Not Even Wrong- the inadequate approach to the treatment of ADHD

How ADHD is being treated in a non-datacentric, inefficient and overly expensive manner.

I thought I’d go a little against convention and kick things off with a graphic. To you it’s pehaps a pretty generic looking graph regarding a somewhat divisive, complex topic. To me, it’s a gameplan to fighting something that never sleeps. And even though it’s just a graphical representation of a rather small survey conducted by 23andme, what it really is, in many ways, is a damning indictment of the current methods used to treat ADHD. Looking at the graphic you’ve perhaps noted the worst performer- Strattera. You would be forgiven, reluctantly, for believing that to have been a poor commercial performer- after all, if patients do not seem to like the drug, remotely, how could it possibly be a success? More than being a side-effect ridden, potential depression exacerbating, black box warning labelling drug however Strattera is also what’s known in the industry as a “rockstar drug”. With approx. $162 million dollars of sales in 2012 and $200 million in 2013, in the US alone, Strattera is just one sample of the detritus that pervades the blind approach to the way ADHD is being treated. CBT had a poor showing as well. Cognitive Behaviour Therapy is the latest buzzword put forth by the psychological profession as the newest way to effectively combat ADHD. The very title screams with hubris- an implied assertion that we can change the very way our brain functions through this therapy. The graph indicates however it doesn’t really work. Subjects found coaching and the learning of organisation skills to be significantly more effective. When you take into account the fact that the average senior psychiatrist makes approx. $200,000 per annum in the US, you begin to ascertain a serious lack of cost effectiveness in the way ADHD is being treated.

And this brings me to one of the things I really want to get people to know- exercise and other forms of physical exertion have enormous potential for treating ADHD. Indeed if this graph is accurate, which is contentious due to the small sample size and methodology (ie survey) then governments might be better of subsidising guidance from personal trainers and gym memberships as opposed to putting their faith in psychology. But why did it do so well here? When I informed my psychiatrist I exercised a lot she said “be sure to keep that up, exercise is good for you”. That statement really bugs me. Good is not a quantity, keeping up is not an appropriate goal. In my research I found that rather than exercise being merely good, it can actually treat ADHD. Obtaining better physical condition leads to a whole host of ancillary benefits for people suffering from ADHD- from enhanced HGH production, increased IGF-1 production, higher testosterone levels… a number of components such as these actively increase focus and attention in the brain. They increase motivation and drive too. These benefits are compounded when the subject engages in a more serious form of exercise- training. And it is because of this, and primarily this, that I myself do a pretty tough programme involving high intensity interval training, strength training, hyperthermic training and endurance training. And I need to do more.

But what of effective medications such as Adderall XR and Ritalin LA? How do subjects respond to these treatments? Well one would have to conclude they represent good value for money. I myself am on Ritalin LA and do find it pretty beneficial. I do however get headaches off it, get a pretty bad crash in the evening and pretty much despise the fact its effects lasts for only about 8 hours during the day. And this leads me to the crux of the problem with Ritalin- calling it an ADHD medication is a bit of an insult to human ingenuity. Methylphenidate was originally designed as a blood pressure medication, among other things. As a method for treating ADHD, it is far from an ideal solution. Pharmaceutical companies are aware of this too and are actively developing alternatives- although the patent expiry of certain other ADHD treatments is a catalyst for such R and D as well. (Yeah I’m not a big fan of big pharma companies).

And now to the conclusion of this brief argument- my essay itself lacks quite a bit in terms of evidence. I’m basing a the whole article on a tiny survey- one conducted not by a government or organisation involved in the treatment of ADHD but rather a private company that has done it out of curiosity as much as anything else. But a lot of it corroborates with what people with ADHD have long suspected. ADHDers consistently complain about Strattera. They consistently highlight differing approaches among psychiatrists- they lament over completely inadequate support structures in college and school. But we don’t need to take into account subjective complaints and variable viewpoints- what we need is quantified data- data which is collated, assimilated and analysed. Data which would be allowed to influence the way we’re treating this problem. And that is not being given an adequate chance to occur. Data which is independent of competing interests and politics. Information technology and data analytics is going to obliterate some of the antique methods currently being allowed to persist with respect to the treatment of ADHD. All I’m advocating is we speed up this process- and fast. Nobody needs to agree with this article- we shouldn’t let words decide how we treat this problem- data must be the arbiter, science must be the guidance. I’m not a pessimistic antagonist with regard to the misfiring way we’re treating ADHD- I’m one of the victims who are caught in the crossfire. I just happen to be more angry about it.

Note: The phrase “not even wrong” is a quote attributed to Wolfgang Pauli- a noted quantum physicist. He used the phrase as a dismissal of any argument or hypothesis which is so quizzical and incoherent that it is essentially a null point- that even though proponents might think it’s saying a lot, it’s not really doing or saying anything at all. Contributing nothing, its pseudo-existence is predicated on misinformation and ignorance.

John is a college student in Ireland. It took him 30mg of Ritalin and 2 espressos to write this.