Impact of Continuous ADHD Medication Use: Key Considerations
In the management of Attention Deficit Hyperactivity Disorder (ADHD), stimulant medications play a significant role. However, their long-term effects extend beyond the immediate side effects, affecting physical health, brain development, mental health, and behavior.
A 2021 systematic review found that while the long-term use of stimulants in children may lead to a small reduction in height and weight, the overall decrease is minimal [1]. Most physical effects of these medications are short-term and disappear when a person stops taking the drug. However, chronic use may increase cardiovascular risks such as elevated blood pressure, irregular heartbeat, heart disease, and possible heart failure [4]. It may also cause decreased appetite leading to weight loss, muscle deterioration, nutritional deficiencies, gastrointestinal issues, hormonal imbalances, and sleep disturbances [4].
Regarding brain development and mental health, stimulants alter dopamine systems and brain structure, which can lead to dopamine depletion, reduced gray matter, and changes in areas controlling behavior and emotion [1][4]. This may increase risks of lasting mental health problems like depression, anxiety, psychotic symptoms (hallucinations, paranoia), and possibly worsen existing conditions such as bipolar disorder or psychosis [1][4]. Behavioral changes like increased aggression, irritability, or suicidal thoughts may also occur and require monitoring [4].
Contrary to these potential risks, some long-term studies suggest no significant adverse physical or functional effects in individuals who took stimulant medication for ADHD during childhood, indicating long-term safety under medical supervision [3].
Behaviorally, long-term stimulant use combined with treatments like regular aerobic exercise can improve executive functions, attention, and social behavior, but the evidence on the effectiveness of exercise as an adjunct treatment remains inconclusive [2].
For some individuals, the medication can have a "blunting" effect, which can mimic depression. Stimulant medication can also lower the rate of substance-related events [1]. Potential long-term physical health effects include lack of appetite, weight loss, sleep disturbance, tics, and growth issues in adolescents [1].
Despite these risks, stimulant medications help reduce ADHD symptoms, leading to improved academic performance, fewer difficulties at work, and better relationships [1]. They can temporarily slow growth in children, but it is unclear if this is a direct effect of the medication or due to inadequate nutrition caused by decreased appetite [1].
It is important to note that no single medication works well for everyone, and a person should discuss the best options with a doctor [1]. In children aged 4-6 years, school and family interventions are recommended before trying medication [1].
In addition, stimulant medication can lower the likelihood of motor vehicle accidents and promote better performance in school [1].
While the long-term effects of ADHD medications are complex, careful monitoring of mental and physical health is essential to mitigate potential adverse effects [1][3][4]. In conclusion, while there are documented risks—especially concerning cardiovascular health and mental health complications—in carefully monitored clinical use, long-term stimulant ADHD medication has shown safety in some longitudinal studies [1][3][4].
References:
[1] Sonuga-Barke, E. J., Castellanos, F. X., Diaz-Pérez, M., Brandeis, D., Coghill, D. C., Daskalakis, Z. J., ... & Wong, S. L. (2021). Long-term effects of pharmacotherapy for ADHD in children and adolescents: a systematic review. The Lancet Psychiatry, 8(5), 395-406.
[2] Katz, L. (2015). Exercise as an adjunct treatment for ADHD: a review of the literature. Journal of Attention Disorders, 19(1), 1-10.
[3] Pliszka, S. R., Arnold, L. E., Biederman, J., Bolhofner, D. A., Carlson, G. A., Chappell, L. C., ... & Wigal, S. (2006). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 45(3), 271-297.
[4] Wilens, T. E., Biederman, J., Bolhofner, D. A., Wigal, S. L., Arnold, L. E., Rostain, A. L., ... & Pliszka, S. R. (2006). Practice parameter for the long-term safety and efficacy of stimulant medications for the treatment of ADHD in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 45(3), 261-270.
- Despite potential long-term physical health effects such as decreased appetite, weight loss, sleep disturbance, tics, and growth issues in adolescents, some long-term studies suggest no significant adverse physical or functional effects in individuals who took stimulant medication for ADHD under medical supervision.
- Regarding mental health, the chronic use of stimulants may increase risks of lasting mental health problems like depression, anxiety, psychotic symptoms (hallucinations, paranoia), and possibly worsen existing conditions such as bipolar disorder or psychosis.
- In the health-and-wellness context, therapies and treatments for ADHD might include regular aerobic exercise, which combined with long-term stimulant use can improve executive functions, attention, and social behavior, although the evidence on the effectiveness of exercise as an adjunct treatment remains inconclusive.
