Monday, March 20, 2023

By Don Sapatkin

Good Monday morning! In today’s Daily: A chorus of Adderall users say their ADHD meds no longer work. In Florida, 100 children a day are being detained for psychiatric evaluations. A Pennsylvania county sues social media giants for worsening students’ mental health. And beware of genetic tests that are supposed to identify the best antidepressant for you. (They don’t work.)

Has Adderall changed?

People with attention-deficit/hyperactivity disorder have flooded social media with video claiming their “adderall isn’t adderalling,” is “not working” or is “fake.” An estimated 9% of American children and 8% of adults have ADHD, impeding their ability to pay attention. The stimulant Adderall is a key treatment, and there’s been a shortage of it for months. All of which helps explain why videos claiming “adhd meds not working” have been viewed 18 million times on TikTok.

But why, exactly, would people think their medication is different?

The FDA and drugmaker Teva Pharmaceuticals said nothing has changed, The New York Times reports. Experts offered possible reasons that were less than satisfying: A tiny subset of patients might notice slight variations in how a generic is manufactured. With Adderall hard to find, more patients are switching, at least temporarily, to other meds. Suddenly stopping a high-dose regimen may cause withdrawal symptoms. Restarting at the same dosage can make you feel jittery or restless, and people with ADHD are sensitive to disruptions in everyday life.

And then there’s what’s known as cognitive bias: People who hear over and over that Adderall doesn’t work anymore may become inherently more skeptical of their medications. Sound familiar?

Genetic tests sold to doctors to help choose a patient’s antidepressant don’t work

Two-thirds of people with depression don’t respond to the first antidepressant they’re prescribed, and a third don’t respond to any. So there’s a big market for so-called pharmacogenomic tests that claim to help determine which antidepressant might be more effective and have fewer side-effects for individual patients. Manufacturers aggressively market them to physicians, and quite a few prescribe them to patients. But the tests are useless, according to a Los Angeles Times story that looked at a ream of evidence and recommendations.

The FDA formally warned patients and doctors in 2018 against using these tests to guide depression treatment. Impartial experts have repeatedly advised the same. At least a dozen clinical trials have studied them, and none has shown evidence of real effectiveness. They are lucrative, however: Myriad Genetics says its GeneSight test has been used by more than 2 million people, and revenue from the test reached $128 million in 2022, when more than 3,000 clinicians ordered it for the first time. Patients pay around $330 if their private health insurance covers it and a lot more if it doesn’t.

Showing mental health symptoms could get a child detained in Florida

A fourth-grader in Florida, frustrated at having to sit out afternoon recess, scrawled “kill” on an outdoor bench. When asked, he told a teacher that’s what he wanted God to do to him. His mother guessed he was hurt and angry, but a sheriff’s deputy working in the school drove away with the terrified boy. His mother followed, watching her son stare out the back window, sobbing, his hand on the glass.

Every day in Florida, a Washington Post investigation found, children and adolescents are involuntarily committed for psychiatric assessments and held for up to three days in a mental health facility under a controversial 1971 law. The Baker Act can be used when a person of any age is thought to pose a “substantial likelihood” of serious harm to themselves or others in the near future without treatment. In fiscal year 2020-21 more than 38,000 involuntary exams – 60% of them initiated by police – were ordered on children under 18. That’s an average of more than 100 a day and a nearly 80 percent increase in the past decade. The law is so enmeshed in state culture that it is widely used as a verb. Some children are taken away in handcuffs.

Critics say the act it is too often used with children, some as young as 5 or 6, who have behavioral issues, disabilities or who say something they don’t mean – and that it benefits profit-driven, substandard mental health facilities. Supporters say the law prevents harm and can force a family to reckon with a child’s need for professional care. Police, mental health clinicians and others used it more than 5,000 times in school settings during the 2020-21 fiscal year. A 16-year-old who joked about running into traffic, a 6-year-old who made an unspecified threat in class and a 15-year-old who spoke of self-harm when the school declined to recognize their gender identity were all Baker Acted.

County sues social media giants over rising costs of youth mental health services

A suburban Philadelphia county filed a federal lawsuit against Instagram, Facebook, Snapchat and YouTube for allegedly triggering the growing youth mental health crisis. Officials in wealthy Bucks County say it’s the first instance of a county government taking aim at Silicon Valley on the intractable issue, the Philadelphia Inquirer reported.

The civil action, filed in California, argues that apps have worsened conditions such as anxiety and depression among students. The 104-page document cites social media’s addictive qualities and role in inspiring negative self-image, and it demands financial damages for the rising cost of mental health services.

Scientists have found increasing evidence of social media’s harms and what it might take to prevent them. Medscape reported last week on findings, published in Psychology of Popular Media, that reducing social media screen time to one hour a day boosted self-image among a small group of teens and young adults with emotional distress, compared with controls in a short-term study. And in a recent Psychology Today blog, clinical psychologist Carla Shuman posts practical ways for adults to manage social media use.

In other news…

Americans seeking methadone treatment within 48 hours for their opioid addiction must drive five times farther, on average, than Canadians, according to a Washington State University press release. Timing is critical for people starting treatment. The researchers, writing in Drug and Alcohol Dependence, concluded that Canadians’ easier, quicker access to methadone is related to a more flexible regulatory approach by the Canadian government. They also called for integrating methadone treatment into more outpatient settings in both countries.

The VA will cover the controversial Alzheimer’s drug Leqembi for veterans who meet certain criteria, Fierce Pharma reported. Two months ago, the FDA approved the twice-a-month infusion, which costs $26,000 annually, after a late-stage clinical trial showed that it slowed cognitive decline − though not enough, some experts said, to be noticeable. Possible side-effects include bleeding and swelling in the brain. Medicare decided a year ago not to cover Leqembi’s predecessor, the even pricier Aduhelm, or similar drugs. It reiterated that decision for Leqembi last month, angering patient groups. The VA is not covering Aduhelm.

The mental health of founders and CEOs of Silicon Valley startups took a hit with the collapse of Silicon Valley Bank, according to Fortune.

Photo illustration: Shutterstock

Despite their presumed comfort with risk, the enormous pressure to remain strong and confident – and to meet payroll – during chaotic times can come at the expense of founders’ mental health. “In those situations as a founder, you actually don’t take care of yourself,” one said. “You put out the fire, and you make sure that everyone else is fed and taken care of before you take care of yourself.”

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...