• Estrogens and antiandrogens prescribed for prostate cancer, and drugs that can act as antiandrogens such as cimetidine (Tagamet), ketoconazole, and cyproterone acetate
• Drugs used to treat benign prostatic hypertrophy (BPH), or enlarged prostate
• Antihistamines used to treat colds and allergies
• Heart drugs, including drugs that lower blood pressure, beta-blockers, calcium channel blockers, ACE inhibitors, and angina drugs
What Do They Do in the Body? These drugs work by increasing blood flow into the penis. Cialis works for up to 36 hours and has been approved for daily use. Cialis and Viagra have also been approved for the treatment of pulmonary arterial hypertension.
What Are They Prescribed For? Erectile dysfunction (ED), or impotence—the inability to get an erection.
What Are the Possible Side Effects? The most common side effects are nausea, back pain, muscle aches, flushing, stuffy or runny nose, impaired or blurred vision, and sudden hearing loss. Other less common side effects can include photosensitivity, eye pain, facial swelling, high blood pressure, very low blood pressure, palpitations, rapid heartbeat, joint pain, muscle pain, rash, and itch. All of these drugs can cause priapism, in which the penis does not return to its flaccid state within four hours. This should be considered a medical emergency and can cause damage to the penis that can result in permanent impotence. These drugs can also cause a heart attack.
CAUTION!
• If you have any type of heart disease or blood vessel disease, do not take this drug without consulting a doctor.
• These drugs can cause vision to change, casting a blue tint over everything. Pilots aren’t allowed to use them before they fly, because they can’t see the numbers on the instrument panel.
Natural Remedies for Impotence
Let’s find out more about natural remedies for impotence. If you’d like a great, Viagra-free sex life—for the rest of your life—the first step is good food, good vitamins, regular exercise, and remembering that a little bit of tenderness goes a long way with your partner. But we also want to let you in on a little secret, backed up by scientific studies. The herb Ginkgo biloba isn’t just great for improving blood flow to the brain and improving memory, it improves blood flow everywhere!
Even if you haven’t been diagnosed with atherosclerosis (clogged arteries), impotence is nearly always a sign that circulation in the penis isn’t as good as it could be. See Chapter 10 on drugs for heart disease for natural remedies for better circulation.
Ginkgo Biloba
This herb, originally from China, is well-known for improving memory by improving circulation to the brain, but it is also known to improve erectile function in those with mild blood vessel disease. It is very gentle and safe and works best when taken daily.
Yohimbine
Made from the bark of the yohimbine tree, this product has been patented for use as a prescription drug called Yocon or Yohimbex. This is a potent stimulating substance, so a man with any type of heart disease should check with his doctor before using it.
Ginseng
This root is known as an adaptogen, which is a substance that tends to bring the body into balance. Its balancing effect increases energy and stamina. Ginseng and ginkgo together is a good herbal tonic for men to use regularly, as they both have a balancing and tonifying effect throughout the body.
Ashwagandha
This is an herb originally used in Ayurvedic medicine in India. Like ginseng, it is a tonic herb and was traditionally used to improve libido and sexual performance.
Arginine
The amino acid arginine is involved in the production of the neurotransmitter and artery-relaxing substance nitric oxide. If you remember, Viagra has its effect through relaxing the arteries in the penis. Arginine has a similar effect on some men, although it is not as potent. Try 1,200 to 1,500 mg of L-arginine on an empty stomach.
Chapter 23
Drugs for Attention Deficit/Hyperactivity Disorder and Their Natural Alternatives
Attention deficit/hyperactivity disorder (ADHD) is believed to affect 1 in 20 American children. As of 2008, between 4 and 12 percent of children in the United States—depending on whose estimate you trust—were said to meet the diagnostic criteria for this disorder. About 56 percent of those children end up being prescribed medication to control their behavior. In some communities, one in five children is on Ritalin or another ADHD drug. These children are currently taking one of a class of stimulant drugs that includes Ritalin, Adder-all, Concerta, Dexedrine, and Metadate.
One to two million more children are being prescribed the selective serotonin reuptake inhibitors (SSRIs), including Prozac, Zoloft, and Paxil; other antidepressants, such as Wellbutrin, Effexor, and trazodone; the antipsychotic drugs Risperdal, Zyprexa, and Haldol; anticonvulsants such as Depakote and Tegretol, used to treat mood disorders and to control anger, irritability, and aggression; and the blood pressure drug clonidine to control inattention, impulsivity, and insomnia. In many instances, kids with behavior problems end up taking a “cocktail” consisting of two or three of these drugs. In 2003, spending on psychotropic drugs for children surpassed spending on antibiotics and asthma medications.
Psychiatrists openly admit that little to nothing is known about these drugs’ long-term impact when given to children. On “The Medicated Child,” a PBS “Frontline” special that aired in 2007, psychiatrist Patrick Bacon said, “It’s really to some extent an experiment, trying medications in these children of this age. . . . It’s a gamble. And I tell parents there’s no way to know what’s going to work.” Parents find themselves faced with a choice between giving their children potentially dangerous drugs for life or having a child who could hurt him- or herself and others and fail socially and academically. Dr. Steven Hyman, a former director of the National Institute of Mental Health, told “Frontline”: “I think the real question is, are those diagnoses right? And in truth, I don’t think we yet know the answer.”
And ADHD isn’t just for kids anymore; nor are the drugs used to treat it. According to a survey of over 3,000 randomly selected American adults between ages 18 and 44, about 4.4 percent of U.S. adults match the diagnostic criteria for ADHD. Drugmakers have made it quite easy for adults to take an ADHD “self-test” online or in magazines, which encourages them to ask their doctors about being diagnosed and treated. Both men and women are being prescribed ADHD medication at increasing rates. For both adults and children, substance abuse is a major concern with the drugs discussed in this chapter; for more on this, refer to Chapter 2.
ADHD isn’t only about hyperactivity anymore, either. There is now an “inattentive” variant of attention deficit disorder (ADD), which is said to be more common in girls. If a child tends to daydream, makes careless mistakes, fails to pay attention to details, can’t pay attention for a long time, is a poor listener, fails to follow through on tasks, is poorly organized, loses things, or is easily distracted or forgetful . . . he or she, too, may end up being pegged as ADD and in need of medication.
Did you know that Winston Churchill had “symptoms” of ADHD as a child? He struggled in school. How would the world be different today if he had been given Ritalin? What about John F. Kennedy, Jr.; Ludwig van Beethoven; Benjamin Franklin; or the Wright Brothers? It has been said that all of these men might have been diagnosed with ADHD if the Diagnostic and Statistical Manual of Mental Disorders (the diagnostic “bible” of the American Psychiatric Association) had existed in their childhood days.
The ADHD diagnosis was created in its present form in the 1980s. For decades before that time, it was recognized that some kids were more active and impulsive than others. Psychiatry called this impulsivity by various names, including “defect of moral control,” “post-encephalitic behavior disorder,” “minimal brain dysfunction,” and “hyperkinetic disorder of childhood.” It took until the 1980s for psychiatry to name and describe the modern version in the Diagnostic and Statistical Manual of Mental Disorders.
As early as the 1930s, low doses of stimulant drugs were used to try to modify the behavior of children with these diagnoses.
It was not until the 1960s that these drugs were widely used for this purpose. During that decade, the notion of biochemical psychiatry really began to catch on. Studies with drugs such as LSD showed that even tiny amounts of certain substances could cause enormous alterations in thoughts, perceptions, and behaviors. If this were so, they reasoned, abnormal behavior must be caused by alterations in the natural substances that carry information through the nervous system. From there, it was a short leap to the idea that by giving them drugs, we could “improve” anyone who seemed psychologically “abnormal.” The question is who gets to define what is normal and abnormal, and what are the implications of allowing the mass medication of children, and adults, based on that definition?
In 1996, Adderall was approved by the Food and Drug Administration (FDA) for treatment of ADHD. Since then, use of these drugs has skyrocketed, and the brands and varieties available have multiplied. At this writing, over 2.5 million children are taking ADHD drugs in United States alone. Growth of ADHD drug use in girls between birth and age 19 in the years 2000 to 2005: 87 percent. Boys in the same age bracket used 48 percent more ADHD meds in 2005 than in 2000.
The double standard embraced by the medical mainstream is plain: Just say no to drugs, kids, unless a man in a white coat tells you to take them because you aren’t socially acceptable without them. If you’re going to take Ritalin to perform better on a test or stay up all night to study, well, that’s not OK—unless you’ve been diagnosed with ADHD. Keep in mind that some of the drugs used to treat ADHD are identical to speed, used by recreational drug users in search of a high, and that kids can (and do) sell their Ritalin for a pretty penny in the schoolyard.
What are the long-term effects of drugging children with medicines that alter their neuro-transmitter activities, carry very real potential for addiction, and overstimulate their brains? No one knows. And where did this disease come from, anyhow? Why had barely anyone heard of it 20 years ago, and why is it suddenly affecting 12 percent of American boys between the ages of 6 and 18?
Here’s how it happened. In 1980, a group of psychiatrists sat down together at the American Psychiatric Convention and brainstormed a list of 18 common behavior problems seen in children, including inattention and “hyperactivityimpulsivity.” They decreed that a child who had six of the problems on their list would, from that point forward, be diagnosed with attention deficit disorder. In 1987, “hyperactivity” was added to this so-called disease’s name. Once the disease had a name and the diagnosis frenzy began, parents felt reassured that their children’s problems had a name and a definition. And, of course, the drug companies had a new market.
Psychiatry has made a big deal out of ADHD, anxiety, and depression being caused by some sort of “biochemical imbalance” in the brain. This theory proposes to explain why neurotransmitter-tweaking drugs can control symptoms—because they “correct” this so-called imbalance. This has not been proven. There is no scientific proof that any biochemical imbalance is behind any psychiatric disorder. There is no proof that the brains of people who are distractible, inattentive, or hyperactive are any different from those of people who are naturally focused and grounded. Any study that claims to show these differences can be easily refuted.
For example, a series of brain scan studies conveyed that the portion of the brain that controls ADHD symptoms is smaller in people with ADHD than that of non-ADHD people . . . but in truth, all the ADHD patients in the study had been on Ritalin for an extended period. Extended use of stimulant drugs has been shown to actually cause shrinkage of parts of the brain! In various studies, scientists have found relationships between the activity of the neurotransmitters serotonin, dopamine, and norepinephrine and behavior problems in children—but none of these studies has indicated whether these neurotransmitter levels are a cause or an effect of those behavior problems. One study found that giving Ritalin to non-ADHD adults increased dopamine levels in their brains, which made boring math tasks feel interesting and increased their motivation to perform these tasks. This is used to support the biochemical imbalance theory: because the drug calms and focuses people by raising dopamine levels, that means ADHD people must not have enough circulating dopamine in their brains. This theory has never been proven or even vaguely supported by strong scientific research.
Any diagnosis of ADHD is a subjective venture. Behaviors that to one person seem out of the ordinary in terms of attention deficit or hyperactivity may seem par for the course to another. In one telling study from McLean University, some teachers rated none of around 1,000 kids as having ADHD, while other teachers saw the potential for the disorder in almost every boy in the group. Martin Teicher, director of McLean Hospital’s Developmental Bio-psychiatry Research Program, told The New York Times’s Tara Parker-Pope that “teachers differ significantly in their sensitivity and tolerance for certain behaviors.” So do parents, and so do doctors.
We don’t deny that some children and adults have big, life-altering problems with inattention, hyperactivity, impulsivity, and difficulty completing tasks. But these problems are too often diagnosed as a disease state and medicated. Although other nations are getting more keen on diagnosing and medicating children for ADHD, the United States uses by far the lion’s share of the world’s ADHD drugs and has by far the most diagnoses of this disorder. Is there something wrong with our brains that doesn’t affect people elsewhere—or is this another example of America’s tendency to turn to the wonders of pharmaceuticals to solve its problems?
Too little exercise, too much sugar and junk food, inadequate healthy food, too little sleep, and too much TV, video, and computer game time could make even the most levelheaded kid into a problem case who seems to require drugs to achieve calm self-control. Throw in exposure to toxins such as pesticides, plastics, and formaldehyde, as well as exposure to potential allergens such as air fresheners, scented laundry detergents, fabric softeners, and cheap perfumes, and you have a recipe for brain dysfunction in children.
Harvard School of Public Health researcher Philippe Grandjean, M.D., has collaborated for decades with Philip Landrigan, M.D., of New York’s Mount Sinai School of Medicine to investigate the possible impact of industrial contaminants on child brain development. It’s widely accepted that lead, mercury, arsenic, PCBs, and toluene can damage a child’s developing nervous system, but Grandjean and Landrigan have identified a total of 202 industrial chemicals that scientific evidence indicates could be contributing to ADHD, autism, and other brain disorders in children. Half of those are commonly used today and are dramatically underinvestigated in terms of their potential harmfulness to developing brains. In their paper, Grandjean and Landrigan point out that, in the past, years—sometimes, decades—passed between the time that a neurodevelopmental threat was recognized and the time that threat’s use was appropriately regulated (e.g., lead was not removed from paint or gasoline until the late 1970s and early 1980s, nearly a century after its link to childhood illness had been established). These scientists, who have long researched the neurotoxic effects of lead and mercury, don’t want to see the same mistakes made with other neurotoxins. This topic is a tough one because so many children may have already been affected, perhaps irreversibly, perhaps subtly, perhaps profoundly. But we owe it to them and to their children to do all we can to reduce the toxic burden on our most vulnerable citizens: babies and children. We also owe it to them to avoid adding to their chemical burden by dosing them up on psychotropic medications with uncertain benefit and frightening risks.
Making bad behavior into a disease state and medicating it may seem like a viable alternative, but that’s a road that leads only to dead ends. When we change brain function, personality, and behavior with drugs, we are not fixing anything. As soon as people with ADHD “symptoms” stop using the drugs, those symptoms return. This is not because they have an incurable disease, bu
t because they didn’t have a disease to begin with.
Drugs for Attention Deficit/Hyperactivity Disorder
Because these drugs are used most often to treat children, we have addressed parents who are considering giving them to a child to treat ADHD. If you are considering ADHD medications for yourself, the precautions, warnings, drug interactions, and side-effect information on the medicines in this chapter apply to adults as well.
Methylphenidate HCl (Ritalin, Concerta, Methylin, Metadate CD)
Dexmethylphenidate (Focalin, Focalin XR)
What Does It Do in the Body? Drugs in this class have a mild stimulant action on the central nervous system. These drugs are thought to work much like the amphetamines, but their mechanism of action is not fully understood. In the dosages used to treat ADHD, these drugs have what’s known as a paradoxical effect—calming rather than stimulating. Dexmethylphenidate is billed as a “rapid onset” version of methylphenidate, but in terms of its effects and side effects, it is very similar to methylphenidate, with some evidence that Focalin is more effective. In the rest of this section, both methylphenidate and dexmethylphenidate are referred to by the generic name, methylphenidate.
What Is It Used For? Treatment of ADHD and narcolepsy. It has also been used off-label to treat depression in the elderly, for brain injury, HIV infection, and anesthesia-related hiccups, and to treat people recovering from strokes.
What Are the Potential Side Effects? Blood pressure and pulse changes (increased and decreased), rapid heartbeat, angina, irregular heartbeat, palpitations, dizziness, headache, inability to sit still, drowsiness, Tourette’s syndrome (see sidebar “Tourette’s Syndrome”), growth suppression, toxic psychosis, anorexia, nausea, abdominal pain, weight loss (during prolonged therapy), hypersensitivity reactions (skin rash, itching, pain, dermatitis), rebound hyperactivity, nervousness, insomnia, abdominal pain, hallucinations, aggressive behaviors, and vision disturbances. May mask symptoms of fatigue, impair physical coordination, or produce dizziness or drowsiness severe enough to impair driving ability.
Prescription Alternatives Page 57