ADHD Pill Faces High Hurdle in Europe as Stigma Persists

In the US, the mentally ill are still often criminalized, and care for mental patients has shifted disturbingly from hospitals to prisons...

Mental illnesses predispose for bad health care coverage...

I certainly agree that major depressive disorder is a real problem, and drugs help it.

But there are two problems with the current consensus that I take issue with.

One is the that it's easy to medicalize normal human variation. Two years ago after an intense battle, I lost my mom to brain cancer. That same year, I lost three other people and had some other majorly bad things happen. At some point I talked to a therapist about depression. She agreed I matched the symptoms, but disagreed that I was depressed. I was grieving, and in her view I should work through it, no matter what other people thought.

I retrospect I can see she was right; I had work to do. But at the time, it would have been very tempting to take a pill that suppressed the symptoms. That's certainly what some people who told me I should be "over it by now" thought I should do. Our current society just doesn't have a lot of room for that.

The other problem I have is that we are putting things like depression all on the individual and some posited internal flaw. I think that's a lazy and disrespectful conclusion given the state of the art. For example, we are discovering that nighttime artificial light triggers depression in animal studies, and we know simulated extra daylight during the day can treat it in humans. For those people, their depression isn't a disease, it's an unintended consequence of our artificial environment. Daily pills to shift brain chemistry are one solution to the problem, but they aren't the only solution.

I think the disease model of medicine has been incredibly successful in improving human lives. But it has limits, and I think mental health is one area where we are overfitting the data to our model.

> What about depression? OCD? Anxieties? Are they "physical ailments with psychological symptoms"?

No one knows, and anyone who claims to know is speaking without any scientific backing. This will eventually change, primarily because of a move away from psychology toward neuroscience, but this is not going to happen quickly.

I will say this. Eventually "mental disorders" will all be either abandoned or turned into treatable biological disorders, diseases with know causes, just like medicine. But that's not around the corner -- it will take years or decades.

A neuroscience operation was recently performed on a woman who was so depressed that her life was essentially over -- she was institutionalized, unable to function at all. In the procedure, a location in the brain called "area 25" was stimulated using criteria that had worked with laboratory animals.

When the electric field was applied, the woman's depression lifted instantly -- instantly. The procedure is still experimental and is not safe for ordinary cases of depression, but it shows where we're headed:

"A depression switch?" : http://www.nytimes.com/2006/04/02/magazine/02depression.html...

It is examples like this that explain why I and many other people are advocating a move away from psychiatry and psychology -- the resources being expended on those activities are being wasted, and are taken away from things that might work.

> ADHD has been well validated.

So has Bigfoot. The difference between Bigfoot and a Grizzly bear is tangible evidence.

Want to prove that ADHD is real? Meet science's requirements, primarily a defined cause, unambiguous evidence, and falsifiability -- the possibility of definitively saying that a given person does not have ADHD.

This is not to argue that ADHD doesn't exist -- it is to say that this is not a matter of science, and until there's some science, anyone can claim to have ADHD, or PTSD, or Asperger's, or claim to have been raped by her father when she is in fact a virgin:

http://www.stopbadtherapy.com/retracts/beth.shtml

There will eventually be science where psychology now stands. But that process cannot begin until people begin to adopt a skeptical outlook appropriate to the subject's unscientific basis.

This is why the NIMH has decided to drop the DSM, and psychiatry along with it.

http://www.newyorker.com/online/blogs/elements/2013/05/the-s...

> Asperger's wasn't "removed" from the DSM-IV, as you claim

First, I never said any such thing. Asperger's was removed from DSM-5, not DSM-IV.

Second, Asperger's was removed from the current DSM, i.e. DSM-5. It was removed because, as one of the voting committee members said, "it's not a evidence-based term."

Asperger's wasn't "folded into" anything. It was recognized as a condition that was so vaguely defined that it could mean anything or nothing. What was folded in the the autism spectrum are those individuals who actually want continued treatment for something less romantic and more stigmatizing.

It wasn't Asperger's that was folded into the autism spectrum, it was those people who, after losing the chance to have a mental illness diagnosis in common with Bill Gates and Albert Einstein, still plan to have anything to do with psychiatry or psychology.

Nothing at all. Methamphetamine, which is not very different than the dextroamphetamine in Adderal, has proven to be a remarkably safe substance and in general, society benefits a great deal when people ingest methamphetamine. I'm sure schoolchildren being prescribed dextroamphetamine to take every single day for years is a very good idea as well.

I disagree, and I'm confident sane history will eventually look back in horror at the idiots giving their kids amphetamines willy-nilly.

Perhaps some children need this. The vast majority receiving these drugs would benefit a lot more from realistic parenting and school situations than from a toxic, addictive stimulant pill.

My mother was only just recently diagnosed with ADD (After having 2 out of her 5 children with the same ADD/ADHD diagnosis). This was AFTER dealing with depression and various diagnoses including bipolar. She is in therapy to not only manage her ADD, but also deal with all the issues as a result of a lifetime of unmanaged ADD. I have ADD, but was diagnosed young, I learned how to manage and only went on meds when I was mid 20's since my non medical management didn't work well outside a structured school setting (and barely did in highschool/college). My depression and anxiety are made worse if not caused by ADD and has affect social and work life (good and bad). While I agree that ADD/ADHD can be overdiagnosed and even possibly overmedicated, I agree that not having a diagnosis can cause a worse life than otherwise.

This was my experience as well. After 6 months on adderall I had already shown signs of addiction (dosage was needing an increase in order to maintain its effectiveness). I have been on the same dosage of Vyvanse for 4 years now, without any problems.

How exactly is it supposed to work then? People don't recognize the symptoms of mental disorders in themselves or others. Sure, you can tell if someone is having an extreme psychotic episode, or an extreme depression. In less extreme cases outwardly "harmless" symptoms of depression or ADHD are wrecking people's lives.

The potential abuse of the system does not mean it doesn't do more good than harm.

Sure. And that's a sign to me that we don't really understand what's going on yet.

Those are interesting to mention in this context. It's a commonplace among hackers that a little OCD or a little Asperger can be beneficial in some circumstances. Indeed, Temple Grandin, perhaps the world's best-known high-functioning autistic, recommends computer programming as a career for people like her. Among artists, the same is true about Bipolar (the book Touched with Fire is an interesting study of why and how that's true).

I think it's relevant that Asperger was a valid diagnosis for a few decades, but it no longer is. (As of DSM-5, people are just placed somewhere on a spectrum of autism.) That's a great sign that we still have a lot to learn.

I'm sure you get this, but I worry that others will misunderstand me, so let me be clear here: I'm not saying that any of these things aren't a problem for people in today's society.

With attention span, for example, high-end classroom-style education and many high-end jobs require a great deal of focus. But that doesn't imply that people with lower-than-average levels of focus are diseased. Indeed, more than half of Americans consume stimulants daily, and many workplaces provide their staff with free stimulants (coffee, Coke) so they can keep up. Many unarguably normal students consume ADHD meds as study aids. If stimulants improve performance for everybody, they can't be considered diagnostic for a problem.

My concern here isn't that people are choosing that. We're half-evolved monkeys; it's great that we can choose who we want to be. My concern is that we're taking natural human variation and medicalizing it mainly because our current educational system finds some of that variation inconvenient.

Those are interesting facts, but I don't think they prove anything about existence of ADHD as an actual disease. Lower-than-average height is also correlated with many diseases but it isn't a disease on its own.

What evidence says it disease? rather simply a normal difference.