Long-term ADHD medication use may increase cardiovascular disease risk – Two studies published in The Lancet Psychiatry and JAMA Psychiatry have shed light on the patterns of ADHD medication discontinuation and the potential cardiovascular risks associated with long-term use.
Early Discontinuation
A multinational study led by researchers at Karolinska Institutet in Sweden analyzed prescription data for over 1.2 million ADHD patients across nine countries. The study’s findings revealed a concerning trend: more than half of all teenagers, young adults, and adults who initiated ADHD medication discontinued treatment within the first year. This discontinuation rate was even higher among 18- to 19-year-olds, suggesting a potential gap in care during the transition from child and adolescent psychiatry to adult psychiatry.
The researchers identified several potential factors contributing to this early discontinuation, including adverse side effects, perceived lack of efficacy, and challenges in maintaining adherence to medication regimens. These factors highlight the need for improved communication between healthcare providers and patients to optimize treatment outcomes and address any concerns or barriers to continued medication use.
Denmark as an Outlier
Interestingly, Denmark emerged as an outlier in the study’s findings. The country exhibited a significantly lower discontinuation rate among children (18%) compared to the overall average of 35%. This discrepancy could be attributed to Denmark’s more conservative approach to ADHD medication prescribing. In Denmark, medication is typically reserved for children with the most severe ADHD symptoms, suggesting that clinicians carefully evaluate the need for medication and engage in shared decision-making with families.
Long-term Use and Cardiovascular Risk
Another study, conducted with over 275,000 Swedish ADHD patients, examined the long-term use of ADHD medication and its association with cardiovascular diseases. The findings indicated that extended use of ADHD medication at higher-than-average doses was linked to an increased risk of hypertension and arterial disease. However, this risk was primarily observed for doses exceeding 1.5 times the average daily dose (defined daily dose, DDD).
Clinical Implications
The studies highlight the importance of monitoring ADHD patients closely, particularly those taking higher doses of medication for an extended period. While the observed risk increase is comparable to other long-term medications, it should be carefully weighed against the benefits of ADHD treatment on a case-by-case basis. Regular follow-ups with healthcare providers are crucial to detect any signs or symptoms of cardiovascular disease.
Study Limitations
It is important to note that these studies are observational in nature, meaning they cannot definitively establish a causal relationship between ADHD medication and increased cardiovascular risk. Other factors, such as underlying medical conditions, lifestyle factors, or concurrent medications, could also play a role.
Future Research Directions
Further research is warranted to investigate the underlying mechanisms behind the observed associations and identify specific patient populations at higher risk of cardiovascular complications associated with long-term ADHD medication use.
Study sources: The Lancet Psychiatry and JAMA Psychiatry
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