Original research
Medical use and combination drug therapy among US adult users of central nervous system stimulants: a cross-sectional analysis
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  • Published on:
    Response to Author's Response to Dr. Pomeroy's Concerns

    Thank you for your response to my concerns and comments on the article. I wish to correct an apparent misunderstanding about concomitant use of SSRIs and stimulants. I did not state that SSRIs have any indication for treating ADHD, I am aware of research to the contrary and have never used SSRIs to treat ADHD. My statement that "SSRIs have FDA-indications for treating both conditions" was intended to refer to the conditions of anxiety and depression; upon re-reading the statement when looking to see how a conclusion was made that I was treating ADHD with SSRIs I can see how it could be mis-construed. Regarding studies of the safety of the combination of stimulants and SSRIs (or other anti-depressants), I also am not aware of any. A prospective study would be challenging to do, to say the least. A retrospective analysis with inclusion of diagnosis-specific information and directly correlating diagnosis, treatment including dosages and duration, and outcomes would probably be challenging as well but I think that degree of detail and specificity is necessary before drawing conclusions about the safety of combinations of medications (drugs) used to treat any condition.
    Thank you again for your careful consideration of my initial comments.
    David P. Pomeroy MD
    Regarding my statement that "stimulants and SSRIs are basically safe" I was not contesting the fact that each has Black Box warnings and serious side effects and...

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    Conflict of Interest:
    None declared.
  • Published on:
    Authors’ Response to Dr. Pomeroy’s Concerns

    Dr. Pomeroy’s rapid response does not dispute our study methods, data, or primary conclusion: That
    nearly half the adult use of Schedule II stimulants occurs in combination therapy with other potent
    psychoactive drugs, notably antidepressants and anti-anxiety drugs. However, we disagree with his
    statements about safety, appropriate clinical use, and characterization of FDA approval status.
     We know of no antidepressants that are FDA-approved (or “on label”) for combination therapy
    with stimulants such as the amphetamines or methylphenidate. In fact, not one of the six most
    commonly prescribed SSRI antidepressants has an FDA-approved indication for treating ADHD in
    monotherapy, let alone with combination therapy. (1)
     His contention that combined use of stimulants with antidepressants “is basically safe” ignores
    the well-documented risks of both drug classes. The U.S. Drug Enforcement Administration
    declares that the Schedule II stimulants are “dangerous,” and the drug prescribing information
    contains a boxed warning about the high risk of addiction and misuse as well as warnings about
    psychiatric side effects, serious cardiovascular reactions, long-term suppression of growth, and
    tics and other persistent involuntary movements.(2) SSRI antidepressants contain warnings
    about suicidality, and adverse effects include sexual dysfunction, weight loss, tremor, insomnia

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    Conflict of Interest:
    None declared.
  • Published on:
    Misleading information of no value

    Combination drug therapy for ADHD and one or more of the common co-occurring disorders experienced by 50-60% of patients with ADHD is appropriate on-label use of stimulant plus anti-depressant for instance. 40% of patients with appropriately diagnosed ADHD have clinically significant anxiety as well, 30% have depression. SSRIs have FDA-approved Indications for treating both of these conditions. Stimulants and SSRIs are basically safe when taken together; rare instances of serotonin syndrome are seen. I do not see any evidence that any professional with experience diagnosing and managing patients with these conditions had any input into this "study"; if there had been then the negative value of the report would have been evident. Without correlating diagnoses with the data cited, as noted in the "limitations" section, the data is of no significance whatsoever. As a physician with 18 years of specialty practice in the field of ADHD and 26 years of general Family Medicine prior to that I can attest to the inaccuracy of the biased conclusions reached in this paper. I have no financial interests or benefit from any manufacturer of pharmaceuticals or any other purported treatments for ADHD. I do have a passion for exposing the "myth-information" surrounding ADHD diagnosis and treatment which abounds in the popular press and unfortunately in professional publications as well.

    Conflict of Interest:
    None declared.