When we brought John home in August, he already had imipromine in his blood stream. In fact, most of the 40 children at John's former residential treatment center receive some kind of psycho-active medication. Although the drug suppressed some of his activity and aggression It did not lengthen his attention span or reduce his impulsivity. Since I have always held a bias against long term drug regimens we weaned him off of this antidepressant and ran for several weeks without any meds, enduring more than a few stressful days and tearful nights. When we finally cried Uncle, his therapist and pediatrician agreed -- bring on the ritalin. We started with 10mg in the morning and I couldn't believe the change. He was calm, happy, and responsive. But by early afternoon the ADHD demon had repossessed his soul, so we started giving him another 10mg at lunch, and sometimes another 5mg in the evening. I was elated with this miracle cure, but a bit uneasy. Our son wasn't really there. He would answer questions coherently, but he never initiated conversation. He just sat in front of the TV and stared; didn't actively engage anybody. Still, it was a vast improvement -- we could fine-tune the dose later.
As the weeks rolled by I noted wild fluctuations in his response to the drug. One day the dose was inadequate, allowing subterranean hyperactivity to burst forth like upwelling magma. The next day the same dose was excessive, squashing him into the fetal position under a blanket. On two occasions the drug produced symptoms of autism. He twirled around on the floor, banging his head and moaning. He was incapable of saying any words or responding to questions. He was terrified as he tried to hide from something he could not comprehend or evade. When I questioned him later he remembered every detail -- the episode was not a ritalin induced seizure (though these are not uncommon).
Each morning we tried to calibrate his ritalin based on his activity level. As described above, two milligrams too high or too low would lead to disaster. Keep in mind, we were administering the drug by cutting 5mg tablets into pieces, an inexact science at best. We certainly couldn't roll the dice in the morning and send him off to school, hoping the dose was correct for that day. Although it bought our family some short term sanity, ritalin was clearly not a viable treatment for the long haul. We had similar experiences with other ADHD medications. Therefore, we had to think of something else.
In retrospect, John's reactions are not surprising. Most pills, capsules and liquids contain artificial colors and flavors, and John reacts to most of these. This is especially true of children's medication, brightly colored pills that are suppose to taste good. Yet even adult tablets often contain unnecessary artificial ingredients. Pills that look white often contain yellow dyes. Read the label carefully. I would love to ban artificial additives from our nation's food supply, but at a minimum, we should ban these additives from our medicines. I can choose to skip the Hostess Cupcake, but if I need a certain drug for my health, and it comes with artificial dyes, I don't really have any choice, do I?
Even when there are no artificial ingredients, some substrates contain natural salicylates and/or amines. This can be a problem for a small minority.
Finally, many drugs are amines or salicylates, regardless of the underlying substrate. Aspirin is the classic example. It is formed from salicylic acid, and a person who is salicylate sensitive will react to aspirin in a big way. This is how the salicylate connection was first discovered. Dr. Feingold noticed that some of his patients reacted violently to aspirin, and after further investigation he found they also reacted to the natural salicylates that are present in certain foods.
Amines are a much bigger problem. Many drugs are amines, or they generate amine metabolites in the body. When a prescription medication is advertised on tv, listen carefully to the fast talking disclaimers at the end. They often warn, "Don't take this if you are on an MAO inhibitor." In the simplest terms, MAO inhibitors are drugs that make it difficult for people to break down amines. If you must take an MAOI, you are on a low amine diet, and you can't take any drugs that are themselves amines, or break down into amines in the body. When our kids reacted to amines, we have to pretend that they are on MAOIs all the time. (They don't seem to react to amines any longer, and we're grateful for that!)
Consult your drug guide or ask your pharmacist; ritalin should not be taken if you are on an MAOI. In other words, it is an amine, or it produces amines in the body. No wonder John reacted badly to it. As it turns out, all the drugs that are typically given to ADHD children are amines. If these meds make your child worse, he may react to amines. Other broad classes of amines include decongestants and cough suppressants.
We use to treat almost everything, from colds to allergies, with Benadryl. This is an antihistamine. In other words, it works against histamine (an amine); it's on our side. Any antihistamine would probably be safe and effective for amine sensitive individuals, but our kids respond well to Benadryl (though it does make them sleepy).
If you or your child reacts to a drug that is suppose to help, there may be a reason. The reaction may be trying to tell you something. Check the ingredients, both active and inactive, and be on the lookout for amines and salicylates. Of course, you might simply react to that particular drug. When it comes to biology, anything is possible.