ADHD, financial distress, and suicide in adulthood: A population study

Abstract

Attention-deficit/hyperactivity disorder (ADHD) exerts lifelong impairment, including difficulty sustaining employment, poor credit, and suicide risk. To date, however, studies have assessed selected samples, often via self-report. Using mental health data from the entire Swedish population (N = 11.55 million) and a random sample of credit data (N = 189,267), we provide the first study of objective financial outcomes among adults with ADHD, including associations with suicide. Controlling for psychiatric comorbidities, substance use, education, and income, those with ADHD start adulthood with normal credit demand and default rates. However, in middle age, their default rates grow exponentially, yielding poor credit scores and diminished credit access despite high demand. Sympathomimetic prescriptions are unassociated with improved financial behaviors. Last, financial distress is associated with fourfold higher risk of suicide among those with ADHD. For men but not women with ADHD who suicide, outstanding debt increases in the 3 years prior. No such pattern exists for others who suicide.

Science Advances 
30 Sep 2020:
Vol. 6, no. 40, eaba1551
DOI: 10.1126/sciadv.aba1551 — https://advances.sciencemag.org/content/6/40/eaba1551

Here in the US we’ve seen an steady increase in ADHD diagnoses.

ADHD diagnosis throughout the years: Estimates from published nationally representative survey data — https://www.cdc.gov/ncbddd/adhd/timeline.html

And an alarming increase in suicide.

https://www.nimh.nih.gov/health/statistics/suicide.shtml

Then my mind wanders to drugs (to drugs, not due to drugs).

To summarize, the psychiatric side effects of methylphenidate are quite similar to those of cocaine and amphetamines, giving more support to the idea that almost all CNS stimulants will produce a similar clinical picture. A person using cocaine can experience nervousness,57,58 restlessness,58 agitation,57 suspiciousness,60 paranoia,61–63 hallucinations and delusions,61,63 impaired cognitive functions,64 delirium,65 violence,57,58,62,65,66 suicide,67 and homicide.67–70

Methylphenidate Abuse and Psychiatric Side Effects — http://Prim Care Companion J Clin Psychiatry. 2000 Oct; 2(5): 159–164. doi: 10.4088/pcc.v02n0502

I just hope I’m wrong.

Hydroxychloroquine does NOT counter SARS-CoV-2 in Hamsters, High Dose of Favipiravir DOES

GREAT NEWS for hamsters!

A high dose of favipiravir, however, had a potent effect. A few days after the infection, the virologists detected hardly any infectious virus particles in the hamsters that received this dose and that had been infected intranasally. Moreover, hamsters that were in a cage with an infected hamster and had been given the drug did not develop an obvious infection. Those that had not received the drug all became infected after having shared a cage with an infected hamster.

KU Leuven. “Hydroxychloroquine does not counter SARS-CoV-2 in hamsters, high dose of favipiravir does: study.” ScienceDaily. ScienceDaily, 9 October 2020. www.sciencedaily.com/releases/2020/10/201009162432.htm.

Hopefully good news for humans.

Favipiravir: A new and emerging antiviral option in COVID-19

Favipiravir was first used against SARS-CoV-2 in Wuhan at the very epicenter of the pandemic. Then, as the pandemic spread to Europe, this drug received approval for emergency use in Italy, and currently has been in use in Japan, Russia, Ukraine, Uzbekistan, Moldova, and Kazakhstan. Approval has also recently been granted in Saudi Arabia and the UAE. Thereafter, Turkey, Bangladesh, and most recently Egypt have also seen recent commercial launches. In June 2020, favipiravir received the DCGI approval in India for mild and moderate COVID-19 infections. As of the 23rd of July, 2020; there are 32 studies registered on clinicaltrials.gov to assess the utility of this drug in the management of COVID-19 (3 completed, 12 recruiting).1

Favipiravir: A new and emerging antiviral option in COVID-19 — http://Med J Armed Forces India. 2020 Sep 2 doi: 10.1016/j.mjafi.2020.08.004 [Epub ahead of print]

Anti-psychotic Added to Antidepressant Linked to Higher Mortality

The current investigators analyzed national healthcare claims from the US Medicaid program from 2001 to 2010 for 39,582 Medicaid beneficiaries (mean age, 44.5 years; 78.5% women) diagnosed with depression. Patients with alternative indications for anti-psychotic therapy, such as schizophrenia, psychotic depression or bipolar disorder, were excluded.

After a period of at least 3 months of treatment with a single antidepressant, more than half of the patients (56.6%) augmented their treatment with one of these atypical anti-psychotics: quetiapine, risperidone, aripiprazole or olanzapine. The remaining patients (43.4%) added a second antidepressant. The average chlorpromazine-equivalent starting dose for all atypical anti-psychotics was 68 mg/day, which increased to 100 mg/day during follow-up.

A total of 153 patients died during 13,328 person-years of follow-up, including 105 who augmented with an atypical anti-psychotic and 48 who augmented with a second antidepressant.

Compared with those who added a second antidepressant, those who added an anti-psychotic had a 45% increased risk of dying during follow up (adjusted hazard ratio,1.45; 95% CI, 1.02 – 2.06).

Antipsychotic Added to Antidepressant Linked to Higher Mortality – Medscape – Oct 07, 2020. https://www.medscape.com/viewarticle/938707?src=rss#vp_1

PPI Use Linked to Elevated Mortality Risk

PPI Use Linked to Elevated Mortality Risk

During a median 10 years’ follow-up, 37% of participants died. There were 46 excess deaths per 1000 PPI users in that time. PPIs were associated with excess mortality from cardiovascular disease (CVD) and chronic kidney disease (CKD). Patients without indications for PPI use had higher mortality risk from CVD, CKD, and also upper gastrointestinal cancer. Longer duration of use was associated with greater risk.

The NEJM Journal Watch summary has a link to the full study from BMJ.

Americans Cross Border Into Mexico To Buy Insulin At A Fraction Of U.S. Cost — Kaiser Health News

When Michelle Fenner signed up to run this year’s Los Angeles Marathon, it got her thinking: Tijuana, Mexico, is only a 2½-hour drive from L.A. Why not take a trip across the border and buy some insulin for her son? “It’s so easy to just go across the border,” mused Fenner. This idea had been…

via Americans Cross Border Into Mexico To Buy Insulin At A Fraction Of U.S. Cost — Kaiser Health News

Fifteen percent of osteoporosis patients who take ‘drug holidays’ suffer bone fractures

A Loyola Medicine study has found that 15.4 percent of patients who take so-called “drug holidays” from osteoporosis drugs called bisphosphonates experienced bone fractures. During a six-year follow-up period, the yearly incidence of fractures ranged from 3.7 percent to 9.9 percent, with the most fractures occurring during the fourth and fifth years.

The study by senior author Pauline Camacho, MD, and colleagues was published in the journal Endocrine Practice.

Read the source article here.

 

Benzo Update 02.25.18

Between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67 percent, from 8.1 million to 13.5 million. Unlike opioid prescribing, which peaked in 2012 and has decreased nearly 20 percent since then, benzodiazepine prescribing continues to rise. The risk of overdose death goes up nearly fourfold when benzodiazepines are combined with opioids, yet rates of co-prescribing benzodiazepines and opioids nearly doubled between 2001 and 2013. Overdose deaths involving benzodiazepines increased more than sevenfold between 1999 and 2015.

Anna Lembke, M.D., is associate professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and author of “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop” (Johns Hopkins University Press, 2016).

You can read the full article here.

Gabapentin Misuse and Abuse

Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state.

A literature review published in 2016 in the journal Addiction found about a fifth of those who abuse opiates misuse gabapentin. A separate 2015 study of adults in Appalachian Kentucky who abused opiates found 15 percent of participants also misused gabapentin in the past six months “to get high.”

In the same year, the drug was involved in 109 overdose deaths in West Virginia, the Charleston Gazette-Mail reported.

Read the article.

Now slowly focus on the following sentences:

Gabapentin can enhance the euphoria caused by an opioid and stave off drug withdrawals. In addition, it can bypass the blocking effects of medications used for addiction treatment, enabling patients to get high while in recovery.