Long-term Benefits and Safety of ADHD Drug Treatment
Posted Jan 07 2013 11:04am
ADHD Drug Treatment in the Long-Term
Long-term Safety and Benefits of ADHD Drug Treatment
Two thirds of patients prescribed ADHD medication stop taking it within a year. Patients stop their medications for all sorts of reasons including side effects, a mistrust of pharmaceutical manufacturers or of the health care system, costs, etc. Patients with Inattentive ADD (ADHD-PI, Inattentive ADHD) may find stimulant medication difficult to stay on because of side effects such as sluggishness, depression or anxiety but other patients and parents stop because of concerns regarding the the long term safety and benefits of ADHD drug treatments.
Those of us with children on stimulant medication have nagging concerns about the long-term brain changes brought about by ADHD drug treatment, the brain changes that will persist into adulthood, and about whether these permanent brain changes will be beneficial or not. There is little disagreement, in the medical community, about the long term effects of not treating ADHD. Researchers and medical providers or all specialties agree that ADHD should be diagnosed early and treated immediately. The reason for this unanimous conclusion is related to the findings from research studies that have followed people with ADHD over long periods of time. These studies, called longitudinal studies, are expensive and difficult to perform but the findings from these studies also carry a great deal of weight.
There have been several longitudinal studies looking at what happens to untreated kids with ADHD when they reach adulthood. The results of these longitudinal studies have consistently shown that untreated ADHD results in increased risks of:
· Poor academic outcomes
· Poor job related outcomes
· Mood disorders
· Addictive disorders
· Adolescent and Young Adult delinquency
Despite an understanding of the negative risks associated with non-treatment, many patients and parents have concerns regarding the long term benefits of drug therapy as well as the long term risks. The most loudly voiced concerns regarding risks involve questions about stimulant treatment and:
The majority of longitudinal studies performed looking at these three specific risks have found that there are no long term cardiac risks from the use of ADHD stimulants, that stimulant use may, in fact, lower not increase the risk of illegal drug use, and that stimulants do cause small reductions in weight and bone growth.
The question of ADHD drug treatment and academic success is less certain. While it is clear that not treating ADHD results in more academic failure. There is little persuasive evidence that patients that are treated with drug therapy fare much better. A longitudinal review study looking at almost 9000 patients with ADHD found that long-term medication use was associated with small improvements in standardized test scores but the evidence for long-term improvements in school grades and grade retention was less compelling.
Other questions such as whether the stimulants permanently change the size or connectivity of the brain, whether the stimulants enable brain plasticity changes that are beneficial in the long term and whether stimulants cause permanent genetic or epigenetic changes that are beneficial or detrimental are more difficult to answer. Some animal and human longitudinal studies have suggested that there are no permanent neurological or genetic changes that result from ADHD drug treatment but other studies have suggested just the opposite.
While these research questions are important and have, as of yet, not been answered, most patients, parents and providers are more concerned with more practical matters such as whether continued stimulant medication use results in any permanent brain improvement or deterioration.
I will discuss these questions in my next post. I have included references for those of you that would like to read more about these important issues.
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