Tag: ADHD

Categories : Mental Health Obstetrics & GynaecologyTags :

Gestational Diabetes Linked to ADHD in Children

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An Edith Cowan University (ECU) study has found children born to mothers who experienced gestational diabetes (GDM) during pregnancy are more likely to develop attention-deficient hyperactive disorder (ADHD) and externalising behaviour. The study appears in BMC Paediatrics.

The study used data from 200 000 mother-child pairs across Europe and Australia, and found that in children aged 7 to 10, those born to mothers with gestational diabetes had consistently higher ADHD symptoms.

Children aged 4 to 6 years, born to mothers with gestational diabetes consistently exhibited more externalising problems than those born who didn’t.

“Externalising symptoms are behaviours directed outward. Instead of experiencing depression or anxiety, these children often display hyperactivity, impulsivity, defiance, or aggression,” explained first author Dr Rachelle Pretorius, ECU Honorary researcher.

“Externalising problems frequently coexist with ADHD symptoms and tend to emerge before medical intervention, especially during the early school years,” she added.

“At younger ages, children may exhibit more externalising problems and as the child matures, symptoms or behaviour related to ADHD may become more apparent. ADHD does not have biological markers for diagnosis, making ADHD a disorder that is difficult to detect before symptoms manifest,” said senior author Professor Rae-Chi Huang.

It is still unclear why children exposed to gestational diabetes retained more externalising problems and ADHD symptoms respectively after adjustments.

“However, our findings suggest that these externalising behaviours may decrease over time but could extend into other domains such as neurodevelopment outcomes such as ADHD symptoms.”

Dr Pretorius noted that while the exact mechanics of gestational diabetes influence on child development is still unclear, it is believed that acute and chronic maternal inflammation during pregnancy may influence certain pathways in a child’s brain programming in-utero and contribute to neurodevelopment, cognitive and behaviour outcomes later in life.

“Several studies suggest that the severity of maternal diabetes, associated with maternal obesity, chronic inflammation have a joint impact on the development of autism spectrum disorder and ADHD in children, which is greater than the impact of either condition alone.”

Source: Edith Cowan University

Categories : Cardiovascular Disease Mental HealthTags :

New Study Investigates Effects of ADHD Medications on the Heart

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A new study led by the University of Southampton has found that medications for ADHD have overall small effects on blood pressure and heart rate after weeks or a few months of use.

There have been concerns about the side effects of ADHD medications but the new findings, coupled with other studies, suggest that the benefits of taking these medications outweigh the risks, while highlighting the need for careful monitoring.

The study, published in The Lancet Psychiatry, conducted the largest and most comprehensive analysis of the cardiovascular effects of ADHD medications based on the results of randomised controlled trials – the most rigorous type of clinical study to assess medication effects.

Professor Samuele Cortese, senior lead author of the study from the University of Southampton said: “When it comes to taking any medication, risks and benefits should always be assessed together. We found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications.

“Other studies show clear benefits in terms of reductions in mortality risk and improvement in academic functions, as well as a small increased risk of hypertension, but not other cardiovascular diseases. Overall, the risk-benefit ratio is reassuring for people taking ADHD medications.”

The study was funded by the National Institute for Health and Care Research (NIHR), within the framework of the NIHR Research Professorships scheme to Professor Samuele Cortese, with Dr Luis Farhat (University of São Paulo, Brazil) as first author and Professor Alexis Revet (University of Toulouse, France) as co-senior author.

It is estimated that attention-deficit/hyperactivity disorder (ADHD) affects around 4 per cent of children in the UK. Of these, around 45 per cent are treated with medication.

The international team of investigators analysed data from 102 randomized controlled trials, including a total of 22,702 participants with ADHD. They used an advanced statistical approach – network meta-analysis – that allowed them to compare the effects of several medications, even when the medications were not directly compared in the trials included in the analysis.

They found that all ADHD medications were generally associated with overall small effects on blood pressure, heart rate, and ECG parameters. With the exception of guanfacine (which leads to decreased blood pressure and heart rate), other medications led to increases in the values of these parameters.

No significant differences were found between stimulants (including methylphenidate and amphetamine) and non-stimulants (atomoxetine and viloxazine) with regard to their effects on blood pressure and heart rate.

“Our findings should inform future clinical guidelines, stressing the need to systematically monitor blood pressure and heart rate, both for stimulants and non-stimulants. This should be particularly relevant for practitioners who might assume that only stimulants have a negative effect on the cardiovascular system,” said Dr Farhat.

The researchers say that those with existing heart conditions should discuss the side effects of ADHD medications with a specialist cardiologist before starting treatment.

Professor Revet added: “Our findings, based on randomised controlled trials that tend to be of short duration due to ethical issues, should be complemented by results from real-world, longer-term studies.”

The research team will now look to see if some groups might be more vulnerable to cardiovascular side effects than others.

NIHR Research Professor Cortese concluded: “While our findings are informative at the group level, that is, on average, we cannot exclude that a subgroup of individuals may have a higher risk of more substantial cardiovascular alterations.

“While it is currently not possible to identify those individuals at higher risk, efforts based on precision medicine approaches will hopefully provide important insights in the future.”

Source: University of Southampton

Categories : Pain Management Substance UseTags :

Co-prescribed Stimulants and Opioids Linked to Higher Opioid Doses

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The combination of prescribed central nervous system stimulants, such as drugs that relieve ADHD symptoms, with prescribed opioid medications is associated with a pattern of escalating opioid intake, a new study has found. 

The analysis of health insurance claims data from almost 3 million US patients investigated prescribed stimulants’ impact on prescription opioid use over 10 years, looking for origins of the so-called “twin epidemic” of combining the two classes of drugs, which can increase the risk for overdose deaths. 

“Combining the two drugs is associated with an increase in overdose deaths. This is something we know. But we didn’t know whether stimulant use has a causal role in high use of opioids, so we conducted a big data analysis of how these two patterns interacted over a long period of time,” said senior study author Ping Zhang, associate professor of computer science and engineering and biomedical informatics at The Ohio State University.

“What we found is that if someone is taking a stimulant and an opioid at the same time, they’re generally taking a high dose of the opioid,” he said. “And if the patient in this study population takes the stimulant before beginning opioid use, they are more likely to have higher doses of subsequent opioids.” 

The study was published in The Lancet Regional Health – Americas.     

The research team obtained data on 22 million patients with 96 million opioid prescriptions from a large US health insurance database. Researchers established a cohort for this study of 2.9 million patients with an average age of 44 who had at least two independent opioid prescriptions between 2012 and 2021. 

Because these prescriptions included a range of oral formulas – codeine, hydrocodone, methadone, oxycodone, morphine and others – researchers standardised every prescription to morphine milligram equivalents (MME) and calculated each patient’s monthly intake of opioids.

First author Seungyeon Lee, a PhD student in Zhang’s lab, used statistical modelling and classified patients into five baseline groups of opioid dosage trajectory over the 10-year study period: very low-dose, low-dose decreasing, low-dose increasing, moderate-dose increasing and high-dose sustained use. 

“Some patients had stable low-dose opioid use, while others had increasing or high dose patterns over time,” Lee said. 

Of the total cohort, 160 243 patients (5.5%) also were prescribed stimulants. The addition of a monthly calculated cumulative number of stimulant prescriptions to the model and statistical analysis showed a shift in the trajectory groups. Characteristics that could serve as risk factors for increasing opioid use also emerged in the data, Lee said. 

Moderate-dose increasing and high-dose groups had an overall higher average MME and a higher proportion of patients with diagnoses of depression, anxiety and attention-deficit/hyperactivity disorder compared to other groups. The low-dose increasing group also had a higher proportion of patients with ADHD compared to the low-dose decreasing group. 

The most common diagnoses linked to co-prescription of stimulants and opioids were depression and ADHD or ADHD and chronic pain. 

“This was an important finding, that many patients with ADHD and depression, also experiencing chronic pain, have an opioid prescription,” said Zhang. “This cohort represents a very realistic health care problem.” 

Even taking those factors into account, the model showed that stimulant use was key to driving up the odds that patients who took both stimulants and opioids would belong to a group of people who increased their doses of opioids. 

“Stimulant use before initiating opioids and stimulant co-prescription with opioids are both positively associated with escalating opioid doses compared to other factors,” Lee said. 

Analysis of geographic and gender data also offered some clues to opioid use patterns in the United States. Patients in the South and West regions had higher total opioid intakes over the 10-year study period compared to the Northeast and North Central regions, with the highest frequency of opioid prescriptions in the South and higher MMEs per prescription in the West. Males also had higher average daily opioid intakes than females. 

The results linking high opioid doses and stimulant use suggest stimulants may be a driving force behind the emergence of the twin epidemic and offer evidence that regulation of stimulant prescribing may be needed for patients already taking prescription opioids, the researchers said. In addition to the increased risk of overdose death, co-using prescription stimulants and opioids can increase the risk for cardiovascular events and mental health problems, previous research has shown. 

Source: Ohio State University

Categories : Mental HealthTags :

New Research Reveals Recent Trends in ADHD Diagnoses

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Source: Paul, et al. 2024, Psychiatric Research and Clinical Practice

New research has identified differing trends in attention-deficit/hyperactivity disorder (ADHD) diagnoses among adolescents and adults, including an increase among adults from 2020 to 2023. The study, published in the American Psychiatric Association Journal Psychiatric Research and Clinical Practice, found a significant downward trends in ADHD incidence among adults from 2016 to 2020 and adolescents from 2016 to 2018. The ADHD incidence rate remained stable for adolescents in subsequent years.

ADHD is a neurodevelopmental disorder involving inattention and/or hyperactivity and impulsivity that interferes with a person’s functioning and ability to perform daily activities, including at school or work. ADHD is often viewed as a condition primarily impacting childhood and adolescence; however, it can also affect adults. Research on the prevalence of ADHD in adults remains limited, with findings varying considerably.

The large retrospective cohort study, conducted by researchers at Saint Louis University and SSM Health, involved more than 140 000 adolescents and adult patients who used services with a large healthcare system located in four states. New ADHD diagnoses were identified using patient charts. Regression analysis was used to determine incidence rates and trends in ADHD diagnoses by age group.

They found a significant downward trend in ADHD incidence among adults from 2016 to 2020 and an upward trend from 2020 to 2023. Among adolescents, a significant downward trend was observed between 2016 and 2018, and the incidence rate remained stable between 2018 and 2023.

“Fluctuations in incidence rates are likely due to a complex interplay of various factors,” the authors write. For example, increased awareness and destigmatisation of ADHD can lead to more diagnoses. Changes in diagnostic criteria, such as the expansion of ADHD criteria in the DSM-5 compared to previous editions, may have contributed to an increase in diagnoses. Variations in diagnostic practices and assessment methods can contribute to differences in incidence rates. In addition, there are some indications, the authors note, that the COVID-19 pandemic may have contributed to new ADHD diagnoses and worsening symptoms.

The authors suggest that this research can support future efforts to identify modifiable risk factors, ensure sufficient treatment resources, develop targeted interventions, and address diagnostic disparities.

Source: American Psychiatric Association

Categories : Mental HealthTags :

Eight Reasons Why ADHD Diagnoses are Increasing

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Sven Bölte, Karolinska Institutet

For a long time it was assumed that somewhere between 5 and 6% of children have attention-deficit hyperactivity disorder (ADHD). But the rates, in practice, are often higher. The American Centers for Disease Control and Prevention put the prevalence at 11.4% in children in 2022.

The Swedish Board of Health and Welfare reports that in 2022 10.5% of boys and 6% of girls received an ADHD diagnosis, which is 50% more than in 2019. And the board forecast that the rates will eventually plateau at 15% for boys and 11% for girls.

So, what might be the reasons behind the startling rise? Here are eight possible causes, many of which overlap and interact with each other.

1. Multiple diagnoses made in the same person

Previously, doctors were recommended by diagnostic manuals and trained to limit diagnoses in an individual to the most prominent one, and not to make certain combinations of diagnoses at all – for example, autism and ADHD. Today, it is recommended and common practice in the mental health sector to make as many diagnoses needed to meaningfully describe and cover the symptoms and challenges of a person.

2. Increased knowledge and awareness by professionals

Today, there is a new generation of professionals working in services with higher awareness and knowledge of ADHD. This has led to earlier detection and to ADHD being diagnosed in groups that were previously neglected, particularly girls and women – but also in adults, generally

3. Reduced stigma

In many societies, ADHD is far less stigmatised than previously. Doctors have fewer doubts about making the diagnosis, and those receiving it feel less stigmatised. For more and more people, ADHD has fewer negative connotations and is becoming a natural part of people’s identities .

4. Modern society places higher demands on cognitive skills

ADHD is not a disease but a malfunctioning composition of cognitive traits that exist on more functional levels even in the general population, such as “attention control” (concentration) and organisational and self-regulation skills. Modern societies are fast and complex, placing high demands on these cognitive traits. So people with lower than average skills in these key cognitive areas begin struggling to cope with everyday demands and might receive an ADHD diagnosis.

5. Higher expectations on health and performance

People’s expectations of their own and others’ performance and health are rising. The so-called “social baseline” of average health and performance is higher today. Therefore, people may express concerns about their own and others’ functioning earlier and more often, and may presume that ADHD could be an explanation.

6. Changes in schools have led to more students struggling

Schools have gone through substantial changes in how they teach, such as digitisation and introducing more project- and group-based learning, as well as much more self-guided education.

These changes have led to a less clear learning environment, including increased demands on students’ motivation and their cognitive skills, factors that can make it harder for students with even just a few traits of ADHD to succeed. It has also caused schools to refer more students whom they suspect of having ADHD for assessment.

7. Policymakers prioritise assessment

Politicians in many countries have tried to address the rising diagnosis rates predominantly by making diagnostic assessments more accessible so that people don’t have to wait a long time to receive a diagnosis.

While this is understandable, it fuels the number of diagnoses made and does not focus on avoiding diagnoses, such as by improving how children are taught, improving workplaces to make them more neurodivergent friendly, and offering support without requiring that a person have a diagnosis.

8. Diagnosis guarantees access to support and resources

In most societies, services are constructed as such that only a clinical diagnosis guarantees access to support and resources. It is often the only way for people and their families to get support.

Generally, not a lot is done for people without a diagnosis as service providers do not get reimbursed and are therefore less obliged to take action. So people in need of support are more likely to actively seek a diagnosis. And professionals are more inclined to assist them by giving a diagnosis, even if the person doesn’t quite meet the diagnostic criteria for ADHD – a phenomenon called “diagnostic upgrading”.

Sven Bölte, Professor of Child and Adolescent Psychiatric Science, Karolinska Institutet

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : Mental HealthTags :

Quarter of Adults Suspect They Have Undiagnosed ADHD, Study Finds

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Attention deficit/hyperactivity disorder – also known as ADHD – is typically thought of as a childhood condition. But more adults are realising that their struggles with attention, focus and restlessness could in fact be undiagnosed ADHD, thanks in large part to trending social media videos racking up millions of views. 

A new national survey of 1000 American adults commissioned by The Ohio State University Wexner Medical Center and College of Medicine finds that 25% of adults now suspect they may have undiagnosed ADHD. But what worries mental health experts is that only 13% of survey respondents have shared their suspicions with their doctor. 

That’s raising concerns about the consequences of self-diagnosis leading to incorrect treatment.

“Anxiety, depression and ADHD – all these things can look a lot alike, but the wrong treatment can make things worse instead of helping that person feel better and improving their functioning,” said psychologist Justin Barterian, PhD, clinical assistant professor in Ohio State’s Department of Psychiatry and Behavioral Health.

An estimated 4.4% of people ages 18 to 44 have ADHD, and some people aren’t diagnosed until they’re older, Barterian said. 

“There’s definitely more awareness of how it can continue to affect folks into adulthood and a lot of people who are realising, once their kids have been diagnosed, that they fit these symptoms as well, given that it’s a genetic disorder,” Barterian said.

The survey found that younger adults are more likely to believe they have undiagnosed ADHD than older generations, and they’re also more likely to do something about it. 

Barterian said that should include seeing a medical professional, usually their primary care provider, to receive a referral to a mental health expert to be thoroughly evaluated, accurately diagnosed and effectively treated. 

“If you’re watching videos on social media and it makes you think that you may meet criteria for the disorder, I would encourage you to seek an evaluation from a psychologist or a psychiatrist or a physician to get it checked out,” Barterian said.

What is Adult ADHD?

Adults struggling with ADHD will have problems with paying attention, hyperactivity and impulsivity that are severe enough to cause ongoing challenges at school, work and home. These symptoms are persistent and disruptive and can often be traced back to childhood.

Adult ADHD occurs in:

  • Adults who were diagnosed as children, but symptoms continue into adulthood.
  • Adults who are diagnosed for the first time, despite experiencing symptoms since they were younger that had been ignored or misdiagnosed. 

Hyperactivity as a symptom is typically less present in adults than in children. Many adults with ADHD struggle with memory and concentration issues. Symptoms of ADHD often worsen with stress, conflict or increased demands in life.

What are common types of ADHD?

The three types of ADHD are:

  • Inattentive ADHD – Inability to pay attention and distractibility. This also is known as attention-deficit disorder (ADD).
  • Hyperactive and impulsive ADHD – Hyperactivity and impulsivity.
  • Combined ADHD – This type causes inattention, hyperactivity and impulsivity.

ADHD can be difficult to diagnose in adults, because some of the symptoms are similar to those in other mental health conditions, such as depression or anxiety.

“Symptoms of ADHD can look different between different people,” Barterian said. “Some people might have more difficulty focusing on lectures or with organisation, while others may have more social difficulties with impulsivity and trouble following along in conversations.”

Source: Ohio State University

Categories : Neurology PaediatricsTags :

Autism and ADHD are Linked to Gut Flora Disturbance in First Year of Life

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Disturbed gut flora during the first years of life is associated with diagnoses such as autism and ADHD later in life. One explanation for this disturbance could be from antibiotic treatment. This is according to a study led by researchers at the University of Florida and Linköping University and published in the journal Cell.

The study is the first prospective study to examine gut flora composition and a large variety of other factors in infants, in relation to the development of the children’s nervous system. The researchers have found many biological markers that seem to be associated with future neurological development disorders, such as autism spectrum disorder, ADHD, communication disorder and intellectual disability.

“The remarkable aspect of the work is that these biomarkers are found at birth in cord blood or in the child’s stool at one year of age over a decade prior to the diagnosis,” says Eric W Triplett, professor at the Department of Microbiology and Cell Science at the University of Florida, USA, one of the study leaders.

Antibiotic treatment could be involved

The study is part of the ABIS (All Babies in Southeast Sweden) study led by Johnny Ludvigsson at Linköping University. More than 16 000 children born in 1997–1999, representing the general population, have been followed from birth into their twenties. Of these, 1197 children (7.3%), have been diagnosed with autism spectrum disorder, ADHD, communication disorder or intellectual disability. Many lifestyle and environmental factors have been identified through surveys conducted on several occasions during the children’s upbringing. For some of the children, the researchers have analysed substances in umbilical cord blood and bacteria in their stool at the age of one.

“We can see in the study that there are clear differences in the intestinal flora already during the first year of life between those who develop autism or ADHD and those who don’t. We’ve found associations with some factors that affect gut bacteria, such as antibiotic treatment during the child’s first year, which is linked to an increased risk of these diseases,” says Johnny Ludvigsson, senior professor at the Department of Biomedical and Clinical Sciences at Linköping University, who led the study together with Eric W. Triplett.

Children who had repeated ear infections before one year of age had a higher risk of a developmental neurological disorder diagnosis later in life. It is probably not the infection itself that is the culprit, but the researchers suspect a link to antibiotic treatment. They found that the presence of Citrobacter bacteria or the absence of Coprococcus bacteria increased the risk of future diagnosis. One possible explanation may be that antibiotic treatment has disturbed the composition of the gut flora in a way that contributes to neurodevelopmental disorders. The risk of antibiotic treatment damaging the gut flora and increasing the risk of diseases linked to the immune system, such as type 1 diabetes and childhood rheumatism, has been shown in previous studies.

“Coprococcus and Akkermansia muciniphila have potential protective effects. These bacteria were correlated with important substances in the stool, such as vitamin B and precursors to neurotransmitters which play vital roles orchestrating signalling in the brain. Overall, we saw deficits in these bacteria in children who later received a developmental neurological diagnosis,” says study first author Angelica Ahrens, Assistant Scientist in Eric Triplett’s research group at the University of Florida.

The present study also confirms that the risk of developmental neurological diagnosis in the child increases if the parents smoke. Conversely, breastfeeding has a protective effect, according to the study.

Differences at birth

In cord blood taken at the birth of children, the researchers measured substances such as fatty acids and amino acids, as well as exogenous ones such as nicotine and environmental toxins. They compared substances in the umbilical cord blood of 27 children diagnosed with autism with the same number of children without a diagnosis.

It turned out that children who were later diagnosed had low levels of several important fats in the umbilical cord blood. One of these was linolenic acid, which is needed for the formation of omega 3 fatty acids with anti-inflammatory properties and other effects in the brain. The same group also had higher levels than the control group of a PFAS substance, used as flame retardants and shown to negatively affect the immune system in several different ways. PFAS substances can enter the body via drinking water, food and the air we breathe.

Opens up new possibilities

As the relationships found in the Swedish children may not be generalisable to other populations, studies in other populations are needed. Another question is whether gut flora imbalance is a triggering factor or whether it has occurred as a result of underlying factors, such as diet or antibiotics. Yet even accounting for risk factors that might affect the gut flora, they found that the link between future diagnosis remained for many of the bacteria.

The research is at an early stage and more studies are needed, but the discovery that many biomarkers for future developmental neurological disorders can be observed at an early age opens up the possibility of developing screening protocols and preventive measures in the long term.

Source: Linköping University

Categories : Cardiovascular Disease Mental HealthTags :

ADHD Stimulants may Increase Risk of Cardiomyopathy in Young Adults, Study Finds

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Young adults who were prescribed stimulant medications for attention-deficit/hyperactivity disorder (ADHD) were significantly more likely to develop cardiomyopathy compared with those who were not prescribed stimulants, in a study presented at the American College of Cardiology’s Annual Scientific Session.

The study found that people prescribed stimulants such as Adderall and Ritalin were 17% more likely to have cardiomyopathy at one year and 57% more likely to have cardiomyopathy at eight years compared with those who were not taking these medications. Cardiomyopathy involves structural changes in the heart muscle that weaken its pumping ability. It can cause a person to tire easily and limit their ability to perform daily tasks, and it often worsens over time.

However, researchers said that the overall risk of cardiomyopathy remained relatively low even when stimulants were used long-term. They said the findings do not necessarily point to a need for clinicians to change their approach to screening patients or prescribing stimulants.

“The longer you leave patients on these medications, the more likely they are to develop cardiomyopathy, but the risk of that is very low,” said Pauline Gerard, a second-year medical student at the University of Colorado School of Medicine in Aurora, Colorado, and the study’s lead author. “I don’t think this is a reason to stop prescribing these medications. There’s very little increased risk of these medications over the long term; it’s a real risk, but it’s small.”

ADHD is one of the most common neurodevelopmental disorders in children, affecting about 1 out of 10 American children aged 3 to 17, and can continue into adulthood. It is typically treated with behavioural therapy initially, which may be combined with stimulant or non-stimulant medications to help control behaviours that interfere with daily life and relationships. Stimulant medications can elevate blood pressure by causing the heart to beat faster and with greater force.

Most previous studies assessing the safety of stimulant medications have focused on the first year or two of use and found no evidence of harm to the heart. Since many patients are prescribed these medications in early childhood and continue taking them into adulthood, this new study was designed to assess their potential to cause harm over a longer period of time, Gerard said.

Using the TriNetX research database that includes information from about 80 hospitals across the U.S., researchers analysed data from people diagnosed with ADHD between 20–40 years of age. Individuals with the presence or absence of a prescription for stimulant medications along with rates of cardiomyopathy that could potentially be linked to stimulant use were included. Those with heart damage caused by other known factors, such as cancer treatments, were excluded.

For the analysis, the researchers paired each person who had been prescribed stimulants with an individual who had not been prescribed stimulants but was as similar as possible in all other respects, such as age, sex and other health conditions. Overall, 12 759 pairs were created and were followed for at least 10 years. Of these pairs, people prescribed stimulants were found to be significantly more likely to develop cardiomyopathy throughout the 10-year follow-up period, with the gap growing larger each year except the last two, when it narrowed slightly.

Despite the significant gap, the overall prevalence of cardiomyopathy was still quite low in both groups. After being prescribed stimulants for 10 years, 0.72% (less than three-quarters of one percent) of patients developed cardiomyopathy, compared with 0.53% (a little over half of one percent) among those who were not prescribed stimulants.

To put the numbers into context, Gerard said, “You can have almost 2000 patients on these medications for a year and you might only cause one of them to have a cardiomyopathy that they otherwise would not have had, but if you leave them on it for 10 years, 1 in 500 will have that happen.”

At these levels, researchers said the study does not suggest that aggressive testing for cardiovascular risk is warranted before prescribing stimulants, given that the potential benefits of testing must be balanced against the risks and costs. They suggest that further studies could help to identify subgroups of patients at greater risk who may benefit from future screening approaches.

Gerard said that it could also be helpful to study potential differences among different types of ADHD medications and different types of cardiomyopathies.

Source: American College of Cardiology

Categories : NeurologyTags :

ADHD Medication Associated with Reduced Mortality

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A Swedish study of more than 140 000 individuals with attention-deficit/hyperactivity disorder (ADHD) found that initiation of ADHD medication was significantly associated with a 21% lower mortality two years after diagnosis, according to results published in JAMA. This reduction was especially pronounced for unnatural-cause mortality. Females and males also saw different reductions in types of mortality.

ADHD is the most prevalent neurodevelopmental condition, affecting 5.9% of youths and 2.5% of adults worldwide, according to the 2021 World Federation of ADHD International Consensus Statement. The disorder is associated with a broad range of psychiatric and physical comorbidities, as well as adverse functional outcomes. Furthermore, individuals with ADHD are at twice the risk of premature death, mainly due to unnatural causes.

Randomised controlled trials have demonstrated that ADHD medications, including stimulant and nonstimulant medications, are effective in reducing core ADHD symptoms for children and adults with ADHS. Pharmacoepidemiological studies have also shown reduced risks of negative outcomes, including injuries, traffic collisions, and criminality, which would be expected to decrease the mortality rate. However, there are concerns regarding the cardiovascular safety of ADHD medications, especially following long-term use, which could increase the mortality rate.

To date, three studies have examined the association between ADHD medication and mortality with mixed results. These studies had significant limitations, such as the absence of a control group. To date, there has been no study on the association in adults with ADHD. There are increasing diagnoses of ADHD among adults, who have a higher prevalence of somatic comorbidities, including cardiovascular diseases and other conditions, compared with children and adolescents.

Using the Swedish national registers, the researchers investigated whether initiation of ADHD medication was associated with mortality, using the target trial emulation approach to avoid key biases in pharmacoepidemiological studies.

They assessed for all 6 medications licensed for ADHD treatment in Sweden (methylphenidate, amphetamine, dexamphetamine, lisdexamfetamine, atomoxetine, and guanfacine) during the 2007-2020 period. Analysis of the data showed that, for a two-year follow-up, lower all-cause (hazard ratio [HR], 0.79) and unnatural-cause (HR, 0.75) mortality for the ADHD medication group, but there was no significant association with natural-cause mortality (HR, 0.86). Under unnatural causes, accidental poisoning mortality was halved (HR, 0.47).

Subgroup analysis revealed that for females, the only significant reduction in mortality was for natural causes. The authors noted that this may be due to higher rates of comorbid depression, sleep disorder, atrial fibrillation, and asthma.

When follow-up was extended to five years, associations attenuated save for unnatural-cause mortality (HR, 0.89).

The authors concluded, “ADHD medication may reduce the risk of unnatural-cause mortality by alleviating the core symptoms of ADHD and its psychiatric comorbidities, leading to improved impulse control and decision-making, ultimately reducing the occurrence of fatal events, in particular among those due to accidental poisoning.”

For limitations, the observational nature of the study cannot establish causation, and the authors noted confounding effects such as nonpharmaceutical treatment of ADHD. Potential type I error resulting from multiple comparisons regarding cause-specific mortality and subgroup analyses meant the results are only exploratory. Two more limitations were uncertain adherence to medication and potential misclassification of deaths such as potential cases of suicide being marked as accidental poisoning.

Categories : Mental HealthTags :

Stopping Long-term ADHD Meds is Common among Young People

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A pair of new studies has show that many patients stop taking ADHD medications within the first year, while those who take higher doses of ADHD medications long term seem to have a higher risk of some cardiovascular diseases. This is according to two new studies led by researchers from Karolinska Institutet and published in The Lancet Psychiatry and JAMA Psychiatry.

The Lancet Psychiatry study found that more than half of all teenagers, young adults and adults who received ADHD medication had stopped taking it within the first year. The proportion was slightly lower in children, whose decisions are made for them by carers, yet 35% still stopped their medication within a year.

Young adults risk falling between the cracks

The researchers analysed prescription data from over 1.2 million patients who started ADHD medication in Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, the UK, Sweden and the USA. The pattern was the same in all countries/regions.

“It’s unlikely that so many people discontinue their treatment because their ADHD symptoms have remitted, meaning that the high rate of early discontinuation may be a major barrier to effective treatment,” says Zheng Chang, senior researcher at Karolinska Institutet who led both studies. “We haven’t been able to analyse the direct causes in this study, but common reasons for discontinuing ADHD medication are adverse reactions and lack of effect.”

The highest rate of medication discontinuation occurred among 18 to 19-year-olds. This is when they leave child and adolescent psychiatry and enter adult psychiatry, a transition where they risk falling between the cracks. This is a shortcoming that the healthcare services must remedy, researchers say.

“We need to improve the transition to adult psychiatry and spread knowledge about the fact that problems associated with ADHD often persist over time,” says Isabell Brikell, research coordinator at Karolinska Institutet, and one of the first authors of the study in The Lancet Psychiatry. “In addition, new digital tools such as simple SMS-based inventions could be used to help people with ADHD manage their medication.”

Denmark sticks out

A country that sticks out in the statistics is Denmark, which had a much lower proportion of children who discontinue their treatment within a year – 18%, as opposed to the mean of 35%. Compared with other Nordic countries like Sweden and Norway, the prescription of ADHD drugs is lower, which could suggest that medication is only prescribed to those with severe ADHD and the greatest need, researchers say.

“Sweden has a relatively high prescription rate of ADHD medication compared with many other European countries, so it is possible that we over-prescribe here,” says Zheng Chang.

In another study conducted with over 275 000 Swedish ADHD patients published in JAMA Psychiatry, Dr Chang and his research group examined ADHD medication use for up to 14 years. They were then able to show that ADHD medication when taken for a longer time and in higher doses than average is associated with a higher risk of some cardiovascular diseases, primarily hypertension and arterial disease. 

The risk of cardiovascular disease increased by approximately 4% per annum. The risk increase was greatest in the first few years of treatment and then levelled off, and it was only statistically significant at doses higher than 1.5 times the average daily dose (the defined daily dose, DDD). This means that those treated with lower doses are not likely to develop cardiovascular disease, according to the researchers.

Follow-up of patients advised

“There is a long list of drugs that have been linked to a comparable increased risk of hypertension when used long-term such as the one found here, so patients should not be alarmed by these findings,” says Le Zhang, postdoc researcher in Dr Chang’s research group and first author of the JAMA Psychiatry study. “However, in clinical practice, the raised risk should be carefully weighed against the recognised benefits of treatment on a case-by-case basis. Doctors should also regularly follow up the ADHD patients to find signs and symptoms of cardiovascular disease while they’re on medication over the long-term.” 

Since this is an observational study, it is not possible to conclude that it is the ADHD medication that leads to an increased risk of cardiovascular disease. As the researchers point out, it could depend on other medications, symptom severity or lifestyle factors.

Source: Karolinska Institutet