdal or Abilify.  These are not stimulants.  They’re atypical antipsychotics.  They’re not approved for ADHD.  So why are practitioners in the community prescribing them for ADHD kids?

Risperdal and Abilify have been available since the 1990’s, and have been marketed as an alternative to older generation antipsychotics for treating schizophrenia and bipolar illness.  We think that they are less likely to cause  EPS (Parkinson-like symptoms). However they do have some potential serious side effects such increased risk for high blood sugar levels, excess body fat around the waist and increased cholesterol levels.

In 2006 the FDA approved the use of the Risperdal to treat irritability in children and adolescents age  5-17 with Autism.  In 2009 Abilify followed suit and also obtained FDA approval for the same indication in children with Autism.

Since the FDA approved Risperdal and Abilify for use in children with Autism, there has been a substantial increase in the use of these medication to treat aggression and disruptive behaviors in non-Autism kids. Sometimes these medications are prescribed rather quickly before exhausting non-drug treatments or other medications with fewer side effects.

The impulsiveness and hyperactivity of Kids with ADHD can look superficially like irritability. It can take a trained psychiatrist to tell the difference.

It really irks me when new patients come to see me on inadequate doses of  stimulants plus  an antipsychotic. When I ask why the antipsychotic was prescribed, parents often say the following: “I thought that the Risperdal was also for the ADHD.”

Sometimes all that’s needed is for the stimulant to be adequately dosed.

In children with Autism, Risperdal and Abilify can be wonder drugs for  aggression, irritability, and tantrums.  But in kids with ADHD, there are usually better solutions that are safer for the child.

Let’s pay attention to diagnosis. And let’s make sure we use the right medicines at the right doses.

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Filed under Adderall, pharmacotherapy, Ritalin

Is stimulant medication for ADHD addictive?

NYC ADHD specialist child psychiatrist, Roey Pasternak, MD responds to the New York Times.

A New York Times Article, “Drowned in a Stream of Prescriptions,” shares a very sad and chilling story about a college graduate whose abuse of stimulant medication eventually cost him his life. His doctors were aware that he was going through his prescriptions in half the time allotted, but they continued to prescribe it.


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You can easily read this article and come away thinking stimulants are extremely dangerous and something to steer clear of.

But what articles like this leave out is that stimulants do not prescribe themselves. It takes a physician to write the prescription and allow this terrible spiral of events to occur.

Many prescribers don’t spend enough time with their patients to find out what’s really going on. As an child, adolescent, and adult ADHD specialist, I feel it’s essential to spend at least 30 minutes with a patient even for a “routine” medication follow up. Get to know your patients well, and you won’t get fooled as often.

Patients in New York State who are worried about addiction can also take some comfort in that fact that New York State has now put in place the I-STOP program, requiring that every time a physician writes a prescription for Ritalin, Adderall, or any other controlled substance, he or she must perform a search on the New York State Department of Health website to make sure no other prescriber has been refilling that medication.

With the advent of this new mandatory monitoring program, it’s become a lot more difficult for patients to abuse medications.

Yes, it’s true that stimulants can themselves be addictive. But as I wrote in a previous article, young people with ADHD are more likely to become drug-dependent when they’re NOT treated with stimulant medication.

Let’s remember that stimulant medications don’t prescribe themselves. If you have ADHD (remember to get a good assessment to find out), and are seeing a well-trained ADHD specialist, go ahead and ask your doctor about the relative risks of taking vs not-taking stimulant medications.

The answer may surprise you.

© Copyright Roey Pasternak, MD 2014

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Filed under Adderall, pharmacotherapy, Ritalin

Does medication for ADHD lead to drug abuse? An ADHD specialist child psychiatrist speaks out.

  • “Is there an association between ADHD and drug abuse?”  Yes.  But the association is with the ADHD itself — NOT the medications we use to treat it.  Untreated ADHD clearly leads to higher rates of substance use.   Kids with ADHD are also more likely to also have conduct problems such as lying, stealing, and skipping school, and all these are are known to contribute to substance abuse.

    But not one study has ever shown that treatment with stimulant medication leads to substance abuse.In fact, research shows the opposite. In large, prospective studies conducted at SUNY Upstate Medical University, adolescents with ADHD who were NOT treated with stimulant medications had a 2 fold increased risk of developing a substance abuse disorder compared to adolescents treated with stimulants.

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    Another recent study published in the New England Journal of Medicine showed that people with severe ADHD symptoms were less likely to commit crimes when they were taking medications. People with ADHD in this study who took their medication had lower rates of criminal activity and were more likely to stay out of prison.

    Cutting the crime rate . . keeping adults out of jail. Now that’s effective pharmacotherapy! And for all my patients who just need some help studying for exams or organizing their lives — it’s not quite as dramatic, but it’s often life-changing.

    Let’s make sure the media conveys this important information — that ADHD treatment reduces substance use and crime.  And let’s put to rest the wrongful idea that ADHD medication causes drug abuse.

    It’s just not so.

© Copyright Roey Pasternak, MD 2014

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Filed under Adult ADHD, pharmacotherapy