What exactly did you research?
“Together with Dutch colleagues, we conducted a study into an alternative way to initiate treatment in children with ADHD with methylphenidate, best known as the drug rilatin. In current practice, children are initially given a low dose, which is gradually increased until the symptoms are under control or the child experiences too many side effects.
“We divided 100 children into two groups. One half was treated in the classic way. The other half were randomly given higher or lower doses for five weeks and also a fake pill for one week. Each time, the children, their parents and teachers had to report on their symptoms and side effects.”
What did that show?
“With this random and placebo-controlled administration we were able to significantly reduce the use of ritatin. Three in ten children with ADHD do not benefit from treatment with ritatin, and with this method we are better able to identify them.
“You see no improvement in their symptoms, many side effects, or those around them report as great an improvement with the fake pill as with the real medicine, which indicates a significant placebo effect. In the experimental group, the number of children who stopped taking ritatin was four times higher, with no difference in symptoms between the two groups. And for the children who did benefit from the drug, a higher dose was not always better.
“It is important that we identify the children who are receiving ritatin unnecessarily. Not only because the drug has side effects, such as headaches and stomach aches, reduced appetite and sleeping problems. But also because these children may miss out on treatment that does work. Because there are also other medicines and therapies without medication.”
Should this new method of prescribing now become the norm?
“Before adjusting the guidelines, you should first repeat this study on a larger scale. We already work this way at the University Psychiatric Center at KU Leuven. But to roll this out more broadly, we also need to get the pharmaceutical industry on board.
“There are short- and long-acting forms of ritatin. A pharmacist can prepare the short-acting form and then insert a fake pill in between to make a comparison with a placebo. For the more popular long-acting form, pharmaceutical companies should provide a fake pill in a package with different doses.”
The use of ritatin has more than doubled since 2005. How did that happen?
“We don’t know exactly. In principle, medication for ADHD is only indicated if the symptoms are sufficiently severe and if the burden of the symptoms is insufficiently controlled with treatment without medication.
“In practice, we notice that ritatin is often prescribed without a clear diagnosis or a good treatment plan. This sometimes also has to do with the long waiting lists for psychological care, whereby a general practitioner simply initiates treatment.
“Although this should always be the case, we notice that in practice the usefulness of the medication is not sufficiently monitored. We did this in our research with e-mail questionnaires, but this takes time and effort. That is something we could also pay more attention to in the classic systematic increase of the dose.”
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2023-12-03 15:30:41
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