Stimulants and Suicide: A Tragic Story With Misleading Implications

The very sad piece in the New York Times yesterday about a young man who committed suicide after serious abuse of stimulant medications was upsetting for a number of reasons. It’s a terribly tragic story about mishandled medication, about the ravages of addiction, and about the powerlessness of parents to help adult children who are self-destructively mentally ill.

It is also verges on the kind of fear-mongering that is unhelpful to parents trying to provide the best support and care to struggling children. Families whose children have ADHD deserve, we think, a more even-handed assessment of the risks of the disorder and its treatments, as well as the circumstances leading to the suicide of Richard Fee.

Fee was a young man who, according to his father, had no symptoms of ADHD, but was able to convince a series of mental heath practitioners that he had the disorder and persuade them to provide multiple prescriptions for stimulant medications he was abusing. The story paints a painful picture of lapses in the mental health care system. Most painful of all was the portrait of his father practically accosting a psychiatrist who had been fooled by his son’s fabrications and begging him to stop providing the prescriptions. It’s appalling that he couldn’t get the message across that his son was an addict, and that a series of mental health practitioners didn’t do due diligence about how many prescriptions he had already filled.

But the story was also disturbing because the writer did painfully little to make it clear how far this kind of abuse of stimulants is from monitored use by children and adolescents who actually have ADHD. It suggests two misleading and frightening notions. First, that taking stimulant medication for ADHD puts kids at higher risk for addiction. Research shows that it doesn’t. For kids with ADHD, medication is not a steppingstone to the kind of abuse Fee was engaged in.

The second misleading suggestion: that it’s easy to take a little too much Ritalin or Adderall and end up in the predicament that Fee was in, addicted and at risk for the kind of psychotic, suicidal crash that ended his life. The fact is that stimulant medications are metabolized rapidly in the body, and when one takes them according to a doctor’s orders the medication does not accumulate in the body. You have to do a lot of sustained doubling up on medications to accumulate enough amphetamines in the body to enable the crippling withdrawal symptoms that Fee is said to have experienced.

It’s terrible that Richard Fee was able to manipulate a lax system to get enough medication to get into very serious trouble. It is terrible that Fee’s caring and tireless parents knew their son was out of control and found themselves powerless to intervene on his behalf.

But it’s also unfortunate that this story slyly inflates the risks of stimulant medications used appropriately by not acknowledging that Fee’s abrupt change in personality, extreme behavior, and suicide may well have had other contributing factors. For a doctor with no connection to Fee to say that stimulants “in all likelihood” were the “primary issue” contributing to his suicide is irresponsible, and to print this statement is reckless. Fee was at a prime age for the onset several other major psychiatric disorders, and was also apparently abusing marijuana, which has also been linked to higher risk of suicidal thoughts, psychotic symptoms and depression. Did he have depression or mania or schizophrenia? We have no idea. Are stimulants fairly safe for people with ADHD under the close care of a physician and with the support of the family? Yes.