RITALIN
Es cada vez mayor el número de niños y adolescentes diagnosticados de Trastorno por Déficit de Atención con Hiperactividad (TDAH) que son tratados farmacológicamente con Metilfenidato (Ritalin, Concerta, Adderall). Lo que muchos padres ignoran es que no sólo la propia existencia del TDAH es cuestionable sino que además el Metilfenidato es una potente droga controlada en Estados Unidos por la conocida DEA -la agencia antidroga- que la considera la antesala del consumo de otras drogas. Además no se les cuenta que hay alertas internacionales contra estos medicamentos -16 en el 2004- avisando de que causan adicción e incitan a comportamientos suicidas.
LO QUE SE OCULTA DEL TDAH
Normalmente no se suele decir que las pruebas sobre la evidencia biológica de la enfermedad no son ni mucho menos concluyentes. De ahí que tenga tanto peso la subjetividad en el diagnóstico. El neurólogo norteamericano Fred Baughman -una de las voces científicas más críticas sobre el actual enfoque del TDAH- aporta al debate algunas de las contestaciones recibidas a su constante petición de pruebas concluyentes sobre el TDAH como enfermedad: James M. Swanson -médico investigador del TDAH y miembro de CHADD Children & Adults with Attention-Deficit/Hyperactivity Disorder- le reconocería en 1998 durante una reunión de la American Society for Adolescent Psychiatry: “Me gustaría tener un diagnóstico objetivo para el desorden (TDAH). Ahora mismo el diagnóstico psiquiátrico es completamente subjetivo… Nos gustaría tener pruebas biológicas, un sueño de la Psiquiatría durante muchos años”.
El doctor Xavier Castellanos -del Instituto Nacional de Salud Mental- le respondería: “He notado sus críticas sobre la validez de diagnóstico del TDAH. Yo estoy de acuerdo en que no hemos encontrado la prueba específica para demostrar la patofisiología específica (la anormalidad) que nosotros creemos fundamental en esta condición”.
Y el doctor Lawrence Diller -médico de la Universidad de California- diría por su parte: “La razón por la que usted ha sido incapaz de obtener cualquier artículo o estudios en los que se presenten claras evidencias de una anormalidad física o química asociada con el TDAH es que no los hay. La búsqueda de un marcador biológico esta condenada de salida debido a las contradicciones y ambigüedades del diagnóstico de TDAH. Yo asemejo los esfuerzos por descubrir un marcador (anormalidad) a la búsqueda del Santo Grial”
El Panel de Expertos de la Consensus Conference sobre el TDHA concluyó en 1998: “No tenemos una prueba independiente válida para el TDAH y no hay ningún dato que indique que el TDAH está motivado por un funcionamiento cerebral defectuoso”.
En un artículo titulado ¨COMETIENDO UN ASESINATO¨, Fred Baughman recuerda: “La Universidad del William B. Carey de Pennsylvania testificó después: ‘Lo que se describe ahora más a menudo como TDAH en Estados Unidos parece ser un juego de variaciones conductuales normales… Esta diferencia pone la validez de la estructura del TDAH en duda’. Se han publicado cuatro estudios de Resonancia Magnética posteriormente. Aunque todos ellos utilizaron sujetos tratados con estimulantes los investigadores concluyeron que el ‘tratamiento’ con Ritalin y otras anfetaminas estaba causando atrofia en el cerebro, no que el TDAH es una enfermedad”.
Ante todo esto Baughman envió una carta -el 15 de abril de 1998- a la entonces Fiscal General de Estados Unidos, Janet Reno, denunciando la situación: “El mayor fraude por lo que respecta al cuidado de salud en la historia americana es la falsedad de la existencia del Déficit de Atención y Desorden de Hiperactividad (ADHD) como una enfermedad real y la drogadicción de millones de niños americanos completamente normales”.
Y es que es indudable que el TDAH está resultando todo un negocio para las farmacéuticas. Se estima que el valor bruto de la producción anual de metilfenidato en 2005 habrá multiplicado al menos por diecisiete el correspondiente a 1990 -según las cifras previstas para ese año en Estados Unidos - pasando en ese período de menos de 2 toneladas a más de 30. El metilfenidato es en la actualidad el psicotrópico bajo fiscalización internacional con mayor distribución en el circuito legal. Los ingresos derivados del mercado de drogas para el TDAH -incluyendo al metilfenidato y sus competidoras- alcanzan sólo en Estados Unidos valores superiores a los 3.100 millones de dólares según datos de la consultora IMS Health.
PELIGROS OCULTOS
Y es que si al menos el metilfenidato sirviera para solucionar algo podría entenderse y hasta justificar tan floreciente negocio pero no es así. Además existen múltiples indicios sobre sus efectos dañinos. Algunos muy recientes:
-El 28 de junio del 2005 un documento publicado en la web de la FDA anunciaba la identificación de posibles problemas de seguridad relacionados con los medicamentos elaborados a partir de metilfenidato. Específicamente notables eran los eventos adversos psiquiátricos relacionados con Concerta, Ritalin y otros medicamentos para tratar a los niños diagnosticados con TDAH. Según se explicaba el fármaco puede provocar alucinaciones visuales, ideas suicidas y comportamientos psicópatas así como agresividad y actitudes violentas. En vista de lo cual la FDA anunció su intención de hacer cambios en el etiquetado y reexaminar otras drogas estimulantes como las anfetaminas, aprobadas también para el tratamiento del TDAH.
-El 7 de julio del 2005 el National Center on Addiction and Substance Abuse emitió un informe según el cual 15 millones de norteamericanos estaban tomando medicamentos analgésicos y drogas psiquiátricas tales como Xanax, Ritalin y Adderall abusando de estas drogas más que de la cocaína, la heroína y las metanfetaminas combinadas. Es más, también 2,3 millones de adolescentes lo hacía. El informe reflejó asimismo que el abuso en la adolescencia de las drogas de prescripción producía 12 veces más probabilidades de consumir heroína, 14 veces más de consumir éxtasis y 21 veces más de consumir cocaína que los adolescentes que no consumen esos medicamentos.
-El 13 de septiembre del 2005 el Estudio de Medicina Basada en Evidencia de la Universidad del Estado de Oregón publicó que el tratamiento farmacológico para el TDAH no demostraba ninguna efectividad. Los investigadores repasaron 2.287 casos sobre este “trastorno” y publicaron un informe de 731 páginas en el que se concluía que la evidencia de que las drogas utilizadas para tratar el TDAH no habían reportado mejora en el rendimiento escolar, ni en el mejoramiento de las relaciones interpersonales, ni terminaban con sus conductas impulsivas las cuales los ponían en riesgo.
-Y el 29 de septiembre -un día antes de la reunión del Comité de las Naciones Unidas sobre los Derechos del Niño- la FDA ordenó que en las cajas de los medicamentos utilizados para el tratamiento del TDAH fueran colocadas cajas negras de advertencia después de admitir que los ensayos clínicos las relacionan “con pensamientos y conductas suicidas”. La FDA indicó que las nuevas advertencias son producto de una revisión continuada de todas las drogas utilizadas y su posible asociación con tendencias suicidas.
LO QUE PREFIERE IGNORARSE
Se podría decir, en suma, que al igual que ocurrió con el Vioxx, cada vez son más las alarmas respecto al uso de estos medicamentos. De hecho, desde hace años se vienen señalando distintos efectos negativos del metilfenidato:
-Borcherding y otros (1990) encontraron que el 51% de los niños que tomaban dextroanfetaminas y metilfenidato desarrollaban obsesión y compulsión.
-Barkley y otros (1990) descubrieron propensión al llanto en el 10% de los niños que consumían dosis bajas del metilfenidato.
-Mayes y otros (1994) descubrieron que el 20% de los niños se volvían letárgicos, adormilados, cansados, deprimidos, atontados, sometidos e inactivos.
-Schachar y otros (1997) documentaron que el 10% de los niños padecían efectos secundarios severos, marcada alteración de conducta, tristeza, deterioro mental, irritabilidad, retiro, letargo, comportamiento violento, manía y disforia.
-Castellanos y otros (1997) encontraron que el 25% de los niños bajo el metilfenidato desarrollaban reacciones adversas y comportamiento obsesivo-compulsivo.
-Firestone y otros (1998) descubrieron que el metilfenidato causaba deterioro marcado donde el 69% se entristecía y el 62% perdía el interés.
El Dr. Psiquiatra Peter Breggin, en su libro ¨Talking Back to Ritalin¨, asevera también que la mayoría de las causas por las que se etiqueta errónea y masivamente a millones de niños con el “síndrome” del Déficit de Atención e Hiperactividad (TDAH) son falsas. Según Breggin las pseudocausas utilizadas para drogar a niños son en su mayoría expresiones normales de niños normales aburridos, frustrados, asustados, enojados, traumatizados, indisciplinados o solitarios. Agregando que en algunos casos se trata de estudiantes atrasados o muy adelantados en las clases o con la necesidad de una atención especial, no de drogas.
“Uno de los más graves riesgos es que los psicoestimulantes -escribe Breggin- tendrán un efecto intencionado en el niño que suprimirá la conducta autónoma, espontánea, social y juguetona provocando complacencia, docilidad, una sobrefocalización obsesiva y una conducta repetitiva. El uso extendido de estimulantes habilita a los adultos a dominar y controlar a los niños sin mejorar su propia condición de padre o profesor y sin mejorar la estructura de la familia, de la sociedad y de los sistemas educativos¨.
CONCLUSION
Así que, después de la descripción de este triste panorama, la pregunta es ¿qué hacer? Pienso que lo primero es que los padres se documenten y asuman posturas más críticas frente a esta situación, que no permitan que sus hijos se conviertan en un producto de mercado y que las multinacionales farmacéuticas se llenen de dinero de sus propios bolsillos.
Artículos relacionados:
El “Déficit de atención” Se dispara el uso entre adultos
Drogas para el Déficit de Atención y riesgo cardiovascular
Se quintuplica prescripción de antipsicóticos a niños
La Estafa del Siglo parte VIII
Fuente: Rossana Fernández
77 comentarios:
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Atc. Sra.Trina Vázquez
Felicitaciones por su loable labor y sea extensivo a todo su equipo, quiero compartir mi experiencia para que se convierta en un llamado de atención para otros padres y una reflexión para los médicos. Mi hijo de 10 años fué diagnosticado con TDAH hace 5 años y desde entonces comenzó tratamiento y terapias en una reconocida Unidad Médico Psico-Educativo de Maracay especializado en el trastorno, todo iba muy bien, mi hijo mejoró muchisimo su comportamiento, tenia un excelente rendimiento academico y practicaba deportes, su tratamiento farmacológico siempre habia sido con bonifen, omega 3, breinox, pero en noviembre del 2006 la Neuropsicologo de dicha unidad le recetó Strattera de 25mg para mejorar la atención,me explico que era un medicamento nuevo pero que le habia dado buenos resultados con otros niños, como nos fué dificil obtener el medicamento y luego vinieron las vacaciones no se cumplió el tratamiento a cabalidad; en Enero la Dra.me indicó que para fuera efectivo el medicamento debia hacerlo continuo y asi lo hice por los 14 días, luego que continuara pero con el de 40 mg; yo leí el primer prospecto que alertaba acerca de efectos secundarios como nauseas, mareo, cansancio, poco apetito, cambios de humor y estuve pendiente, el día que comence con el de 40mg ese día el niño manifestó con llanto que no quería ir al colegio y al preguntarle si se sentia mal me dijo que no pero no queria ir, cuando siempre le ha encantado ir a su escuela; al darle el medicamento me llamó la atención que el prospecto era más grande y lo leí; quede asustada al leer que entre sus efectos secundarios estaban: pensamientos suicidas, ansiedad, irritabilidad seguir impulsos peligrosos, depresión, ataques de panico. Al siguiente día el niño habia presentado insomnio, apatia por sus actividades normales, un llanto incontrolable, además de vomito y diarrea; por supuesto no le dí mas el medicamento y llame a la Dra. le dije los sintomas y me dijo que le hiciera examen de heces porque podría ser viral, le dije que yo temía que fuera el medicamento y me dijo que no creia pero si yo queria que se lo suspendiera; lleve al niño a su pediatra en los examenes de rutina salío bien pero el médico me comentó que lo notaba muy decaido, lo dos siguientes días siguió igual; al comunicarme con la Dra. me dijo que el niño podia estar manipulando y me dijó que no lo podía ver porque tenía muchos pacientes pero mi esposo le exigió que lo viera, esa tarde lo vió y me dijo que lo veia bien que yo estaba exagerando, ante mi desesperación me comuniqué directamente via e-mail con Laboratorios lilly y sus visitadores; los cuales me refirieron a la Dra. Nancy Martínez; la cual consideró al igual que pediatra, maestros, psicopedagogos, terapista, instructores, padres del niño que si el niño tenía excelente rendimiento academico(cuadro de honor)comportamiento normal en clase, hogar y entrenamiento POR QUÉ recetarle ese medicamento. Además el prospecto explica que mi hijo tenia riesgos altos de pensamiento suicida porque tiene antecedentes familiares y la Dra. tiene eso en la historia. Por otro lado, ella no me advirtió de dichos efectos secundarios y no estuvo alerta a los mismos; en todo momento yo fuí la que insistió en que la causa era el medicamento. Pero la gota que colmó el vaso de agua fué que me llamó la secretaria de la Dra. para preguntarme porque el niño no había asistido a su terapia de lenguaje y para que fuera a cancelar la consulta por examinar al niño. El problema no era cancelar la consulta sino la integridad de mi hijo, nuestra angustia como padres y nuestra decepción de creer que nuestro hijo estaba en buenas manos de un profesional preocupado por su bienestar, si así hubiese sido y aceptando su teoría de que el niño estaba manipulando y de que no era el medicamento porque no referirlo al psicologo o psicopedagogo de su institución; porque si un niño modifica su comportamiento de un día para otro a tal extremo debe existir una causa y hasta grave. Gracias por darnos la oportunidad de manifestar nuestra decepción y esperamos que sigan adelante exitosamente con su labor.
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