Attention-deficit/hyperactivity disorder (ADHD) is often considered a childhood condition, but it frequently persists into adulthood. Understanding the patterns of medication use – and discontinuation – across the lifespan is crucial for effective management of the disorder. New research sheds light on why individuals with ADHD stop taking medication, and how these patterns vary based on age, sex, and country. The study also explores the potential interplay between ADHD, its treatment, and cardiovascular health, a growing area of concern given observed links between ADHD and increased risk of heart problems.
ADHD and Cardiovascular Risk
A recent investigation, conducted by researchers at Karolinska Institutet, examined individuals with and without ADHD who had experienced a heart attack. The findings, while showing similar health histories between the two groups, revealed key differences in lifestyle factors. Individuals with ADHD were more likely to smoke or use smokeless tobacco, less likely to attend follow-up appointments, and showed a lower rate of smoking cessation. This suggests that addressing cardiovascular risk factors requires a tailored approach for individuals with ADHD, acknowledging potential challenges with adherence to preventative measures.
Medication Discontinuation Across the Lifespan
The study also investigated how patterns of ADHD medication discontinuation differ across age groups. Researchers found that children were the least likely to discontinue medication, while young adults exhibited the highest rates of treatment interruption. Interestingly, many who stopped medication eventually resumed treatment. When accounting for these restarts, a larger proportion of individuals continued medication over time. After five years, approximately 50-60% of children and 30-40% of adolescents and adults in most countries were still receiving medication.
Impact on Blood Pressure Management
The research further explored the connection between ADHD, ADHD medication, and adherence to blood pressure treatment. The findings indicated that individuals with ADHD were more likely to discontinue their blood pressure medication, highlighting a potential challenge in managing co-occurring conditions. Here’s particularly relevant given the known effects of some ADHD medications on heart rate and blood pressure.
Understanding Medication Persistence and Adherence
Discontinuation of ADHD medication is a common occurrence, despite it often being prescribed for long-term treatment. A systematic literature review published in analyzed patient persistence, adherence, and the reasons behind medication discontinuation. The review, encompassing 91 original studies and 36 expert opinion pieces published between and , found that treatment persistence on stimulants averaged 136 days for children and adolescents and 230 days for adults. The medication possession ratio, a measure of adherence, was less than 0.7 for all age groups and medication classes over a 12-month period.
Reasons for Discontinuation
Adverse effects were consistently cited as the most common reason for discontinuing ADHD medication across all studies. However, other factors also played a significant role, including lack of symptom control, dosing inconvenience, social stigma associated with ADHD medication, and the patient’s overall attitude towards treatment. These findings underscore the importance of a comprehensive approach to ADHD management, addressing not only symptom control but also potential side effects and psychosocial factors.
The Role of Medication Formulation
The type of medication formulation also appears to influence treatment duration. Long-acting formulations and amphetamines were associated with longer treatment duration compared to short-acting formulations and methylphenidates, suggesting that convenience and sustained symptom control may contribute to better adherence.
Implications for Clinical Practice
These findings have important implications for clinical practice. Recognizing the varying patterns of medication discontinuation across the lifespan allows healthcare providers to tailor treatment strategies to individual patient needs. Addressing cardiovascular risk factors, particularly in adults with ADHD, is crucial. Open communication about potential side effects and addressing psychosocial concerns can improve adherence and treatment outcomes. Considering long-acting formulations may enhance treatment persistence. A recent report highlights the importance of considering adherence and acceptability when choosing between different ADHD medications, including viloxazine ER.
Ongoing Research and Future Directions
Research continues to investigate the long-term effects of ADHD and its treatment, including potential cardiovascular risks. A study published in May notes that most ADHD treatments elevate heart rate and blood pressure by stimulating the sympathetic nervous system. Further research is needed to fully understand the complex interplay between ADHD, medication, and cardiovascular health, and to develop strategies for minimizing potential risks while maximizing treatment benefits. The need for standardized measures to assess ADHD treatment discontinuation across countries is also highlighted, as noted in a study published in , to better guide clinical practice and improve patient care.
