VIRGINIA BEACH — Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.
It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”
It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.
The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.
Continue reading the main storyMedications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.
Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.
Very few people who misuse stimulants devolve into psychotic or suicidal addicts. But even one of Richard’s own physicians, Dr. Charles Parker, characterized his case as a virtual textbook for ways that A.D.H.D. practices can fail patients, particularly young adults. “We have a significant travesty being done in this country with how the diagnosis is being made and the meds are being administered,” said Dr. Parker, a psychiatrist in Virginia Beach. “I think it’s an abnegation of trust. The public needs to say this is totally unacceptable and walk out.”
Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors.
“Any step along the way, someone could have helped him — they were just handing out drugs,” said Richard’s father. Emphasizing that he had no intention of bringing legal action against any of the doctors involved, Mr. Fee said: “People have to know that kids are out there getting these drugs and getting addicted to them. And doctors are helping them do it.”
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“...when he was in elementary school he fidgeted, daydreamed and got A’s. he has been an A-B student until mid college when he became scattered and he wandered while reading He never had to study. Presently without medication, his mind thinks most of the time, he procrastinated, he multitasks not finishing in a timely manner.”
Dr. Waldo M. Ellison
Richard Fee initial evaluation
Feb. 5, 2010
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Richard began acting strangely soon after moving back home in late 2009, his parents said. He stayed up for days at a time, went from gregarious to grumpy and back, and scrawled compulsively in notebooks. His father, while trying to add Richard to his health insurance policy, learned that he was taking Vyvanse for A.D.H.D.
Richard explained to him that he had been having trouble concentrating while studying for medical school entrance exams the previous year and that he had seen a doctor and received a diagnosis. His father reacted with surprise. Richard had never shown any A.D.H.D. symptoms his entire life, from nursery school through high school, when he was awarded a full academic scholarship to Greensboro College in North Carolina. Mr. Fee also expressed concerns about the safety of his son’s taking daily amphetamines for a condition he might not have.
“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”
Richard’s first experience with A.D.H.D. pills, like so many others’, had come in college. Friends said he was a typical undergraduate user — when he needed to finish a paper or cram for exams, one Adderall capsule would jolt him with focus and purpose for six to eight hours, repeat as necessary.
So many fellow students had prescriptions or stashes to share, friends of Richard recalled in interviews, that guessing where he got his was futile. He was popular enough on campus — he was sophomore class president and played first base on the baseball team — that they doubted he even had to pay the typical $5 or $10 per pill.
“He would just procrastinate, wait till the last minute and then take a pill to study for tests,” said Ryan Sykes, a friend. “It got to the point where he’d say he couldn’t get anything done if he didn’t have the Adderall.”
Various studies have estimated that 8 percent to 35 percent of college students take stimulant pills to enhance school performance. Few students realize that giving or accepting even one Adderall pill from a friend with a prescription is a federal crime. Adderall and its stimulant siblings are classified by the Drug Enforcement Administration as Schedule II drugs, in the same category as cocaine, because of their highly addictive properties.
“It’s incredibly nonchalant,” Chris Hewitt, a friend of Richard, said of students’ attitudes to the drug. “It’s: ‘Anyone have any Adderall? I want to study tonight,’ ” said Mr. Hewitt, now an elementary school teacher in Greensboro.
After graduating with honors in 2008 with a degree in biology, Richard planned to apply to medical schools and stayed in Greensboro to study for the entrance exams. He remembered how Adderall had helped him concentrate so well as an undergraduate, friends said, and he made an appointment at the nearby Triad Psychiatric and Counseling Center.
According to records obtained by Richard’s parents after his death, a nurse practitioner at Triad detailed his unremarkable medical and psychiatric history before recording his complaints about “organization, memory, attention to detail.” She characterized his speech as “clear,” his thought process “goal directed” and his concentration “attentive.”
Richard filled out an 18-question survey on which he rated various symptoms on a 0-to-3 scale. His total score of 29 led the nurse practitioner to make a diagnosis of “A.D.H.D., inattentive-type” — a type of A.D.H.D. without hyperactivity. She recommended Vyvanse, 30 milligrams a day, for three weeks.
Phone and fax requests to Triad officials for comment were not returned.
Some doctors worry that A.D.H.D. questionnaires, designed to assist and standardize the gathering of a patient’s symptoms, are being used as a shortcut to diagnosis. C. Keith Conners, a longtime child psychologist who developed a popular scale similar to the one used with Richard, said in an interview that scales like his “have reinforced this tendency for quick and dirty practice.”
Dr. Conners, an emeritus professor of psychiatry and behavioral sciences at Duke University Medical Center, emphasized that a detailed life history must be taken and other sources of information — such as a parent, teacher or friend — must be pursued to learn the nuances of a patient’s difficulties and to rule out other maladies before making a proper diagnosis of A.D.H.D. Other doctors interviewed said they would not prescribe medications on a patient’s first visit, specifically to deter the faking of symptoms.
According to his parents, Richard had no psychiatric history, or even suspicion of problems, through college. None of his dozen high school and college acquaintances interviewed for this article said he had ever shown or mentioned behaviors related to A.D.H.D. — certainly not the “losing things” and “difficulty awaiting turn” he reported on the Triad questionnaire — suggesting that he probably faked or at least exaggerated his symptoms to get his diagnosis.
That is neither uncommon nor difficult, said David Berry, a professor and researcher at the University of Kentucky. He is a co-author of a 2010 study that compared two groups of college students — those with diagnoses of A.D.H.D. and others who were asked to fake symptoms — to see whether standard symptom questionnaires could tell them apart. They were indistinguishable.
“With college students,” Dr. Berry said in an interview, “it’s clear that it doesn’t take much information for someone who wants to feign A.D.H.D. to do so.”
Richard Fee filled his prescription for Vyvanse within hours at a local Rite Aid. He returned to see the nurse three weeks later and reported excellent concentration: “reading books — read 10!” her notes indicate. She increased his dose to 50 milligrams a day. Three weeks later, after Richard left a message for her asking for the dose to go up to 60, which is on the high end of normal adult doses, she wrote on his chart, “Okay rewrite.”
Richard filled that prescription later that afternoon. It was his third month’s worth of medication in 43 days.
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“The patient is a 23-year-old Caucasian male who presents for refill of vyvanse — recently started on this while in NC b/c of lack of motivation/ loss of drive. Has moved here and wants refill”
Dr. Robert M. Woodard
Notes on Richard Fee
Nov. 11, 2009
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Richard scored too low on the MCAT in 2009 to qualify for a top medical school. Although he had started taking Vyvanse for its jolts of focus and purpose, their side effects began to take hold. His sleep patterns increasingly scrambled and his mood darkening, he moved back in with his parents in Virginia Beach and sought a local physician to renew his prescriptions.
A friend recommended a family physician, Dr. Robert M. Woodard. Dr. Woodard heard Richard describe how well Vyvanse was working for his A.D.H.D., made a diagnosis of “other malaise and fatigue” and renewed his prescription for one month. He suggested that Richard thereafter see a trained psychiatrist at Dominion Psychiatric Associates — only a five-minute walk from the Fees’ house.
With eight psychiatrists and almost 20 therapists on staff, Dominion Psychiatric is one of the better-known practices in Virginia Beach, residents said. One of its better-known doctors is Dr. Waldo M. Ellison, a practicing psychiatrist since 1974.
In interviews, some patients and parents of patients of Dr. Ellison’s described him as very quick to identify A.D.H.D. and prescribe medication for it. Sandy Paxson of nearby Norfolk said she took her 15-year-old son to see Dr. Ellison for anxiety in 2008; within a few minutes, Mrs. Paxson recalled, Dr. Ellison said her son had A.D.H.D. and prescribed him Adderall.
“My son said: ‘I love the way this makes me feel. It helps me focus for school, but it’s not getting rid of my anxiety, and that’s what I need,’ ” Mrs. Paxson recalled. “So we went back to Dr. Ellison and told him that it wasn’t working properly, what else could he give us, and he basically told me that I was wrong. He basically told me that I was incorrect.”
Dr. Ellison met with Richard in his office for the first time on Feb. 5, 2010. He took a medical history, heard Richard’s complaints regarding concentration, noted how he was drumming his fingers and made a diagnosis of A.D.H.D. with “moderate symptoms or difficulty functioning.” Dominion Psychiatric records of that visit do not mention the use of any A.D.H.D. symptom questionnaire to identify particular areas of difficulty or strategies for treatment.
As the 47-minute session ended, Dr. Ellison prescribed a common starting dose of Adderall: 30 milligrams daily for 21 days. Eight days later, while Richard still had 13 pills remaining, his prescription was renewed for 30 more days at 50 milligrams.
Through the remainder of 2010, in appointments with Dr. Ellison that usually lasted under five minutes, Richard returned for refills of Adderall. Records indicate that he received only what was consistently coded as “pharmacologic management” — the official term for quick appraisals of medication effects — and none of the more conventional talk-based therapy that experts generally consider an important component of A.D.H.D. treatment.
His Adderall prescriptions were always for the fast-acting variety, rather than the extended-release formula that is less prone to abuse.
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“PATIENT DOING WELL WITH THE MEDICATION, IS CALM, FOCUSED AND ON TASK, AND WILL RETURN TO OFFICE IN 3 MONTHS”
Dr. Waldo M. Ellison
Notes on Richard Fee
Dec. 11, 2010
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Regardless of what he might have told his doctor, Richard Fee was anything but well or calm during his first year back home, his father said.
Blowing through a month’s worth of Adderall in a few weeks, Richard stayed up all night reading and scribbling in notebooks, occasionally climbing out of his bedroom window and on to the roof to converse with the moon and stars. When the pills ran out, he would sleep for 48 hours straight and not leave his room for 72. He got so hot during the day that he walked around the house with ice packs around his neck — and in frigid weather, he would cool off by jumping into the 52-degree backyard pool.
As Richard lost a series of jobs and tensions in the house ran higher — particularly when talk turned to his Adderall — Rick and Kathy Fee continued to research the side effects of A.D.H.D. medication. They learned that stimulants are exceptionally successful at mollifying the impulsivity and distractibility that characterize classic A.D.H.D., but that they can cause insomnia, increased blood pressure and elevated body temperature. Food and Drug Administration warnings on packaging also note “high potential for abuse,” as well as psychiatric side effects such as aggression, hallucinations and paranoia.
A 2006 study in the journal Drug and Alcohol Dependence claimed that about 10 percent of adolescents and young adults who misused A.D.H.D. stimulants became addicted to them. Even proper, doctor-supervised use of the medications can trigger psychotic behavior or suicidal thoughts in about 1 in 400 patients, according to a 2006 study in The American Journal of Psychiatry. So while a vast majority of stimulant users will not experience psychosis — and a doctor may never encounter it in decades of careful practice — the sheer volume of prescriptions leads to thousands of cases every year, experts acknowledged.
When Mrs. Fee noticed Richard putting tape over his computer’s camera, he told her that people were spying on him. (He put tape on his fingers, too, to avoid leaving fingerprints.) He cut himself out of family pictures, talked to the television and became increasingly violent when agitated.
In late December, Mr. Fee drove to Dominion Psychiatric and asked to see Dr. Ellison, who explained that federal privacy laws forbade any discussion of an adult patient, even with the patient’s father. Mr. Fee said he had tried unsuccessfully to detail Richard’s bizarre behavior, assuming that Richard had not shared such details with his doctor.
“I can’t talk to you,” Mr. Fee recalled Dr. Ellison telling him. “I did this one time with another family, sat down and talked with them, and I ended up getting sued. I can’t talk with you unless your son comes with you.”
Mr. Fee said he had turned to leave but distinctly recalls warning Dr. Ellison, “You keep giving Adderall to my son, you’re going to kill him.”
Dr. Ellison declined repeated requests for comment on Richard Fee’s case. His office records, like those of other doctors involved, were obtained by Mr. Fee under Virginia and federal law, which allow the legal representative of a deceased patient to obtain medical records as if he were the patient himself.
As 2011 began, the Fees persuaded Richard to see a psychologist, Scott W. Sautter, whose records note Richard’s delusions, paranoia and “severe and pervasive mental disorder.” Dr. Sautter recommended that Adderall either be stopped or be paired with a sleep aid “if not medically contraindicated.”
Mr. Fee did not trust his son to share this report with Dr. Ellison, so he drove back to Dominion Psychiatric and, he recalled, was told by a receptionist that he could leave the information with her. Mr. Fee said he had demanded to put it in Dr. Ellison’s hands himself and threatened to break down his door in order to do so.
Mr. Fee said that Dr. Ellison had then come out, read the report and, appreciating the gravity of the situation, spoken with him about Richard for 45 minutes. They scheduled an appointment for the entire family.
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“meeting with parents — concern with ‘metaphoric’ speaking that appears to be outside the realm of appropriated one to one conversation. Richard says he does it on purpose — to me some of it sounds like pre-psychotic thinking.”
Dr. Waldo M. Ellison
Notes on Richard Fee
Feb. 23, 2011
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Dr. Ellison stopped Richard Fee’s prescription — he wrote “no Adderall for now” on his chart and the next day refused Richard’s phone request for more. Instead he prescribed Abilify and Seroquel, antipsychotics for schizophrenia that do not provide the bursts of focus and purpose that stimulants do. Richard became enraged, his parents recalled. He tried to back up over his father in the Dominion Psychiatric parking lot and threatened to burn the house down. At home, he took a baseball bat from the garage, smashed flower pots and screamed, “You’re taking my medicine!”
Richard disappeared for a few weeks. He returned to the house when he learned of his grandmother’s death, the Fees said.
The morning after the funeral, Richard walked down Potters Road to what became a nine-minute visit with Dr. Ellison. He left with two prescriptions: one for Abilify, and another for 50 milligrams a day of Adderall.
According to Mr. Fee, Richard later told him that he had lied to Dr. Ellison — he told the doctor he was feeling great, life was back on track and he had found a job in Greensboro that he would lose without Adderall. Dr. Ellison’s notes do not say why he agreed to start Adderall again.
Richard’s delusions and mood swings only got worse, his parents said. They would lock their bedroom door when they went to sleep because of his unpredictable rages. “We were scared of our own son,” Mr. Fee said. Richard would blow through his monthly prescriptions in 10 to 15 days and then go through hideous withdrawals. A friend said that he would occasionally get Richard some extra pills during the worst of it, but that “it wasn’t enough because he would take four or five at a time.”
One night during an argument, after Richard became particularly threatening and pushed him over a chair, Mr. Fee called the police. They arrested Richard for domestic violence. The episode persuaded Richard to see another local psychiatrist, Dr. Charles Parker.
Mrs. Fee said she attended Richard’s initial consultation on June 3 with Dr. Parker’s clinician, Renee Strelitz, and emphasized his abuse of Adderall. Richard “kept giving me dirty looks,” Mrs. Fee recalled. She said she had later left a detailed message on Ms. Strelitz’s voice mail, urging her and Dr. Parker not to prescribe stimulants under any circumstances when Richard came in the next day.
Dr. Parker met with Richard alone. The doctor noted depression, anxiety and suicidal ideas. He wrote “no meds” with a box around it — an indication, he explained later, that he was aware of the parents’ concerns regarding A.D.H.D. stimulants.
Dr. Parker wrote three 30-day prescriptions: Clonidine (a sleep aid), Venlafaxine (an antidepressant) and Adderall, 60 milligrams a day.
In an interview last November, Dr. Parker said he did not recall the details of Richard’s case but reviewed his notes and tried to recreate his mind-set during that appointment. He said he must have trusted Richard’s assertions that medication was not an issue, and must have figured that his parents were just philosophically anti-medication. Dr. Parker recalled that he had been reassured by Richard’s intelligent discussions of the ins and outs of stimulants and his desire to pursue medicine himself.
“He was smart and he was quick and he had A’s and B’s and wanted to go to medical school — and he had all the deportment of a guy that had the potential to do that,” Dr. Parker said. “He didn’t seem like he was a drug person at all, but rather a person that was misunderstood, really desirous of becoming a physician. He was very slick and smooth. He convinced me there was a benefit.”
Mrs. Fee was outraged. Over the next several days, she recalled, she repeatedly spoke with Ms. Strelitz over the phone to detail Richard’s continued abuse of the medication (she found nine pills gone after 48 hours) and hand-delivered Dr. Sautter’s appraisal of his recent psychosis. Dr. Parker confirmed that he had received this information.
Richard next saw Dr. Parker on June 27. Mrs. Fee drove him to the clinic and waited in the parking lot. Soon afterward, Richard returned and asked to head to the pharmacy to fill a prescription. Dr. Parker had raised his Adderall to 80 milligrams a day.
Dr. Parker recalled that the appointment had been a 15-minute “med check” that left little time for careful assessment of any Adderall addiction. Once again, Dr. Parker said, he must have believed Richard’s assertions that he needed additional medicine more than the family’s pleas that it be stopped.
“He was pitching me very well — I was asking him very specific questions, and he was very good at telling me the answers in a very specific way,” Dr. Parker recalled. He added later, “I do feel partially responsible for what happened to this kid.”
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“Paranoid and psychotic ... thinking that the computer is spying on him. He has also been receiving messages from stars at night and he is unable to be talked to in a reasonable fashion ... The patient denies any mental health problems ... fairly high risk for suicide.”
Dr. John Riedler
Admission note for Richard Fee
Virginia Beach Psychiatric Center
July 8, 2011
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The 911 operator answered the call and heard a young man screaming on the other end. His parents would not give him his pills. With the man’s language scattered and increasingly threatening, the police were sent to the home of Rick and Kathy Fee.
The Fees told officers that Richard was addicted to Adderall, and that after he had received his most recent prescription, they allowed him to fill it through his mother’s insurance plan on the condition that they hold it and dispense it appropriately. Richard was now demanding his next day’s pills early.
Richard denied his addiction and threats. So the police, noting that Richard was an adult, instructed the Fees to give him the bottle. They said they would comply only if he left the house for good. Officers escorted Richard off the property.
A few hours later Richard called his parents, threatening to stab himself in the head with a knife. The police found him and took him to the Virginia Beach Psychiatric Center.
Described as “paranoid and psychotic” by the admitting physician, Dr. John Riedler, Richard spent one week in the hospital denying that he had any psychiatric or addiction issues. He was placed on two medications: Seroquel and the antidepressant Wellbutrin, no stimulants. In his discharge report, Dr. Riedler noted that Richard had stabilized but remained severely depressed and dependent on both amphetamines and marijuana, which he would smoke in part to counter the buzz of Adderall and the depression from withdrawal.
(Marijuana is known to increase the risk for schizophrenia, psychosis and memory problems, but Richard had smoked pot in high school and college with no such effects, several friends recalled. If that was the case, “in all likelihood the stimulants were the primary issue here,” said Dr. Wesley Boyd, a psychiatrist at Children’s Hospital Boston and Cambridge Health Alliance who specializes in adolescent substance abuse.)
Unwelcome at home after his discharge from the psychiatric hospital, Richard stayed in cheap motels for a few weeks. His Adderall prescription from Dr. Parker expired on July 26, leaving him eligible for a renewal. He phoned the office of Dr. Ellison, who had not seen him in four months.
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“moved out of the house — doesn’t feel paranoid or delusional. Hasn’t been on meds for a while — working with a friend wiring houses rto 3 months — doesn’t feel he needs the abilify or seroquel for sleep.”
Dr. Waldo M. Ellison
Notes on Richard Fee
July 25, 2011
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The 2:15 p.m. appointment went better than Richard could have hoped. He told Dr. Ellison that the pre-psychotic and metaphoric thinking back in March had receded, and that all that remained was his A.D.H.D. He said nothing of his visits to Dr. Parker, his recent prescriptions or his week in the psychiatric hospital.
At 2:21 p.m., according to Dr. Ellison’s records, he prescribed Richard 30 days’ worth of Adderall at 50 milligrams a day. He also gave him prescriptions postdated for Aug. 23 and Sept. 21, presumably to allow him to get pills into late October without the need for follow-up appointments. (Virginia state law forbids the dispensation of 90 days of a controlled substance at one time, but does allow doctors to write two 30-day prescriptions in advance.)
Virginia is one of 43 states with a formal Prescription Drug Monitoring Program, an online database that lets doctors check a patient’s one-year prescription history, partly to see if he or she is getting medication elsewhere. Although pharmacies are required to enter all prescriptions for controlled substances into the system, Virginia law does not require doctors to consult it.
Dr. Ellison’s notes suggest that he did not check the program before issuing the three prescriptions to Richard, who filled the first within hours.
The next morning, during a scheduled appointment at Dr. Parker’s clinic, Ms. Strelitz wrote in her notes: “Richard is progressing. He reported staying off of the Adderall and on no meds currently. Focusing on staying healthy, eating well and exercising.”
About a week later, Richard called his father with more good news: a job he had found overseeing storm cleanup crews was going well. He was feeling much better.
But Mr. Fee noticed that the more calm and measured speech that Richard had regained during his hospital stay was gone. He jumped from one subject to the next, sounding anxious and rushed. When the call ended, Mr. Fee recalled, he went straight to his wife.
“Call your insurance company,” he said, “and find out if they’ve filled any prescriptions for Adderall.”
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“spoke to father — richard was in VBPC [Virginia Beach Psychiatric Center] and OD on adderall — NO STIMULANTS — HE WAS ALSO SEEING DR. PARKER”
Dr. Waldo M. Ellison
Interoffice e-mail
Aug. 5, 2011
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An insurance representative confirmed that Richard had filled a prescription for Adderall on July 25. Mr. Fee confronted Dr. Ellison in the Dominion Psychiatric parking lot.
Mr. Fee told him that Richard had been in the psychiatric hospital, had been suicidal and had been taking Adderall through June and July. Dr. Ellison confirmed that he had written not only another prescription but two others for later in August and September.
“He told me it was normal procedure and not 90 days at one time,” Mr. Fee recalled. “I flipped out on him: ‘You gave my son 90 days of Adderall? You’re going to kill him!’ ”
Mr. Fee said he and Dr. Ellison had discussed voiding the two outstanding scripts. Mr. Fee said he had been told that it was possible, but that should Richard need emergency medical attention, it could keep him from getting what would otherwise be proper care or medication. Mr. Fee confirmed that with a pharmacist and decided to drive to Richard’s apartment and try to persuade him to rip up the prescriptions.
“I know that you’ve got these other prescriptions to get pills,” Mr. Fee recalled telling Richard. “You’re doing so good. You’ve got a job. You’re working. Things with us are better. If you get them filled, I’m worried about what will happen.”
“You’re right,” Mr. Fee said Richard had replied. “I tore them up and threw them away.”
Mr. Fee spent two more hours with Richard making relative small talk — increasingly gnawed, he recalled later, by the sense that this was no ordinary conversation. As he looked at Richard he saw two images flickering on top of each other — the boy he had raised to love school and baseball, and the desperate addict he feared that boy had become.
Before he left, Mr. Fee made as loving a demand as he could muster.
“Please. Give them to me,” Mr. Fee said.
Richard looked his father dead in the eye.
“I destroyed them,” he said. “I don’t have them. Don’t worry.”
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“Richard said that he has stopped Adderall and wants to work on continuing to progress.”
Renee Strelitz
Session notes
Sept. 13, 2011
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Richard generally filled his prescriptions at a CVS on Laskin Road, less than three miles from his parents’ home. But on Aug. 23, he went to a different CVS about 11 miles away, closer to Norfolk and farther from the locations that his father might have called to alert them to the situation. For his Sept. 21 prescription he traveled even farther, into Norfolk, to get his pills.
On Oct. 3, Richard visited Dr. Ellison for an appointment lasting 17 minutes. The doctor prescribed two weeks of Strattera, a medication for A.D.H.D. that contains no amphetamines and, therefore, is neither a controlled substance nor particularly prone to abuse. His records make no mention of the Adderall prescription Richard filled on Sept. 21; they do note, however, “Father says that he is crazy and abusive of the Adderall — has made directives with regard to giving Richard anymore stimulants — bringing up charges — I explained this to Richard.”
Prescription records indicate that Richard did not fill the Strattera prescription before returning to Dr. Ellison’s office two weeks later to ask for more stimulants.
“Patient took only a few days of Strattera 40 mg — it calmed him but not focusing,” the doctor’s notes read. “I had told him not to look for much initially — He would like a list of MD who could rx adderall.”
Dr. Ellison never saw Richard again. Given his patterns of abuse, friends said, Richard probably took his last Adderall pill in early October. Because he abruptly stopped without the slow and delicate reduction of medication that is recommended to minimize major psychological risks, especially for instant-release stimulants, he crashed harder than ever.
Richard’s lifelong friend Ryan Sykes was one of the few people in contact with him during his final weeks. He said that despite Richard’s addiction to Adderall and the ease with which it could be obtained on college campuses nearby, he had never pursued it outside the doctors’ prescriptions.
“He had it in his mind that because it came from a doctor, it was O.K.,” Mr. Sykes recalled.
On Nov. 7, after arriving home from a weekend away, Mrs. Fee heard a message on the family answering machine from Richard, asking his parents to call him. She phoned back at 10 that night and left a message herself.
Not hearing back by the next afternoon, Mrs. Fee checked Richard’s cellphone records — he was on her plan — and saw no calls or texts. At 9 p.m. the Fees drove to Richard’s apartment in Norfolk to check on him. The lights were on; his car was in the driveway. He did not answer. Beginning to panic, Mr. Fee found the kitchen window ajar and climbed in through it.
He searched the apartment and found nothing amiss.
“He isn’t here,” Mr. Fee said he had told his wife.
“Oh, thank God,” she replied. “Maybe he’s walking on the beach or something.”
They got ready to leave before Mr. Fee stopped.
“Wait a minute,” he said. “I didn’t check the closet.”
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“Spoke with Richard’s mother, Kathy Fee, today. She reported that Richard took his life last November. Family is devasted and having a difficult time. Offerred assistance for family.”
Renee Strelitz
Last page of Richard Fee file
June 21, 2012
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Friends and former baseball teammates flocked to Richard Fee’s memorial service in Virginia Beach. Most remembered only the funny and gregarious guy they knew in high school and college; many knew absolutely nothing of his last two years. He left no note explaining his suicide.
At a gathering at the Fees’ house afterward, Mr. Fee told them about Richard’s addiction to Adderall. Many recalled how they, too, had blithely abused the drug in college — to cram, just as Richard had — and could not help but wonder if they had played the same game of Russian roulette.
“I guarantee you a good number of them had used it for studying — that shock was definitely there in that room,” said a Greensboro baseball teammate, Danny Michael, adding that he was among the few who had not. “It’s so prevalent and widely used. People had no idea it could be abused to the point of no return.”
Almost every one of more than 40 A.D.H.D. experts interviewed for this article said that worst-case scenarios like Richard Fee’s can occur with any medication — and that people who do have A.D.H.D., or parents of children with the disorder, should not be dissuaded from considering the proven benefits of stimulant medication when supervised by a responsible physician.
Other experts, however, cautioned that Richard Fee’s experience is instructive less in its ending than its evolution — that it underscores aspects of A.D.H.D. treatment that are mishandled every day with countless patients, many of them children.
“You don’t have everything that happened with this kid, but his experience is not that unusual,” said DeAnsin Parker, a clinical neuropsychologist in New York who specializes in young adults. “Diagnoses are made just this quickly, and medication is filled just this quickly. And the lack of therapy is really sad. Doctors are saying, ‘Just take the meds to see if they help,’ and if they help, ‘You must have A.D.H.D.’ ”
Dr. Parker added: “Stimulants will help anyone focus better. And a lot of young people like or value that feeling, especially those who are driven and have ambitions. We have to realize that these are potential addicts — drug addicts don’t look like they used to.”
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Documentary screening and panel discussion on ADHD, “ADD and Loving It?!”
Listing, The Virginian-Pilot
Oct. 10, 2012
•
The Fees decided to go. The event was sponsored by the local chapter of Children and Adults with Attention Deficit Disorder (Chadd), the nation’s primary advocacy group for A.D.H.D. patients. They wanted to attend the question-and-answer session afterward with local doctors and community college officials.
The evening opened with the local Chadd coordinator thanking the drug company Shire — the manufacturer of several A.D.H.D. drugs, including Vyvanse and extended-release Adderall — for partly underwriting the event. An hourlong film directed and narrated by two men with A.D.H.D. closed by examining some “myths” about stimulant medications, with several doctors praising their efficacy and safety. One said they were “safer than aspirin,” while another added, “It’s O.K. — there’s nothing that’s going to happen.”
Sitting in the fourth row, Mr. Fee raised his hand to pose a question to the panel, which was moderated by Jeffrey Katz, a local clinical psychologist and a national board member of Chadd. “What are some of the drawbacks or some of the dangers of a misdiagnosis in somebody,” Mr. Fee asked, “and then the subsequent medication that goes along with that?”
Dr. Katz looked straight at the Fees as he answered, “Not much.”
Adding that “the medication itself is pretty innocuous,” Dr. Katz continued that someone without A.D.H.D. might feel more awake with stimulants but would not consider it “something that they need.”
“If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”
Mr. Fee slowly sat down, trembling. Mrs. Fee placed her hand on his knee as the panel continued.
An earlier version of a quote appearing with the home page presentation of this article misspelled the name of a medication. It is Adderall, not Aderall.
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Jimmianne, the spotted owl
Silk Hope, NC February 3, 2013ADHD medications are very tricky.
I've been on one for three years. I tell myself I could stop any time I want, but I know I'm an addict that can't function without the drug because once you've taken it, even for a short time, stopping makes you confused and despondent.
I'm 65 years old and smart enough to limit my dose. I found that I need only 1/8 of the recommended dose to function, but of course on that you miss out on the euphoria and intense concentration.
Even at the lower dose I feel the drug is keeping me alive and killing me at the same time. I don't connect to people as well as I did and have fewer emotions.
My psychopharmacologist writes me Rx's for so much that I could become a street vendor. When I tell her I think it's become a problem, she tells me I need it and writes another 90 days worth. Of course I fill the Rx to stockpile in case it gets hard to get, as it has at certain times.
Those teens and 20's don't stand a chance.
Christine
St. Simons Island, Georgia February 3, 2013It is extremely difficult to have an adult involuntarily committed for psychiatric care for a length of time to allow for effective treatment. The comments of the doctors show a lack of care in terms of presecribing and monitoring their patients' use of the drug. Some seem to misunderstand the dangers of abuse it poses. Dr. Ellison heard the parents' concerns. Why not prescribe the extended release Adderall? The report notes it is more difficult to abuse. Psychiatric care in this country is inadequate in many ways, with non psychiatrists diagnosing serious disorders and prescribing powerful medications without the training and expertise needed to treat these patients. What makes this case so sad is that the patient actually visited psychiatrists and still lost. I think the article is really just trying to draw attention to the dangers of these drugs, which should prompt parents with children diagnosed as ADHD to ask more questions about treatment, treatment alternatives, and safety. I don't think the fees or the reporter are anti med at all.
chrisp339
rockville February 3, 2013Recent studies have shown that stimulants are not additive to those with ADHD and that they do not lose their efficacy over time. If a person shows signs of needing more and more stimulant and/or addiction then they don't have ADHD. It is that simple.
Jim you are not addicted if you cannot function without taking stims. You have ADHD so you fall from 'normal' to ADHD levels. The ADHD is what makes you deficient, not withdrawl. When you stop taking your very small amount of stims do you instantly crave more? Do you do anything to get more? It sounds like you do not.
Plus, why they are not started on Strattera is a mystery to me. Also, the article notes the nurse put him on 40 mg Strattera to start. First, Strattera has a side effect of 'suicidal ideation' so why he would be given that instead of Aderall is a mystery to me. Second, you start Strattera slowly in limited does spanning a month. Just hitting the guy with 40 mg. . . Wow. . .
I do concur on the dulling of emotions. I hate taking the stims and only do it when I have a test or something that will require that level of concentration.
dc lambert
nj February 3, 2013It is certainly true that ADHD is a real diagnosis & as a special ed teacher I have seen many students' lives markedly improved with the medication.
However, our nation has a dysfunctional approach to drugs overall that cause untold misery.First, we arbitrarily declare some drugs legal & some illegal. Marijuana is illegal in many states yet it is not nearly as dangerous as a stimulant like Adderall. Yet it certainly gets a lot of private prisons rich, keeps courts nice & busy,& locks away a whole lot of African Americans.
Meanwhile, our health insurance industry aligned to Big Pharm pushes for simple diagnoses with chemical solutions. THis also gets a lot of people rich. How many adults take meds? I know SO MANY adults who casually take pills to go to sleep, then pills to stay awake, who take pills to lose weight, pills to feel happy, pills to stem anxiety, who horde Oxy's then pop them to get high.Many pills have VERY potent side effects (watch the disclaimers). A friend takes anti-anxiety meds & has serious memory loss (a documented side effect). Therapy isn't covered in her insurance.
Upper middle class kids don't take to pills in a vacuum. I know MANY who casually sell, crush, snort, mix, & pop all manner of legally proscribed pills. This is VERY common. It is common for kids to fake diagnoses to get the pills, then take them, or sell them. What do we expect when our adults are doing the same thing?
Look in the mirror.
SGEE
Houston, TX February 3, 2013This is more likely a symptom of the "Managed Care System". When doctors have to see 100 patients a day to be profitable, or make a bonus, or whatever, they tend to get sloppy. Not a good excuse, but there all the same.
David Bresch MD
Philadelphia February 3, 2013This article makes me cringe. I am a neuropsychiatrist so I prescribe the medications described in this article on a weekly basis to both children and adults.
To the extent one can take anything reassuring from this case with a tragic end, it had numerous signs that are pretty easy to watch for, high doses and concerned family members. As I look back over my experience, these warning signs actually did flag patients who had problems with stimulants. Unfortunately, once one identifies patients with difficulties, one usually loses them to follow-up as they seek more permissive physicians.
Most medications have benefits and dangers. While I have definitely seen cases of psychosis or mania related to stimulants, I have seen just as many cases of psychosis related to cough syrup abuse in my decade, which is available over the counter without a prescription. But this is nothing compared to the mortality in my region due to pain medications, which psychiatrists do not generally prescribe.
There is always a subtext in the NYTimes' articles that MD's are financially incentivized to give in to patients' demands, but the reality in the managed care environment is the reverse, I make much more money if I dissatisfy the patient as soon as possible so he goes elsewhere and I have time for more new patients.
David Bresch MD (neuropsychiatry and sleep medicine)
chairman, Department of Psychiatry
Saint Francis Medical Center Neuroscience Institute
Health Lawyer
Western State February 3, 2013My state has a prescription drug database and requires physicians to check it before writing prescriptions as a way of identifying patients who are seeking drugs. The database is also used to identify physicians who are "outliers", meaning that they appear to be overprescribing compared to their peers. The primary impetus for this is the overprescribing of opioids, which is a huge national problem only in the U.S. at present. There is a mentality in this country to look to a pill to solve any problem. A child psychiatric expert recently told a legislative committee that it is not uncommon for parents to demand medication for troublesome children. There is no doubt that this country has a problem with the overprescription of drugs. Furthermore, most prescription drugs that are abused have been legally prescribed.
Eddie
anywhere February 3, 2013This is a terribly sad story. As a neuroscientist, in the 1990s, I was shocked when I heard that parents were giving drugs to their children for a 'disorder' that was not fully characterized -- nor even recognized by many doctors and scientists. I kept telling people: nobody has ever investigated the long-term effects of these drugs on the brain -- how can you give them to a child?
I understand how difficult some children can be. I'm certain that my son would have been diagnosed with ADHD, but even when various behavioral interventions didn't work, and even when his teachers were complaining, I absolutely refused to give him psychoactive drugs. My feeling is: if he has a disorder, then I want him to learn to deal with it without resorting to drugs. It did not make life easy for me, but I'd rather have a crazy, difficult, energetic kid than one who is doped up. Now my son is a perfectly healthy, mentally stable, drug-free 18-year old, doing great in college.
The pharmaceutical industry just wants to sell drugs, and if it means billions in income, they'll happily do it even when a few lives are lost.
I think in many cases these drugs are given for the benefit of the parents, not the child. Children are "born to be wild", and parents should go back to medicating themselves with "Mother's little helpers" if they can't deal with the normal unrulyness of healthy children -- far better than to permanently distrupt these beautiful growing brains.
Dennis McSorley
Burlington, VT February 3, 2013Our society needs to slow down. All of our culture is enveloped in impulsive fast moving images and actions.
If we slow down we'll actually get to know our friends, get to have deeper relationships and absorb much needed peace of mind.
i grew up in a home that had one telephone on the wall, one TV, music from a radio and tons of friends that I met outside in school, the playground, dances and social events, etc. Plus my parents weren't weaning me in my 20's and still attempting to 'help me grow up'. I had been making choices and getting advice up thru teen years and my decisions were mine and I was 'allowed to not be perfect'.
As a former educator, father and grandpa now- those ideas still work.
By the way- what's wrong with daydreaming? I do it all the time.....
Dennis McSorley
Burlington, VT
juanitasherpa2
Appalachia February 3, 2013Many people are blaming the doctors, the parents, the media culture...maybe we should also look at school, where the "one size fits all" definition of success puts enormous pressure on those students whose strengths happen to lie outside the competitive academic rat race.
If we--parents and schools and colleges-- did a better job of identifying the unique talents and strengths of children, maybe they could reach their own personal "best" without so much medicine.
Ankit Garg
Dallas, TX February 3, 2013Nurse practitioners can prescribe such drugs? Are they under any supervision from a doctor? This seems very disturbing to me especially how the NP ramped up the dosage of Adderall merely at the patient's request.
This is not to insinuate that NPs are the root of the problem here. It appears the doctors were practicing just as bad medicine.
I always felt that psychoactive drugs are too loosely prescribed without proper follow-up or appropriate, complementary psychotherapy. More generally speaking, many drugs are over-prescribed without proper evaluation since medicine has become a very lucrative business where it is more important to maximize patient load at the cost of decreasomg time spent with each patient. Additionally, since insurance companies reimburse doctors based on individual services, ethics have become considerably strained.
I really hope stories like this one help to stop these terrible practices from continuing.
Barbie Coleman
Washington DC February 3, 2013We're a nation in a hurry, we want everything RIGHT NOW! A few years ago while nuking a cup of tea and I caught myself wildly waving my arms, yelling at the microwave, "Come on! Come on! Come on!" Fortunately, I stopped and laughed at myself, realizing the folly of my impatience.
What a tragedy this story relates, reemphasizing a problem both doctors and families face every hour of every day: Is this kid really sick or is he just seeking a quick solution to a recurring problem he can't cope with?
Over-stimulation is run amok today, starting in the crib -- with colored mobiles, jangly toys and comfy pacifiers. Later, the problems for children multiply, as they try to excel both for themselves and for their parents, while living in a society that continually tests, compares, charts, nudges, criticizes, encourages, intimidates, lectures, withholds sometimes and over-extends at other times, rewards or penalizes various behaviors, and sends so many mixed signals that kids get overwhelmed.
And yes, doctors and big pharma agree, "We've got a pill for that!"
The entire industry needs to have a conversation, and HIPAA needs a drastic overhaul to allow more input from parents like the Fines, who lived so many years in the line of fire with their son, and their worst fears came true for their son because doctors weren't listening and weren't consulting databases due to either laziness or a lack of patient care, and finally because addicts are the greatest liars in the world.
J. Cornelio
Washington, CT February 3, 2013In the recent revisions to the DSM (the therapists' bible for defining psychic disorders), I read that even therapists have acknowledged that every jot and tittle of human behavior has become pathologized.
One can blame Big Pharma and various professional lobbies. But it's also time for us to recognize that we have become expert at infantilizing not only our children but also ourselves. It's just easier to blame sadness, addiction, anxiety ... or whatever on a "disease" and take one of our miracle pills to "cure" it.
Instead, those feelings are to be expected as part of being human, especially in a world where we no longer have to struggle every day to survive. Instead, we have way too much time to moan, complain and weep about our lives, failing to recognize just how blessed we are.
Ben Deese
Champaign, IL February 3, 2013I am not aware of any friends/peers who are abusing stimulants at my college, but it does make me worried because it is definitely occurring. In an era when this is happening, I am disappointed in a lack of proper mental health education in high schools and colleges around the country. Most students — who are taking the drugs illegally — are not inherently malicious, but just trying to achieve more. It upsets me to no end when my grades are then curved against these possible drug abusers, students who can score much higher on exams than I could.
What will it take for the mental health care field to realize that patients will lie to get what they want. I would love to see the Drug Enforcement Administration take some action on this issue; the Obama Administration via the Department of Education could draft legislation that requires freshmen seminar classes in high schools and universities to cover substance abuse topics such as alcohol, tobacco, and now prescription drugs. Another idea could be forcing the drug manufacturers to clarify all sides effects in more detail.
Obviously the federal government becoming involved is a huge step, and I would much prefer the schools to be able to handle this crisis on their own. However, as other commenters have pointed out: How does one distinguish between actual ADHD and a liar?
This is a very tough issue that needs to be carefully evaluated, as the people with legitimate uses for the drug should NOT be subject to unjust hardship.
norabosworth
NY, NY February 3, 2013I'm 24. I started studying for the LSAT months ago. Law school pals kept telling me they used adderall for the exam. One guy said I was set to fail if I didnt take them, as I was competing with 100s of people on performance enhancing drugs.
My friend directed me to a psychiatrist whom he described as a "pill vending machine. I do not have ADD. I'm spacy and have trouble focusing when things bore me but can focus when I need to. I went to a prestigious high school and Brown University without ever feeling overwhelmed by an inability to concentrate.
Anyway, under panic over the test, I decided to get a prescription. It shocked me how easy it was. I told the doctor- a graduate of NYU med school, that I was having trouble focusing. He wrote me two prescriptions, one for Adderall and the other for Vyvanse. He told me the pills work as a diagnosis in themselves, because if they don't help, you don't have the disorder.
"Don't they help everyone focus?" I asked.
He looked uncomfortable and said that was a "good question". College kids pass this doctor's name around as someone who will give you drugs as long as you recite a couple Wikipedia symptoms.
I tried the pills for a few weeks. Of course they helped me focus. They also gave me huge mood swings, crying jags, an awful temper, and low emotional IQ. I took the bottle and told my boyfriend to throw it out. Since then I've been scoring in the mid 170s on my practice tests, and, best of all, I have my mental health.
Tim
FL February 3, 2013This article is fantastic and disturbing. One thing that bothered me about it though is its focus on whether or not a proper diagnosis was made. I think this is a secondary issue. Psychiatric drugs have a vastly underestimated potential to cause adverse affects, both short and long-term, regardless of whether the patient has received the proper diagnosis. That is, these drugs are not antidotes, they create abnormal brain and body states rather than correct them. This is what makes Katz's assertion at the end so backwards. Both the veridical and the self-exaggerated patient are at risk for addiction, insomnia, psychosis, etc. from adderral, not to mention the sea of other prescriptions that Fee cycled through, by virtue of their creating these abnormal states. Certainly the most absurd idea is that a psych drug would be somehow physiologically inert in a healthy individual. By that logic, street drugs, alcohol, marijuana, cigarettes, would have no effect in most people because they don't 'need' them to counteract whatever properly diagnosed condition.
This story demonstrates how such backwards logic leads to misplaced trust in pharmaceuticals. This in turn has led to thoughtless overprescribing, which magnifies risks and leads to tragedies such as this. If I had received Katz's answer as Mr. Fee did, I would have been inclined to do more than tremble quietly.
Lana
Brooklyn February 3, 2013Honestly, I blame a society where parents look for any angle to better their children's chances. We've all heard of parents who've had their kids marked for some learning disorder in order to let them take tests in longer periods of time. What happens when those kids learn that it's ok to fudge the truth to get ahead? Or when other kids see that and don't see their parents standing up and saying that's wrong. You get a culture where Adderall is used as a study substitute (not a study aid). Kids don't feel the need to study when they can party and then just take a handy pill that will let them cram before an exam.
Guess what, college wasn't as easy as high school (and shouldn't be) and I had to learn how to study harder (or at all in some cases), that's what makes you a responsible adult, not popping pills to get past the exams.
Gabrielle Shapiro, MD
New York City February 3, 2013As a physician and mental health professional, this tragic case is extremely disturbing. Unfortunately the state of our health care system has relegated psychiatrists to performing medication management, with less and less time given for diagnosis and therapy. Richard saw a nurse practitioner for his initial diagnosis, not an MD. Although I understand that it is economically motivating to have less expensive licensed personnel see patients, psychiatrists and psychologists have many more years of diagnostic training, and thankfully in most states only MD's can prescribe. Use of physician extenders for mental health treatment,cutting diagnostic and therapy time for physicians with patients,all set up a situation where patients and families end up losing out, sometimes with tragic consequences.
Despite working with mostly impoverished patients in a community mental health clinic, I refuse to compromise my clinical work by writing scripts for Stimulants,, sleeping aids and benzodiazepines , which often makes me unpopular, for patients who simply request them, or have had them prescribed by someone in the past.
Each patient and family has a complex history and we have to have the time to thoroughly assess and evaluate a patient diagnostically before prescribing.
I sincerely hope that our health care system will return to allowing us to have this essential ability.
Benny
NYC February 3, 2013I recently kicked my 8 year addiction to Adderall. I work in NYC in the fast paced fashion industry. I am ambitious and needed it to perform. I thought I could quit at any time during the eight years, I couldn't. I convinced myself that I needed it or I would fall apart. While I was on it, I had terrible mood swings and would become really depressed. I slept 4-5 hrs a night on it & I would crash for a day or two when I would take a break from it.
I started taking Adderall in my early 20's and always told myself that I had to get off it when I turned 30. I'm 32 and haven't taken it for 3 months. Only now that I am off it can I see the side effects it gave me. I am so much happier now. I would not trade more productivity with that depression for anything.
Dr. Katz is completely wrong, I felt that I needed Adderall or I would fall apart, lose my job and be a basket case.
Am I a legit ADHD case? I am not sure. I do space out way too much, I have trouble completing tasks and focusing. It is a daily struggle to not take the pill. I am afraid of becoming addicted again. I am trying to have a healthier diet for more energy. I am trying to train myself to be self motivated, to complete things. I know that I am stronger than this.
wellertrust
ca February 3, 2013in reading this article, i found it was a story that could have been written about our son. our son hanged himself six months ago at age 39. our son had taken adderall off and on for about ten years. as parents we were always against our son from taking aderrall but he was an adult and he never did anything that would have prompted us to call the authorities. we could only caution our son about possible side affects or addition.
when it was first prescribed to him by a family doctor at age 29 while he was living in utah, i could immediately see personality changes. i too, called the doctor and told him to stop prescribing adderall or ambien to him. even though my son was in his late 20's and much to my surprise, this doctor did stop prescribing both. i had read about utah doctors and the ease in which they prescribed mood altering drugs. my son was upset that i had called his doctor and told me how easy it was to get either adderall or ambien so he didn't need a doctor.
after our son's death, i found an empty medicine bottle where he had been prescribed adderall approximately three weeks prior.
i would say to all parents, get educated about the various drugs that are being prescribed to your children, young or adult, and question the doctors whether they are willing to discuss your adult child's treatment or not. some doctors may even listen to you.
tom silverman
santa cruz ca February 3, 2013I'm a pediatrician; I feel that ADHD is real and if untreated, can have serious consequences. As these kids grow into adults, they are much more likely to self-medicate with alcohol and drugs of abuse, much more likely to be involved in motor vehicle accidents, be unsuccessful at their jobs and relationships, and brush up against law enforcement. Also, many if not most kids with ADHD 'outgrow' the problem at some point before adulthood.
According to the article, this individual did not have ADHD as a child , or if he did, was able to compensate and do well academically in spite of it. Like may college kids, he gamed the system. Even so, I suspect his outcome is very unusual and shouldn't be used to broadly condemn a class of medication that is very safe when prescribed, monitored, and used appropriately.
The doctor-patient relationship is always fraught with danger, of multiple sorts, and both sides should be extremely wary.
marly harris
Southern California February 3, 2013I'm 80 and I've had ADHD all of my life. In the 1930s, I was simply considered a bright fidgety pain-in-the-butt kid. Despite a high IQ and enormous art/music talents, I never fulfilled my gifts because I never completed anything (including marriages).
Do I wish I'd been aided by medication? I'm ambivalent. Yes, it would be nice to have a body of work as my legacy as I approach the cremation stage of life. Cancelling concerts and not meeting contractual deadlines were hideously embarrassing to me. Being restless destroyed all of my relationships.
I've reached this great old age sans credentials. However, my energy level and curiosity and creative juices are bubbling; I feel optimistic and healthy and strong. Since I cannot redo my life, I feel that the final part of it is compensation for the lifelong miseries of ADHD.
Vinode Rubins
Alachua, FL February 3, 2013Is it possible that Richard Fee was moving into schizophrenia or a mood disorder, and the Adderall and stress of school accelerated that decline? I wouldn't blame the medication on his suicide. Rather, the deadly combination of an emerging mental disorder, incorrect diagnosis, stress, Adderall addiction and multiple physicians permitted this young man to "fall through the cracks."
ctflyfisher
Danbury, CT February 3, 2013As a mental health worker for 45 years, I have seen every kind of behavior. There are definitely kids who exhibit difficulty tolerating life in their own skin and appear ADHD. They seem unable to sit for 2 minutes let alone an entire hour. They hear the peripheral sounds that most of us automatically block out. And.... they did not exist 30 or 40 years ago!
I believe that attention deficit disorders are on the same plain as childhood obesity--- they are not entirely explained by psychiatric diagnoses. They do not seem to be amenable to drug therapy over time (once the initial placebo or nocebo effect has worn off).
In the meanwhile, there have been exciting new breakthroughs in understanding epigenetics, and obesogens which can contribute to a larger understanding of many current maladies through our food chain and pesticides, not to mention GMO's. When we introduce chemicals (like drugs) to our immature developing bodies, we are doing damage that can sometimes even alter genetics.
In the interim, until science catches up with what we are putting in our food and environment, we still have the option of behavior modification, talk therapy, laughter, meditation and love as our tools for serious change in our human suffering.
Carrie
Flemington, NJ February 3, 2013I was diagnosed in college with ADHD by my school's (Johns Hopkins University) student counseling center. Looking back, I am shocked I wasn't diagnosed as a young child. I was incredibly hyperactive, impulsive, and easily distracted. I think I flew under the radar because I was smart and always got straight As. The way the Hopkins counseling center handled my meds was a model that other schools should emulate. I was required to attend weekly one-hour therapy sessions that included behavioral management or I would not get my prescription. The MD saw me for every refill, checked my weight and blood pressure, and asked me a bunch of questions about side effects, behavioral strategies, etc. I was never given more than one month's prescription at a time. If I ever missed an appointment with the therapist or the MD, they called me daily until I returned. This close monitoring and attention to detail could help prevent the abuse.
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