Kids Need An EKG Before Taking ADHD Meds
18 CommentsBy Ed Silverman // April 21st, 2008 // 8:46 pm
The American Heart Association is recommending that children should be screened for heart problems with an electrocardiogram before getting drugs to treat ADHD, because the meds can increase blood pressure and heart rate. This isn’t a problem for most kids, but the meds - which are stimulants - could make them more vulnerable to sudden cardiac arrest and other heart problems if they already have heart conditions. The AHA also suggests kids already taking one of the pills get an EKG.
About 2.5 million American children and 1.5 million adults take ADHD pills, such as Ritalin, Concerta and Adderall, according to the Associated Press. And the meds already carry warnings of possible heart risks in those with heart defects or other heart problems, although some critics say those were added due to concerns of overuse of the drugs than safety. The AHA is now recommending a thorough exam, including a family history and an EKG, before any child is put on the drugs to make sure they don’t have any undiagnosed heart issues. (AHA statement).
“We don’t want to keep children who have this from being treated. We want to do it as safely as possible,” Victoria Vetter, a pediatric cardiologist at the University of Pennsylvania School of Medicine and head of the committee making the recommendation, tells the AP. She adds that a screening of about 1,100 children found that about 2 percent had some kind of heart problem. “We thought it was reasonable to include the electrocardiogram as a tool for the pediatrician, the psychiatrist so that this would help identify additional children who have heart disease.”
But Steven Pliszka, a child psychiatrist at the University of Texas in San Antonio, tells the AP he’s baffled by the EKG recommendation, because he believes there’s no evidence that sudden death is a bigger problem for kids taking stimulants than for those who aren’t. He adds that an EKG may deter people from seeking treatment because it’s an added expense and hassle. Psychiatrists aren’t likely to have an EKG machine, and pediatricians might not either, making patients go elsewhere to get the test, he argues. Pliszka, by the way, is a consultant to Shire, which sells Adderall, and McNeil Pediatrics, which markets Concerta.
The American Academy of Child and Adolescent Psychiatry recently updated its treatment guidelines for ADHD, and did not recommend routine EKGs, says Pliszka, who was the lead author. “We definitely did not feel we needed to screen everyone,” Pliszka tells the AP, and notes that the AHA doesn’t recommended EKG screening for young athletes to prevent sudden death. The group has said it wasn’t feasible or cost-effective to screen all student athletes.
The label warnings were added after a database review by the FDA found reports of 19 sudden deaths in children treated with ADHD drugs and 26 reports of other problems including strokes and fast heart rates between 1999 and 2003. There were also reports of heart problems in adults; the committee didn’t look at adults.
An ADHD advocacy group called CHADD said parents should monitor their child’s reaction to all medications. EKG screening “will bring an even further measure of safety to what is already a safe clinical treatment approach,” the group said.
The Medical Quack: Kids Need An EKG Before Taking ADHD Meds
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pg
It’s a good idea in that it might help some, but what happens if stimulants CAUSE heart problems in perfectly healthy children and adults, just as they cause other multiple adverse drug effects?
“…Our fourteen year old son Matthew suddenly died on March 21, 2000. The cause of death was determined to be from the long-term (age 7-14) use of Methylphenidate, a drug commonly known as Ritalin.
According to Dr. Ljuba Dragovic, the Chief Pathologist of Oakland County, Michigan, upon autopsy, Matthew’s heart showed clear signs of small vessel damage caused from the use of Methylphenidate (Ritalin).
*The certificate of death reads: “Death caused from Long Term Use of Methylphenidate, Ritalin.”
I was told by one of the medical examiners that a full-grown man’s heart weighs about 350 grams and that Matthew’s heart’s weight was about 402 grams. Dr. Dragovic said this type of heart damage is smoldering and not easily detected with the standard test done for prescription refills. The standard test usually consists of blood work, listening to the heart, and questions about school behaviors, sleeping and eating habits.
*What is important to note here is that Matthew did not have any pre-existing heart condition or defect.…”
( http://www.ritalindeath.com )
pg
Isn’t CHADD a front group for the pharmaceutical industry?
http://www.fightforkids.org/what_chadd_doesnt_tell_you.html
Laurie
“He adds that an EKG may deter people from seeking treatment because it’s an added expense and hassle. ”
This line of garbage is getting very old. If there is ANY cardiac risk an EKG is the least you can do before you drug your child. Unbelievable that ANY doctor would take the above quoted attitude. Disgusting.
pg
Maybe Pliszka doesn’t want EKGs on children because:
Where children (or adults) who have EKGs which show healthy heart states are then prescribed ADHD drugs after EKG ‘clearance’ - if some die the drugs will be under more suspicion?
pg
My guess is that he receives some financial back hander in some way (you know, freebies, shares, ‘educational’ grants, speakers fees,) from a company or companies that make ADHD drugs.
http://www.verusmed.com/pages/editorial_advisors/
“Disclosures: Dr. Pliszka has disclosed he has received grant/research support from Eli Lilly and AstraZeneca. He also disclosed he has served as a consultant to McNeil Pediatrics and Shire and has served on the speakers bureau for McNeil Pediatrics.”
Like - McNeil Pediatrics make Concerta, Shire make Adderall, and so on.
truthman30
The proof that ADHD is a real diagnostic disorder is very dubious. A lot of kids have behavioural problems and become hyperactive because most families have both parents working and it is more the times we live in than an actual ADHD epidemic. Combine that with the massive stimuli that kids have nowadays with cellphones, computers, TV, playstation , sugary drinks and junk food and you have a recipe for disaster.
There is an Irish psychiatrist called Micael Corry and he does not believe that ADHD is a real disorder and compares Ritalin to an Amphetamine …
From the researh he has studied and from decades of clinical practice he reckons Ritalin is highly dangerous and toxic..
http://www.depressiondialogues.ie/
AA
Truthman,
I agree with 99.9% of what you write on this blog but this is one time where I disagree with you. As you are well aware, I am very opposed to the use of psych meds and that includes stimulants.
However, as one who has a strong family history of ADHD, I can tell you the disorder is quite real. If you spend time with someone who has true ADHD, you will see it isn’t an issue of anything else but ADHD.
I am not sure I have ADHD or not but I definitely have a learning disability which occurs commonly with ADHD or by itself. Many people like Breggin and company say isn’t real. As grateful as I am for their research on the dangers of psych meds, it angers me greatly that they comment on something they know nothing about.
I agree that they are definitely over diagnosed. Also, as one whose LD symptoms were greatly worsened by these meds, it worries me greatly that people diagnosed with ADHD/LD whether it is legitimate or not, are being put on them. That is happening to even people just diagnosed with LD.
But please don’t dismiss legitimate disorders just because they aren’t diagnosed correctly. Otherwise, you’re unintentionally dismissing people who struggle with these issues and judging from what you have previously written, I know you would not want to do that.
AA
AA
PG,
As one who has gotten some benefit from CHADD local support groups, I don’t want to totally trash them. But to answer your question, the answer is yes.
What greatly angers me further about this organization is that while they allow drug companies to advertise at will in CHADD magazines, they don’t demand that in return, the companies have plans to help people who can’t afford to pay for the meds. I complained bitterly about this to CHADD headquarters but of course, no one listened.
A few years ago, my health insurance prescription deductible was reached mid year and I was scrambling to pay for meds. I brought some of my meds from Canada but due to US regulations, wasn’t allowed to purchase Adderall from the country. Of course, depending on the insurance plan, you’re allowed to purchase Adderall through a mail order pharmacy. Hmm.
Because the company that made Adderall didn’t have a patient assistance plan, I was forced to pay full price for the drug and it was expensive. I thank god I am off that med as I am without health insurance.
Anyway, fish oil capsules are working great and while they aren’t cheap (at least the brand that I am using isn’t), the risk/reward ratio is a million times better.
AA
AA
Laurie,
The doctor who made that idiotic comment is a consultant to Shire, which sells Adderall, and McNeil Pediatrics, which markets Concerta.
That says it all.
AA
Kelly
On the other hand, it seems like a convenient way to get loads of people to get EKGs and for *those* people to get reimbursements. One can see corruption anywhere you look. People really need to work with their docs as individuals not as part of a statistical group.
truthman30
I didnt dismiss it pg..
I just said that it is diagnostically dubious..
In other words it can and is appled to a range of behaviours in individuals where it is not possible to prove it exists..
That’s danger with all psychiatric definitions..
Almost anyone can be diagnosed with any psychiatric disorder because the symptoms are all behavioural..
And those behaviours are inherent and exhibited in all people to some degree..
My younger brother has a “behviour” disorder, he has dyspraxia, he is correctly diagnosed but he could have been easily diagnosed with ADHD because some of his behaviour has the diagnostic characteristic, luckily he had a very astute psychologist who recognised that his behaviour stems from his dyspraxia..
He is also on medication for epilepsy, and guess what? The side effects listed include aggression, rage, depression, suicidal thoughst etc, the med is also used for bipolar (Keppra) , so it would be very easy for a psychiatrist to diagnose his temper tantrums induced from the med as something else, luckily i keep a close eye on his treatment..
truthman30
Sorry i meant to address that to AA , not pg…
Thanks..
AA
Hi Truthman,
Now I understand. I have a non verbal learning disability which I believe
includes a dyspraxia component. NLD is also commonly misdiagnosed as ADHD.
That is good you are keeping a close watch on your brother. I hope he realizes how lucky he is to have a sibling like you.
AA
Grieving
The poster who lost her child to Ritalin has a good point. Is there a way or protocol to test for heart damage while on these dangerous (and unnecessary ) drugs? And yes, those who test for heart conditions pre taking stimulants would be making money but there should also be some precursors in this situation as well.
I will never forget the little Hispanic boy put on stimulants for ADHD at the encouragement of the school then needing to be rushed to the hospital. He was lucky to survive and his family would never in a million years put him on anything ever again. And don’t think the other parents didn’t take note. The word got around.
Grieving
My sympathies to the parent who lost her child. I know what it’s like, having lost mine to a psychotropic drug as well. It never goes away.
Laurie
Interesting how the cardiologists have no problem with this..yet psychiatry fights it. Once again, witholding medical information for the sake of compliance is NEVER ethical.
Lisa Van S
Laurie,
Maybe Psychiatry has a problem w/diagnosing cardiac Arythmia, prolonged QT,… Maybe the American Heart Association would consider educating the Psychiatric Community… Gee,.. an honest way to earn CME Credits, dont you think?