Manaea’s weight loss a common side effect of ADD meds

For Sean Manaea, a 25-year-old second-year starting pitcher, a season that ends in a 12-10 record and 4.37 ERA is not terribly bad.

The big lefty, though, began his 2017 campaign on pace for numbers far more worthy of his astronomical expectations. Through the first three months of the season, Manaea appeared on his way to a very justifiable All-Star bid. But, around the All-Star break his velocity began to dip and his ERA began to climb.

Between July 22 and Sept. 12, he went 2-5 with a 6.75 ERA, ballooning his runs allowed per nine almost a full run, from 3.68 to 4.65.

After allowing a single unearned run in 6-2/3 innings to beat the Rangers in his final start of the season on Thursday, Manaea spoke to the media in Texas. He addressed his game, his team and his season, which included the revelation that he had been diagnosed with Attention-Deficit Disorder prior to the season, and thus placed on medication.

Manaea told Martin Gallegos of the Bay Area News Group:

“I got it prescribed in spring training and we were trying to dial in the dosage the entire season. It definitely took a couple of months for me to find that right dosage and the stuff I’m on right now definitely helps. Before, the dosage I was on, I couldn’t eat. I would take like two bites and be full. It was bad. ”

Before he and his doctor were able to find the correct dosage of the correct medication, Manaea battled a loss of appetite which led to massive weight loss — 25 pounds, he said, in a few short months.

Still, the 6-foot-5 lefty who comfortably pitches at a normal weight of around 245 pounds battled through a tumultuous season. One that saw his average fastball velocity plummet from 93-94 miles per hour to 90, and often below. For a guy who depends heavily on the heater — using it about 57 percent of the time, according to fangraphs — a four- to five-mph dip in velocity can be damning.

Despite the physical struggles, Manaea will finish the 2017 season as the A’s leader in wins (12), starts (29), innings (158-2/3) and strikeouts (140) — all up from a year ago.

Looking forward, Manaea should be expected to make a complete recovery, and return to form, according to pharmacist Ngami Ha.

Ha, who has been informing patients of the effects, side-effects and dangers off ADD and ADHD medications like Ritalin and Adderall for seven years, told SFBay that this type of drastic loss in appetite is somewhat standard:

“Appetite suppression is a *very* common side effect of ADD medications. I generally tell my patients to eat a good breakfast before taking the first dose of the day.”

She further explained that appetite suppression will commonly happen exactly the way Manaea described it: a complete loss of interest after only a few bites and, at times, no interest in food at all. Why? Containing chemicals like methylphenidate — nervous system stimulants — all ADD and ADHD medications could elicit a reaction similar to that of amphetamines.

That is what makes prescribing the correct medication and dosage difficult. According to Ha, not only are there different medications with containing different chemical structures, there are different “delivery systems.”

“Some drugs have the same medication, just different release systems. Sometimes, simply changing the release type of the medication can decrease side effects. Other times, a totally different medication is required. Ideally, these issues are addressed at follow-up appointments with the doctor, especially during the first few months of starting a new medication.”

Manaea’s physical reaction could have come from taking the wrong medication, meaning he needed to transition to a different one. Or, he could have taken an immediate-release form of his medication, meaning his body got the entirety of the active ingredients in one “jolt” when he needed the sustained-release (constant “drip”) or extended-release form. Or, perhaps, vice versa.

Asked about Manaea’s case in particular, Ha said that it does take some time for a doctor and patient to “dial in dosage”:

“I don’t believe that this is over- or under-prescribing, ADD or ADHD diagnosis are not given readily. Together the doctor and patient came to the conclusion that he required medication.”

Manaea, whose weight dipped down near 220, says that he feels more comfortable now at around 230, but would like to put on a bit more muscle, tipping the scales back up near the 245 range. While he chose not to address the particulars of his medications, the hurler said:

“Everybody started taking notice and I lost all that weight. It was a tough time but the stuff I have now is perfect.”


Kalama Hines is SFBay’s sports director and Oakland Athletics beat writer. Follow @SFBay and @HineSight_2020 on Twitter and at SFBay.ca for full coverage of A’s baseball.