Should adults with ADHD take stimulants?
NEW YORK |
NEW YORK (Reuters Health) - Ritalin is not just for kids anymore, suggests a new study.
A team of Swedish psychiatrists found that stimulants relieved symptoms in 4 out of 5 adults with attention-deficit hyperactivity disorder (ADHD). Further, the long-term side effects of the drugs appeared to be few and mild.
"ADHD problems are often carried into adulthood, although they look a bit different from the outside," lead researcher Dr. Susanne Bejerot of the Karolinska Institute in Stockholm told Reuters Health by email. "Adults with ADHD are extremely susceptible to stress, forgetfulness and restlessness. They also have low self-esteem and are often emotionally unstable."
"Not that stimulant treatment helps with everything," she added, "but it usually makes life a bit easier for these adults."
Stimulant drugs, including Ritalin and Adderall, are FDA-approved for children with the disorder. However, not all of the drugs are approved for adults, as data on safety and efficacy in this age group lag behind those in children.
This is crucial hole to fill, note the researchers, especially since an estimated 3 to 4 percent of adults have ADHD -- many of whom are now using the stimulants for extended periods of time.
Bejerot and her colleagues identified and followed 133 adults with ADHD who received stimulants from their Stockholm clinic between 2001 and 2008. In nearly half of the adults, the treatment was prescribed on top of existing anxiety or depression medications. Half were also too disabled to be employed or in school full-time, even though the group was of average intelligence.
By 6 to 9 months into the study, 80 percent of patients had successfully controlled their ADHD symptoms with stimulants. Side effects were not considered severe, and included a 10 beat-per-minute average increase in heart rate, decreased appetite and dry mouth.
Despite the help most patients found with the drugs, one of every two adults quit taking them within 2 years. Not surprisingly, those who experienced the greatest reductions in symptoms during the first 6 to 9 months -- particularly an improvement in attention over time -- were more likely to continue on treatment.
Anxiety and depression led the list of reasons for dropping out. Just 15 percent of patients blamed a lack of treatment effect.
ADHD has only become a widely recognized diagnosis in the last couple decades. So, while many of the adults followed in the study had received psychiatric help as children, only one had a childhood diagnosis of ADHD. That individual happened to be Bejerot's son.
"In the early nineties I was able to get him into a drug trial with stimulant treatment in Sweden," she said. "For my son, the treatment made it possible to attend a normal class and learn; it made all the difference in the world. The drug treatment still makes all the difference."
Other treatment options do exist for adults with ADHD, including a non-stimulant medication called atomoxetine (Strattera). However, as Bejerot noted, people tend to find the drug's side effects more bothersome than stimulants. Talk therapy and mindfulness training may also help lessen symptoms, she said.
The researchers note that the best treatment of ADHD should go beyond medications and therapies to include a team of caregivers who understand the disorder and how its very symptoms can get in the way of its treatment. The study clinic, for example, reminded forgetful patients of appointments by phone and text message.
Megan Davidson of Queen's University in Ontario, Canada, agreed with the need for a team approach to help patients stick to their therapies and deal with the educational, occupational and marital problems that often accompany the disorder.
"Treatment of adult ADHD should not only involve psychiatrists or family physicians," she said in an email to Reuters Health, "but also psychologists, social workers, and occupational therapists."
Journal of Clinical Psychiatry, online June 1, 2010.
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