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Weighing the Risks and Benefits of Adult ADHD Medications

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

As mentioned, 70% of those with ADHD benefit from taking ADHD medications. Although these medications are generally considered safe, and the risk of complication low, the risks must still be evaluated.

risk ahead street signBefore starting any sort of medication for ADHD, adults should get a complete medical workup. Be sure to inform your healthcare professional of any current health conditions and medications. Any ADHD medication risk assessment for adults must consider that underlying health conditions increase with age. Because people visit different healthcare providers, it is important to review all medical conditions and medications with each provider, ideally at each visit.

The benefits of medication include rapid and dramatic improvement. A person can now focus on project completion when before they could not. Medications help people be more attentive to other people's feelings, thus improving relationships. Typical ADHD symptoms, such as inattention, hyperactivity, and impulsivity, are reduced. For those fortunate 70 % who are helped by medication, they see the world with a fresh new perspective. This provides the stimulus and motivation to make behavioral improvements.

Individuals who respond well to medication demonstrate clear improvements in both quality and quantity of the work they do. However, medication is not a cure. It is an opportunity to recognize problem areas; develop plans for improvement; and, to take steps to implement the plan.

Like all drugs, stimulants do have side effects. The most common side effects are appetite suppression and weight loss. This is a greater concern for growing children but it can also become a problem for some adults. Usually, these side effects are minor annoyances that resolve after a few weeks. However, if a person begins to fall below a healthy weight (or fails to gain weight in children), the situation requires attention. The person may not be eating enough and their nutrition may be compromised.

Recently, cardiac abnormalities have been identified as a risk factor for stimulant use. As might be expected, stimulants increase blood pressure and pulse rate. This could lead to strokes and heart attacks in vulnerable patients. People at risk for heart disease, and/or hypertension (i.e., high blood pressure), should not take stimulant medications. Strattera is an ADHD medication that bears special mention. It has been linked to seizures and irregular heartbeat. If someone has a history of seizures, Strattera should not be used. A category of medications, called tricyclic antidepressants, can also trigger seizures. The prescription of tricyclic antidepressants for the treatment of ADHD is an off-label use. This means this use, for this drug, has not been reviewed by the FDA. Therefore, these medications should only be used as a last resort, even for those without a history of seizures.

Some people have difficulty with mood or emotional regulation. They may become easily upset, tearful, angry, or irritable. When this is the case, stimulant medication can worsen their symptoms. Stimulant medication can also exacerbate anxiety, depression, excessive anger, or obsessive compulsive disorder. On the other end of the spectrum, stimulants can even cause a person to seem "like a zombie" when the dose is too high. Usually, this is easily resolved by lowering the dose. Additionally, there are some antidepressant medications known to increase suicidal thoughts when first administered. Therefore, people who have recently been prescribed anti-depressant medication (particularly teens and young adults) should be closely monitored.

The misuse and abuse of ADHD medications

Most concerns about the misuse of ADHD medication are unfounded. Several long-term studies have demonstrated the clinical use of stimulants (by teenagers) does not increase the likelihood of the subsequent development of a substance abuse problem. In fact, it may even provide a protective factor (CHADD Fact Sheet, 2015). Likewise, adults with ADHD have a reduced likelihood for addiction. Other studies have found that those children and teens with ADHD who are not adequately treated with medication may experience an increased risk of developing a substance use disorder (CHADD Fact Sheet, 2015). In fact, most adults on the stimulant drug, Ritalin, gradually lower their dose of stimulants as they age, rather than increase use. It is theorized that this is because continued medication use increased the number of dopamine receptors available. Current research demonstrates that stimulants affect people with ADHD differently than those without the condition. Promising research on these topics is ongoing.

Nonetheless, more than 50% of people who seek treatment for self-reported, ADHD concerns are between the ages of 18 and 24. The 2008 National Institute of Drug Abuse survey found this is the very same age group most likely to abuse stimulant medication. In fact, the rate of stimulant abuse by college students was reported to be twice that of other age groups (Flory, Payne, & Benson, retrieved 2016). Some more recent studies suggest the magnitude of the problem may not be as great as in previous years. Nonetheless, the possibility of drug-seeking behavior must be a central consideration during adolescent and adult ADHD assessments.