Littlemantate

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I was wondering if any of you are in or thinking of going into child psych or even on your child psych rotations-Have you every had an ethical problem treating kids? For example one of the most prescribed drugs is the amphetamine dervis-adderall, ritalin, concerta-all of the like stimulants. Now our common physiology and medicine knowledge tells us (well atleast me) that pumping in stimulants from the age of 6 sometimes and possibly them staying on it for 20-40 years (now with adults staying on more and more) that just is a recipe for all sorts of bad things to happen with BP, ischemia everywhere-etc-you guys know just like the ill-effects of cocaine/meth to a smaller degree-especially over that lenght of time.

Even with the new things that come out, such as ablify for example. I see TONS of that prescribed to kids now for all sorts of things and there is such little data on how most drugs in general effect kids over their lifetime and I guess an inner feeling does not feel right about giving kids meds that potentially have bad long term effects.

Some argue it is worth it because they need the drugs-but how many kids that are pumped full of lots of drugs really are doing "well" in society anyway ya know. Yes a little bit of ritalin or something helps many kids I am sure but other than that, kids on 1 or more AD/s, plus some anxiolitic and bam-the kid is so overmedicated it is unlikely they are that functional anyway.

Anyway, I am not judging meds and children, I know currently they have their place but I guess I just do not want to feel responsible for a kid's possible ill effects later down the line.

Adults are quite different as there are MUCH more studies, especially long term studies on adults and lets face it-the adult and child are just different specimens considering their brains.

Anyway just a thought
 

kevinnbass

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I am not yet in med school, so I don't have the experience that you do, but does not the doctor have discretion in their treatment of patients?
 
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It is a concern for sure. However, after you are in practice and have sat with these patients, their families etc.. and seen how disruptive the disorders are, you feel a little differently. FYI, studies have shown those treated appropriately for ADHD with stimulants have much more successful lives than those who are not, with no increase in mortality, and less incidence of substance abuse. Also, the doses of pharmaceutical grade amphetamine are far less than the doses used by meth addicts, not to mention the absence of additives etc... Amphetamine, like opiates in relatively low doses is virtually lacking in adverse physical effects.
 

sdn1977

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It is a concern for sure. However, after you are in practice and have sat with these patients, their families etc.. and seen how disruptive the disorders are, you feel a little differently. FYI, studies have shown those treated appropriately for ADHD with stimulants have much more successful lives than those who are not, with no increase in mortality, and less incidence of substance abuse. Also, the doses of pharmaceutical grade amphetamine are far less than the doses used by meth addicts, not to mention the absence of additives etc... Amphetamine, like opiates in relatively low doses is virtually lacking in adverse physical effects.

I don't agree that they are lacking in adverse physical effects. There are many adverse effects of both amphetamines & opiates in both children & adults, even at low doses.

It is a balance of risk to benefits & often requires medication changes & dosage adjustments as well as other interventions to treat the adverse effects.
 
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