By: Nathaniel Geyer, DrPH, CPH, GISP
Currently in the United States and the United Kingdom there is a shortage of ADHD medication. At the same time medical debt and inflation are keeping prices high. Due to this crisis, they are unable to receive their medication on time and the people’s quality of life has gone down. Ironically, older cheaper medications like imipramine, with more side effects are being underutilized. From 1950-1990s, Imipramine was the medication of choice because it treated conditions holistic for depression and bedwetting. However, in the 1990s it was discovered that there were extensive side effects and annual blood tests, that lead many doctors to wane their patients off the drugs, due to fears of adverse reactions.
It was during that time in 1988 when I was first given imipramine and it improved my symptoms, but two years later I was forced on to newer medications that make my symptoms worse. It got so bad that when I was 12 years old, that lead my parents to demand that the doctor put me to be put back on imipramine, which I have been taking for more than 30 years. Unfortunately, when I was in my 20s, I got into some medication adherence problems that led me to be taking a small dosage of Abilify, which led me to experience shakiness and a low white blood cell count.
Based on my experience, the ADHD medication crisis could have been prevented by choosing older medications like imipramine that are in high supply and not on patents, which lead the drug companies to lower supply to make profit. Unfortunately, most doctors are reluctant to prescribe older medication out of fear of side effects. As a public health researcher with autism, I see a need for parental and self-advocacy to be willing to think outside the box to ask doctors why my family member should be on a waiting list for drugs and have behavioral problems and debt to make a profit. This is an ethical dilemma that I hope that neurodivergent people
have the courage like my family to find a better solution than being in limbo. This is why I am advocating for patients by writing this post for grassroots movement that more families advocate for using second tier drugs that despite having more side effects help improve the patient’s quality of life. I could never have gotten my Doctor
of Public Health and worked full-time for almost 15 years if I was in constant fear of not having enough older medical debt or medication to support my quality of life.
For people who are frustrated about the low supply of ADHD medicines, it is important to realize that waning off medication takes time and support. Simply stopping taking medication without the support of doctors is not acceptable and can lead to unnecessary hospitalization. Another drawback is the imipramine level needs to be monitored for toxicity, via blood test for adverse reactions, which was why newer medications were developed. Despite these drawbacks, I believe that older medications can be used as a solution to help stop the dependency on newer medications, that are not as monitored for adverse effects than imipramine. For example, there is no blood test on adverse effects from Abilify, which can lower white blood cell counts that can increase the amount of infection. As a public health researcher, I advocate for more research on treating unmet needs and adverse
effects of ADHD medications.
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