My mother has been taking Ritalin for her adult ADD for more than 10 years. This afternoon it was found out that she just had a minor stroke and has evidence of possible prior strokes. Strokes do not run in the family, she is not elderly and has no history of heart disease.

My question is twofold. One, could it be possible that her diagnoses of ADD was really due to tiny strokes and not an illness in and of itself?

And two, could stimulant medication be making whatever neurovascular condition she has worse?

Her internist has stopped her Ritalin and doesn't want her to ever take it again. When will psychiatry do more than just treat the symptoms?

Answered by: Peter Shapiro

When an individual has had numerous small strokes, the overall effect can be to make his or her intellectual function worse, but this would not be likely to appear as an "attention deficit" problem, and it almost always happens in the elderly. The Food and Drug Administration has only recently compiled evidence that stimulant medication may increase risk for strokes and heart attacks; this might be especially an issue for patients who have an increase in blood pressure from taking stimulants. This is an area of controversy and still being investigated. If your mother has atherosclerosis and high blood pressure, she is already at increased risk of having a stroke. In those circumstances it would be especially important to be cautious about using a stimulant medicine. I certainly agree with the hope that you express that psychiatry will develop more effective, safe treatments that are designed to treat the causes of mental disorders rather than the symptoms. The past 20 years have seen an explosion in our knowledge of the brain's functioning in health and disease, and this new knowledge has helped develop new treatments, but there is a vast amount we still need to learn.

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Peter Shapiro, M.D.
Director, Fellowship Training Program in Psychosomatic Medicine 

Peter A. Shapiro, M.D., is Professor of Psychiatry at Columbia University Medical Center, and Director of the Psychosomatic Medicine Fellowship Program and Associate Director of the Consultation-Liaison Psychiatry Service at New York Presbyterian Hospital-Columbia University Medical Center.

His research has focused on psychiatric outcome after organ transplantation and on psychological factors and psychiatric problems in heart disease. He was a co-investigator for the REMATCH, SADHART, and CODIACS trials.

Dr. Shapiro is a past president of the Society for Liaison Psychiatry, ...
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