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mental health mondays :: a.d.d. it up

so, it turns out that many of you are probably not going to be able to focus on what is written here for long enough to make it to the end of this sentence.

for those of you who are still with me, congratulations. i mention the difficulty focusing because it turns out that many, many more of us seem to be getting diagnosed with attention deficit and hyperactivity disorder. once considered a code term for an obstreperous child who probably needed to get out more, the disorder has become better understood over the last twenty years or so and is identified more in adults these days. [while adults still account for a minority- 44%- of diagnoses, the number of diagnosed adults is increasing rapidly, while cases among children have been at a plateau for several years.] that should be both a relief- people who need treatment will get it- and a concern, because along with increased diagnoses, there will be increased prescriptions and the medications for add/ adhd can be a little scary.

the most common medications for the disorder are all derivatives of methamphetamine. drugs like ritalin, concerta and adderall are all amphetamines [plus of course there is desoxyn, which is chemically identical to methamphetamine, but used as a prescription] and more adults are getting them all the time. given that the conditions for being diagnosed with add are still a little open-ended and that, despite the increased awareness, researchers still can't really tell what causes it [which makes it difficult to cure], the handing out of high-quality meth that seems to work on the symptoms [researchers aren't sure about exactly how they work or why they help either] seems like it could become a little problematic.

in total, medications for adhd are expected to increase by about 13% this year. that's massive. most corporations set even optimistic growth targets at half that and year over year differences in pharmaceutical or over the counter drug sales are often much less [even when they're considered successful]. part of that difference is accounted for by the fact that the affordable care act in the united states has included psychiatric medications among those that must be covered by insurers, which means that people who get prescriptions are more likely to fill them. but the the growth in sales is not exclusive american phenomenon.

in fact, the growth in the add "market" is growing much faster in other parts of the world. parts of asia where there is a greater emphasis on high productivity, longer working hours and less job security are showing especially high growth rates, which seems to back theories that link adhd to anxiety. [people diagnosed with adhd also have an above average rate of anxiety disorders and depression.] there also seems to be an underlying message that by putting such emphasis on productivity and workplace gains that we are potentially aggravating a health condition, but we've already talked about that.

[now would be as good a time as any to mention that adult adhd and child adhd are not different conditions. in fact, to be diagnosed as an adult, there needs to be some evidence that symptoms of the disorder emerged between the ages of six and twelve. add is believed to begin manifesting at this age for everyone and those who are diagnosed as adults simply weren't identified at a younger age.]

psychiatric professionals are clear that drugs are not a cure for adhd or any mental disorder. they blunt the symptoms in order to make daily life easier, but it's generally through therapy that patients are able to find ways to "correct" their mind and come to terms with the roadblocks it has put up for them. think of it in the same way you would a debilitating physical injury: drugs will calm inflammation and fight infection, but it's through physiotherapy and related practices that you learn to get your limbs to work properly again. but with the wait time to see psychologists running in the months and the cost [because while the drugs may be covered, the therapy to complement it generally isn't] prohibitive to many, treatment remains an incomplete process.

if we are going to seriously address the issue of adhd and seek to reduce its cultural and economic cost, we should be looking at how to treat the entire problem. it is a first step to make sure that drugs are covered, so that they are accessible to those who need them. but we also need to make sure that drugs, especially ones as powerful and contentious as those used for adhd, are not used as a long-term solution. that means making sure that people have access to therapy at little to no cost [as is done for people who have physical conditions like multiple sclerosis, the one with which i am most familiar] and we need to look at other factors like unnecessarily stressful working conditions that might be making the condition worse. otherwise, we're just lining the pockets of drug companies to make ourselves feel better. 

Comments

I (and my psychiatrist) am pretty certain that I have mild inattentive-type ADHD. Looking back at my progress reports from middle school, there were some obvious signs (difficulty focusing in class and working on long-term projects, etc), and I'm kind of surprised that the teachers at my fancy school for gifted children didn't put together the pieces. I've evolved coping strategies over the years (I'm working on a dissertation now, after all), but I still have significant problems with short-term memory and keeping my apartment tidy and such. I could get medication if I wanted it, but I'm hesitant to take what is essentially speed, even if it could improve my life. Honestly, just knowing my diagnosis has made a big difference, as I'm now more compassionate and patient with myself.

Overprescription of ADHD medication is certainly a problem, but that problem has received so much press over the years that, in my opinion, it's increased the stigma attached to ADHD. My friends and family have been reluctant to accept my diagnosis because "you're smart!"--never mind that I forget to turn off the gas burners on my stove regularly.
Kate MacDonald said…
I absolutely agree with you that the criticism of over-prescription has resulted in a sort of backlash. ADHD gets it the worst, but it's also an issue for people with depression and anxiety disorders. There's a tendency for people to assume that a sharp increase in cases and prescriptions means that the condition is really just something that's been made up to describe natural eccentricities.

And you're right- sometimes just being able to put a name to your problem makes things better. It at least gives you something to research and something you can understand, as opposed to just feeling "weird" or incapable.

Please be careful with the gas burners, though. ;-)

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