(Read this article on The New York Times website)
A teenager complains of difficulty concentrating. The doctor is consulted. The teenager does not meet formal criteria for A.D.H.D., but the doctor says, “Why not try Adderall? Let’s try it and see whether it helps.” A prescription is dispensed. The student reports more energy, improved ability to concentrate, even a happier mood. Everybody’s pleased. What’s not to like?
“Let’s try it and see whether it helps” is a good strategy only if the risks of medication are known to be low. But that’s not true with regard to medications like or Focalin or Metadate or Concerta or any of the other stimulants popular for A.D.H.D. There is now substantial evidence that these medications may damage the nucleus accumbens, an area of the brain crucial to motivation and drive. The nucleus accumbens is not involved in cognitive functions like learning and memory. If the nucleus accumbens is damaged, there will be no impairment of cognitive function. But the motivation to achieve will be diminished.
If your doctor says ‘Let’s try it and see whether it helps,’ find a new doctor. A.D.H.D. drugs may cause long-term brain damage, reducing motivation.
I have seen many such people, mostly young men, in my own practice. This boy was on Ritalin as a child and then Adderall as a teenager. Now he spends most of his time playing video games on his parents’ 55-inch flat screen. He’s 29 years old. He’s guildmaster of his guild in World of Warcraft, but in the real world, he’s nobody. His parents are frantic, but he is content. That may be the end result when the nucleus accumbens is damaged. Medications are not solely to blame for this phenomenon – there are other factors in play – but the fact that this boy was on stimulant medications for many years is most likely a contributing factor.
The next time you hear a doctor say, with regard to prescribing stimulant medications, “let’s try it and see whether it helps,” I suggest that you run – do not walk – to the nearest exit.