Are ADHD drugs responsible for mental illness in college?

Recently, I “launched” my oldest off to college. As anticipated, it was an intense emotional experience full of joy, sadness, and many things in between. (I have to tip my hat to Beverly Beckham for her piece I was the sun, the kids were my planets that was very helpful. However, I might have written that my child was the sun, a burst of light in our household, and the experience of leaving her is like being temporarily knocked out of orbit as our family re-orients to life without her.)

The same week I received in the mail, in exchange for filling out a questionnaire about a study on diversion — use of ADHD medications by individuals for whom it was not prescribed — this pretty laminated poster of all the drugs currently available for treatment of ADHD.

Statistics indicate that serious mental health problems in the college community are growing at rapid rates. Some optimistically speculate that this is because of decreased stigma for getting care. But I wonder at the paradox of the parallel increase in availability of new psychiatric drugs — I counted 22 different formulations for ADHD medications on that poster — and the rise of serious mental health problems. Could it be that the drugs themselves are responsible for this increase? If the drugs were effective in childhood, shouldn’t we see a significant decline in serious mental illness in college?

How would this work? Starting at a young age, rather than learning to manage stress in the context of supportive relationships, the symptoms are medicated away. The brain is actually wired in relationships, and in the absence of this kind of co-regulation of emotion, the areas of the brain responsible for emotional regulation do not develop properly. All forms of mental illness, including depression, anxiety and attention problems are essentially problems of emotional regulation. Then as the challenges of life increase in complexity, the medications often increase in strength and complexity. Children learn to be defined by their medication and are further estranged from a core sense of self. Add to that unknown side effects on the developing brain, and it is no wonder that there is a significant increase in serious mental illness by the time a child gets to college.

But what about that issue of decreased stigma? That also is likely true. At a superb talk given by a psychology professor at our child’s orientation, we learned about the school’s  “invisible safety net.” It is made up of an elaborate interconnected system of students, faculty and mental health professionals to monitor the emotional well-being of the students. It is all about relationships and connection.

The very existence of this net reduces the stigma of emotional struggles. The fact that the school goes to the trouble to train such an elaborate system of care (sophomore advisors — or “SA’s” — the front line of this system, must apply in January of their freshman year, and they get several weeks of training prior to the start of the school year), conveys to both students and parents that it is normal and expected that people will struggle and need help.

I believe there is something to be learned from this “invisible safety net” model. If we as a country were to implement a model of preventive mental health care, we would have in place a net made up of primary care clinicians, early childhood educators, childcare workers, mental health care professionals, as well as others who come in contact with young children and families. There would be open and expected lines of communication. (At this college, if a parent calls with a concern about their child, within the hour there is a person making face-to-face contact with that student, even if it is just inviting them out for a slice of pizza — and that person is trained to recognize when it is necessary to call in a higher level of intervention.)

If such a net were there from infancy — including a system for identification and treatment of perinatal mental health problems- — through adolescence, then maybe kids wouldn’t need all those pretty little pills to take to college.

Claudia M. Gold is a pediatrician who blogs at Child in Mind and is the author of Keeping Your Child in Mind.

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  • CG

    Kindergarten… and the chronic stress that kids are exposed to starting at this stage… is the cause of mental illness in college.

    • adh1729

      You meaning to imply that children should be cared for in families? By their parents? Horror of horrors. Children do far better when cared for by strangers. That’s why we spend all those countless billions to run schools, day care, summer camps, etc. Get the kids away from the parents, before the parents have a chance to ruin them!!! And get those parents into the work force making widgets! Else how can we compete with the widget factories from China?

  • mmer

    // Why does a hyperactive child improve with a stimulant?//

    Because at therapeutic doses, they don’t act like stimulants and the “paradox” is solved.

    Study uncovers how Ritalin works in brain to boost cognition, focus attention
    Mounting behavioral and neurochemical evidence suggests that clinically relevant doses of Ritalin primarily target the PFC, without affecting brain centers linked to over-arousal and addiction. In other words, Ritalin at low doses doesn’t appear to act like a stimulant at all.

    “It’s the higher doses of these drugs that are normally associated with their effects as stimulants, those that increase locomotor activity, impair cognition and target neurotransmitters all over the brain,” says Berridge. “These lower doses are diametrically opposed to that. Instead, they help the PFC better do what it’s supposed to do.”

    Also see:

    Mystery of Psychostimulant Paradox Solved
    “Psychostimulant drugs are effective for the treatment of
    attention-deficit hyperactivity disorder (ADHD) because when they activate the dopamine D4 receptors in the basal ganglia and thalamus, they depress, rather than enhance, motor activity, new research shows. The finding, from research done in rats, is published in the February 2012 issue of Neuropharmacology and solves the decades-long mystery of how psychostimulant drugs calm, rather than exacerbate, hyperactivity..”

  • Annie

    “If the drugs were effective in childhood, shouldn’t we see a significant decline in serious mental illness in college?”

    If any of the psychotropic drugs we’re handing out like lollies were truly effective, you’d think we’d see a significant decline in serious, disabling mental illness in the community.

    But we don’t.

    In fact, we now have an “epidemic” of anxiety, depression, etc, even among children, and even as prescribing rates have skyrocketed. Our suicide rate is reversing a long trend of steady decline and starting to rise again.

    For all of the tens of millions of prescriptions of various psychotropic drugs being doled out and eagerly consumed, are we, and our children, and better off, mental health wise, than we were in the past?

    How many Americans are on disability today for mental health issues, — absolutely positively too disabled to do any job of any kind — compared to 40 or 50 years ago?

  • Suzi Q 38

    A couple of teachers hinted that our son had ADHD.
    I didn’t think he was that bad, as I saw boys that were far worse.
    I listened to the teachers, gave them my phone number, told them to call me when there was a problem.
    I also told them that he was a boy, and NOT a girl, so therefore he was not going to sit with his hands folded all day long.
    I also reminded them that some girls are just as active.

    I worked hard, by staying in touch with teachers, helping out, buying them gift cards at Staples, and eventually the infractions decreased to once or twice a year.

    No meds.

    He is really smart, has good business sense, and is a gifted computer engineer. He likes to run his own business. He has a better social life than I do.

    He never had a psychologist or psychiatrist.
    Drugs are not always the answer.

  • KJK

    This was very interesting to read I never realized that there could be a connection between mental illness and formation of relationships and support.

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