by Kelly Patricia O’Meara

Washington Times, Insight Magazine
Vol. 15, No. 24 — June 28, 1999

Despite decades or warnings about the potential for abuse of Ritalin, experts continue to argue that the benefits far outweigh the consequences.

Though shocked by bizarre shootings in schools, few Americans have noticed how many shooters were among the 6 million kids now on psychotropic drugs.

Just three weeks after Eric Harris and Dylan Klebold went on their April 20 killing spree at Columbine High School in Littleton, Colorado, President Clinton hosted a White House conference on youth violence. The president declared it a strategy session to seek “the best ideas from people who can really make a difference: parents and young people, teachers and religious leaders, law enforcement, gun manufacturers, representatives of the entertainment industry and those of us here in government.”

There was, however, complete silence from the president when it came to including representatives from the mental-health community, whom many believe can provide important insight about the possible connection between the otherwise seemingly senseless acts of violence being committed by school-age children and prescription psychotropic drugs such as Ritalin, Luvox and Prozac.

There are nearly 6 million children in the United States between the ages of 6 and 18 taking mind-altering drugs prescribed for alleged mental illnesses that increasing numbers of mental-health professionals are questioning.

Although the list of school-age children who have gone on violent rampages is growing at a disturbing rate – and the shootings at Columbine became a national wake-up call – few in the mental-health community have been willing to talk about the possibility that the heavily prescribed drugs and violence may be linked. Those who try to investigate quickly learn that virtually all data concerning violence and psychotropic drugs are protected by the confidentiality provided minors. But in the highly publicized shootings this spring, information has been made available to the public.

April 16: Shawn Cooper, a 15-year-old sophomore at Notus Junior-Senior High School in Notus, Idaho, was taking Ritalin, the most commonly prescribed stimulant, for bipolar disorder when he fired two shotgun rounds, narrowly missing students and school staff.

April 20: Harris, an 18-year-old senior at Columbine High School, killed a dozen students and a teacher before taking his own life. Prior to the shooting rampage, he had been under the influence of Luvox, one of the new selective serotonin reuptake inhibitor; or SSRI, antidepressants approved in 1997 by the Food and Drug Administration, or FDA, for children up to the age of 17 for treatment of obsessive-compulsive disorder; or OCD.

May 20: T.J. Solomon, a 15-year-old at Heritage High School in Conyers, Ga., was being treated with Ritalin for depression when he opened fire on and wounded six classmates.

Two other high-profile cases from last year show a similar pattern:

May 21, 1998: Kip Kinkel, a 15-year-old at Thurston High School in Springfield, Ore., murdered his parents and then proceeded to school where he opened fire on students in the cafeteria, killing two and wounding 22. Kinkel had been prescribed both Ritalin and Prozac. Although widely used among adults, Prozac has not been approved by the FDA for pediatric use.

March 24, 1998: Mitchell Johnson, 13, and Andrew Golden, 11, opened fire on their classmates at Westside Middle School in Jonesboro, Ark. Johnson had been receiving psychiatric counseling and, although information about the psychotropic drugs that may have been prescribed for him has not been made public, his attorney, Val Price, responded when asked about it: “I think that is confidential information, and I don’t want to reveal that.”

A great deal has been written about all of these cases. There have, however; been no indications that all of these children watched the same TV programs or listened to the same music. Nor has it been established that they all used illegal drugs, suffered from alcohol abuse or had common difficulties with their families or peers. They did not share identical home lives, dress alike or participate in similar extracurricular activities. But all of the above were labeled as suffering from a mental illness and were being treated with psychotropic drugs that for years have been known to cause serious adverse effects when given to children.

At the top of the list of so-called “mental illnesses” among children is attention-deficit/hyperactivity disorder; or ADHD, which is diagnosed when a child meets six of the 18 criteria described in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, published by the American Psychiatric Association, or APA.

ADHD was determined by a vote of APA psychiatrists to be a “mental” illness and added to the DSM-IIIR in 1987. By definition, children with ADHD exhibit behaviors such as not paying attention in school, not listening when spoken to directly, failing to follow directions, losing things, being easily distracted and forgetful, fidgeting with hands or feet, talking excessively, blurting out answers or having difficulty awaiting turn. The most common ADHD remedy among pediatricians and representatives of the mental-health community is, as noted, Ritalin.

First approved by the FDA in 1955, Ritalin (methylphenidate) had become widely used for behavioral control by the mid-1960s. It is produced by the Swiss pharmaceutical company Novartis. According to the Drug Enforcement Administration, or DEA, the United States buys and uses 90 percent of the world’s Ritalin. A U.N. agency known as the International Narcotics Control Board, reported in 1995 that “10 to 12 percent of all boys between the ages of 6 and 14 in the U.S. have been diagnosed as having ADD [attention-deficit disorder; now referred to as ADHD] and are being treated with methylphenidate”

But opponents are concerned about evidence they say confirms a close relationship between use of prescribed psychotropic drugs and subsequent use of illegal drugs, including cocaine and heroin. While the United States has spent more than $70 billion on the war on drugs, says Bruce Wiseman, president of the Citizens Commission on Human Rights, a California-based organization that investigates violations of human rights by mental-health practitioners, “if you think the Colombian drug cartel is the biggest drug dealer in the world, think again. It’s your neighborhood psychiatrist putting our kids on the highest level of addictive drugs.”

This complaint is not new and there is a lengthy list of government agencies connecting the prescribed psychotropic drugs to use of illegal substances.

Twenty-eight years ago the World Health Organization, or WHO, concluded that Ritalin was pharmacologically similar to cocaine in its pattern of abuse and cited Ritalin as a Schedule II drug – the most addictive in medical usage. The Department of Justice followed the WHO by citing Ritalin in Schedule II of the Controlled Substances Act as having a very high potential for abuse. As a Schedule II drug, Ritalin joins morphine, opium, cocaine and the heroin substitute methadone.

According to a report in the 1995 Archives of General Psychiatry, “Cocaine is one of the most reinforcing and addicting of the abused drugs and has pharmacological actions that are very similar to those of Ritalin” In the same year the DEA also made the Ritalin cocaine connection, saying, “It is clear that Ritalin substitutes for cocaine and d-amphetamine in a number of behavioral paradigms,” expressing concern that “one in every 30 Americans between 5 and 19 years old has a prescription for the drug.”

Despite decades of warnings about the potential for abuse of Ritalin, experts continue to argue that the benefits far outweigh the consequences. Yet the INCB has reported that “Methylphenidate’s [Ritalin] pharmacological effects are essentially the same as those of amphetamine and methamphetamine. The abuse of methylphenidate [Ritalin] can lead to tolerance and severe psychological dependence. Psychotic episodes [and] violent and bizarre behavior have been reported.”

These are, in fact, some of the same symptoms exhibited by Eric Harris. David Fassler, a child and adolescent psychiatrist and chairman of the APA group on Children, Adolescents and Their Families, says he is unaware of any research to suggest a correlation between the recent cases of violent behavior in school-age children and the widespread prescription of psychotropic drugs. Fassler argues that the number of school-age children suffering from mental illnesses such as depression is “more than earlier believed and it is important that there be a comprehensive evaluation by a mental-health clinician trained in this area.” He stresses that “treatment should be multimodal – not left to medications alone.”

Mike Faenza, president and chief executive officer of the National Mental Health Association, the country’s oldest and largest mental-health group, notes that “there is little known about how the drugs affect brain function.” Faenza adds that “we do know that a hell of a lot of kids commit suicide because they aren’t getting the help they need. It’s irresponsible not to give them the help just because we don’t know what causes the mental illness.”

Opponents are quick to capitalize on this admission. “There is no such thing as ADHD,” declares Wiseman. “It’s not a deficiency of ‘speed’ that makes a kid act out. If you look at the criteria listed in the DSM-IV for ADHD, you’ll see that they are taking normal childhood behavior and literally voting it a mental illness. This is a pseudoscience, entirely subjective. Unlike medical conditions that are proved scientifically, with these mental illnesses the only way you know you’re better is if the psychiatrist says you’re better. That’s not science.”

Pediatric neurologist Fred Baughman not only agrees that there is no such illness as ADHD, but says: “This is a contrived epidemic, where all 5 million to 6 million children on these drugs are normal. The country’s been led to believe that all painful emotions are a mental illness and the leadership of the APA knows very well that they are representing it as a disease when there is no scientific data to confirm any mental illness.”

Peter Breggin, a psychiatrist and director of the International Center for the Study of Psychiatry and Psychology and author of Talking Back to Prozac, Toxic Psychiatry and Talking Back to Ritalin, for years has waged a war with the APA about what he regards as its cavalier diagnoses of mental illnesses. “Psychiatry has never been driven by science. They have no biological or genetic basis for these illnesses and the National Institutes of Mental Health are totally committed to the pharmacological line.” He is concerned that “there is a great deal of scientific evidence that stimulants cause brain damage with long-term use, yet there is no evidence that these mental illnesses, such as ADHD, exist.”

Breggin points out that the National Institutes of Health, or NIH, admitted as much at their 1998 Consensus Development Conference on the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. Thirty-one individuals were selected by NIH to make scientific presentations to the panel on ADHD and its treatment. The panel made the following observations and conclusions: “We don’t have an independent, valid test for ADHD; there are no data to indicate that ADHD is due to a brain malfunction; existing studies come to conflicting conclusions as to whether use of psychostimulants increases or decreases the risk of abuse, and finally after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains speculative.”

If so, there is little evidence to support a scientific basis for classifying ADHD as a mental illness. On the other hand, there is an abundance of evidence that stimulants such as Ritalin can produce symptoms such as mania, insomnia, hallucinations, hyperactivity, impulsivity and inattention. And the DEA’s list of potential adverse effects of Ritalin includes psychosis, depression, dizziness, insomnia, nervousness, irritability and attacks of Tourette’s or other tic syndromes.

While Ritalin is the drug of choice for treating ADHD, other mental illnesses such as depression and obsessive-compulsive disorder; or OCD, from which Columbine shooter Harris suffered, are being treated with new SSRI antidepressants. Harris’ autopsy revealed that he had used Luvox (Fluvoxomine), an SSRI, prior to the shooting spree. And days earlier he had been rejected by the Marine Corps because he was taking the psychotropic drug.

Luvox, a cousin of Prozac, has been approved by the FDA for pediatric use, although research shows that a small percentage of patients experience adverse effects such as mania, bouts of irritability, aggression and hostility. But many physicians still prescribe it to children.

More disturbing to those who believe sufficient evidence exists that prescription psychotropic drugs may play a role in the violence being carried out by school-age children is the response of physicians to the issue. Rather than erring on the side of caution by reducing the number of kids on mind-altering drugs, physicians instead are prescribing psychotropic drugs even to infants and toddlers. The warning label states that “Ritalin should not be used in children under 6 years, since safety and efficacy for this age group has not been established” and “sufficient data on safety and efficacy of long-term use of Ritalin in children are not yet available.”

A report in the July 1998 issue of the Clinical Psychiatric News revealed that in Michigan’s Medicaid program, 223 children 3 years old or younger were diagnosed with ADHD as of December 1996. Amazingly, 57 percent of these children, many of whom are not yet capable of putting together a complete sentence, were treated with one or more psychotropic drugs including Ritalin, Prozac, Dexedrine, Aventyl and Syban. Thirty-three percent were medicated with two or more of these drugs.

But it is Ritalin that is being prescribed to 6 million American children. Children’s Hospital in Washington has been running television advertisements expressing concern. According to its spokeswoman, Lynn Cantwell, the ads were part of a series covering many medical issues. “We wanted to advocate that children get a comprehensive evaluation because we are finding that children were coming in who were taking Ritalin who actually did not have ADHD.”

Wiseman has suggested that the only way to gain control of the situation is to expose widespread “fraudulent diagnoses” of psychiatrists. “Without the diagnoses, you can’t get the drugs,” he says. Baughman’s answer isn’t too far from Wiseman’s. He says, “A big-time class-action lawsuit needs to be filed.”