In Brief: Encouraging news about ADHD drugs and heart risk in adults

In Brief

Fast on the heels of a report that drugs for attention deficit hyperactivity disorder (ADHD) do not increase the risk of death from heart disease in children comes another reassuring study — this one in adults.

In a paper published in The Journal of the American Medical Association, researchers report that they analyzed medical records from four health plans in the United States. The sample included 150,000 adults taking stimulant drugs such as methylphenidate (Ritalin) and dextroamphetamine (Adderall) that are commonly used to treat ADHD, and another 300,000 adults not taking these drugs. The researchers found no association between ADHD drugs and heart attack, sudden cardiac death, or stroke.

Slightly more than 4% of U.S. adults meet the diagnostic criteria for ADHD listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Although the problem usually originates in childhood, symptoms of ADHD tend to evolve and become more subtle with age. By adulthood, the primary difficulty is usually with memory and attention — causing problems not only at work, but also with personal relationships and finances.

Stimulants are considered first-line medications for adults with ADHD, as they are for children, because these drugs are effective and work quickly. As such, this study provides reassurance that the drugs pose no threat to heart health.

For those who want alternatives, there are several types of psychotherapy that might be worth considering. These therapies emphasize acquiring and practicing new skills that help patients compensate for attention problems.

For example, cognitive behavioral therapy can help adults with ADHD break the self-defeating cycle of failure, anxiety, blame, and additional failure. This treatment emphasizes practical skills, such as time management and organizational strategies.

Other options include dialectical behavioral therapy, a variation of cognitive behavioral therapy in which patients learn to enhance mindfulness and modulate emotional distress. The goal is to improve self-esteem and gain control over emotions. Metacognitive therapy, also related to cognitive behavioral therapy, aims to help patients better plan and manage their time. Finally, coaching is an action-oriented approach that has particular appeal in fields, such as business and sports, where achievement can be measured in quantitative terms.

Habel LA, et al. “ADHD Medications and Risk of Serious Cardiovascular Events in Young and Middle-Aged Adults,” Journal of the American Medical Association (Dec. 12, 2011): Electronic publication ahead of print.


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