Dr. Harold Koplewicz is one of the nation’s leading child and adolescent psychiatrists. He is widely recognized as an innovator in the field, a strong advocate for child mental health, and a master clinician. He has also been at the forefront of public education to dispel the myths and stigma surrounding children and adolescents living with psychiatric disorders. Koplewicz has been repeatedly recognized in America’s Top Doctors, Best Doctors in America, and New York Magazine’s “Best Doctors in New York.” In 2006, he was appointed Director of the Nathan S. Kline Institute for Psychiatric Research (NKI), making him the third person to hold that position since the institution’s founding in 1952. He is also the founding president of the Child Mind Institute.
Question: Do ADHD drugs affect a “normal” brain differently than a brain with ADHD?
Harold Koplewicz: Well I think that’s a myth. I think there’s a myth out there that if you are a hyper-active, or ADHD kid, Ritalin or Ritalin-like medications are going to work on you differently than they will on the normal population. And that’s what it is. It’s a myth; it’s inaccurate. So for all of us, whenever we would take on of these medicines, your dopamine and norepinephrine is going to be more readily available in your brain. You will be more focused. You will be more attentive, you will also, might be a little more uptight and a little more hyper-vigilant. And when you take any medicine, there’s a cost/benefit ratio. Any time you take a medicine, there’s a potential side effect. So if you don’t have ADHD and you’re going to take this medicine, any psychostimulant, any type of drug like this is going to increase your heart rate, it may elevate your blood pressure, it will decrease your appetite. Those things are side effects that are unnecessary if your dopamine and norepinephrine levels are normal. In the same way that if you take too many aspirin. It will thin your platelets, which might be good, but might be bad. And if you take too much aspirin you can actually get an ulcer.
So this is something that every time you get prescribed a medicine, a doctor is thinking about what the cost/benefit ratio is. A little quick soundbyte..
So, but the important part for us to remember is that when someone with ADHD gets these medicines, they get closer to what a normal, typical brain response is. So that they look less hyper-active, they look more attentive, therefore they’re less impulsive. They are able to do what they’re capable of doing. It doesn’t increase your IQ points, it doesn’t make you smarter, it lets you get to the IQ points that you do have. And therefore, while you’re never as attentive as a typical or normal individual, and you never stop moving around and stay as still as a typical normal, you are more in the normal range that permits you to be more contemplative, insightful, and therefore get in touch with and use your intelligence.
Question: Is there any danger of addiction or long-term chemical changes?
Harold Koplewicz: Well, I think there are other side effects. So, for instance, particularly if you take Dexedrine—which is a more potent version of Ritalin, slightly different chemical structure—there is no doubt that you will also get a slight rise in your mood and you will feel somewhat more euphoric and you will feel more expansive. And therefore, if you start taking that medicine on a regular basis, when you don’t have it you very possibly will feel a crash, or you will feel down. And therefore, that’s the potential side effect that could be quite serious, that you become used to it or become almost addicted to the sensation of feeling good when it’s not necessary to cause you to focus or you don’t need it for extended attention.
Recorded August 18, 2010
Interviewed by Max Miller