Cardiovascular safety of central nervous system stimulants in children and adolescents: population based cohort study

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e4627 (Published 18 July 2012)
Cite this as: BMJ 2012;345:e4627

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This article interested me. I've felt concern over dopaminergic medications in children ever since knowing a childhood friend who was given Ritalin fall into drug dependency.

Some principles seem well established:

Firstly, Dopaminergic agents can promote affective disorders, by hijacking the 'seeking' system (1).

Secondly, there is a scarcity of safety data for methylphenidate looking at social and psychiatric consequences beyond 2 years (2).

Thirdly, Methylphenidate shares pharmacodynamic porperties with cocaine, but is ameliorated by its longer duration of action. Like cocaine, methyphenidate is also a drug of abuse (3).

Fourthly, exposure to one drug of abuse will prime a person for abuse of other drugs, creating a vulnerability which may persist for years and may lead to relapse.

Lastly, many people first experiment with hedonic drugs in their teens.

We then induce a conclusion: that giving children dopaminergic drugs risks promoting addictive, high seeking behaviour in later life?

Who will fund that one?

1. Jaak Panksepp. Affective Neuroscience: The Foundations Of Human And Animal Emotions. Oxford University Press. 2004
2. FDA, Psychiatric Adverse Events Associated with Drug Treatment of ADHD: Review of Postmarketing Safety Data. 3rd March 2006. http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4210b_11_01_Adverse...
3. Misuse and Diversion of Stimulants Prescribed for ADHD: A Systematic Review. Wilens et al. Journal of the American Academy of Child & Adolescent Psychiatry - January 2008 (Vol. 47, Issue 1, Pages 21-31,)

Competing interests: None declared

Felix EK May, Medical Student

Peninsula, John Bull building, Derriford

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Psychotropics in children and adolescents is bad practice. It interferes with the normal development of sensitive, developing nervous systems, and invites iatrogenic conditions. Let’s rethink this practice, and make it a rare last resort.

Competing interests: None declared

Hugh Mann, Physician

Retired, Eagle Rock, MO, USA

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As long as it is remembered that medication alone is not enough for treatment of ADHD. It requires school support also (teachers, guidance counselors) and psychological support for child and parents

Competing interests: None declared

Bernard A. Yablin, ret asst clin prof Peds

URMC-retired, 2021 Winton Rd South Rochester,NY

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