EXPLORING THE LINK BETWEEN ADHD MEDICATION AND LOWER MORTALITY RISK

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that is prevalent in approximately 6.1 million children in the United States alone^[1]. It is characteristic of hyperactivity, impulsivity, and difficulty paying attention. While ADHD is commonly associated with children, it can also persist into adulthood, affecting an estimated 2.5% of adults and 8.4% of children worldwide.

For many years, there has been controversy surrounding the use of medication to treat ADHD. The debate around ADHD medications centers on concerns about overprescription and potential side effects like appetite loss and heart issues. These concerns must be weighed against the significant benefits these medications can provide in managing ADHD symptoms and improving the quality of life for those diagnosed with the disorder.

A new study has shed light on the benefits of medications for those with ADHD, particularly in lowering the risk of premature mortality.^[2]

This article sheds light on the link between ADHD medication and mortality, essential considerations, and potential explanations for the findings.

Study Finds ADHD Medication Lowers Mortality Risk

The study, published in JAMA, analyzed data from 148 578 individuals in Sweden who were diagnosed with ADHD between 2007 and 2018. The researchers compared mortality rates between those who had an ADHD medication prescription, comprising 56.7% of participants, and those who did not.

The results show that individuals with a prescription had a significantly lower risk of death over 2 years compared to those who were not. In those taking ADHD medication, the risk of:

• All-cause mortality was lower by 18.7%
• Mortality ascribed to unnatural causes was substantially reduced by 46.2%
• Mortality ascribed to natural causes was lower by 10.9%

While the study did not explore the specific reasons for the reduced risk of death among individuals taking ADHD medication, there are several potential explanations.

Improved Symptom Management: One possible explanation is that ADHD medication helps individuals manage their symptoms, leading to a decrease in risky behaviors and an improvement in overall health. The study highlights that a lack of treatment leading to unnatural causes of death pertains to classic ADHD symptoms and comorbidities, such as accidents, injuries, suicide, or drug overdose, particularly in men with the condition. Treatment can help to lower impulsivity and hyperactivity and treated ADHD individuals may be less likely to engage in dangerous activities that could lead to accidents or injuries.

Better Mental Health: ADHD medication can improve mental health and reduce the risk of comorbid conditions such as depression and anxiety, which heighten the risk for impulsive behaviors and drug abuse disorders. Additionally, comorbid mental health conditions can have a significant impact on an individual's overall health and well-being, and treating them can lead to a longer life expectancy.

Lifestyle Changes: It is also possible that individuals with an ADHD medication prescription are more likely to make positive lifestyle changes. For example, they may be more likely to seek treatment for other health conditions, exercise regularly, and maintain a healthy diet. These lifestyle changes can lead to a longer life expectancy.

Study Limitations

While the findings of this study are promising, there are some important considerations to keep in mind.

Like any study, the limitations are necessary to take into account. The study was observational, meaning that it cannot prove causation. Other factors could have influenced the results.

Additionally, the study only examined individuals in Sweden, so the findings may not apply to other populations. More research is needed to confirm the results and explore potential explanations.

Benefits of ADHD Medication

The potential benefits of ADHD medication go beyond reducing the risk of premature death.

There are two types of medication used to treat ADHD: stimulant and non-stimulant medications. Stimulants target the brain neurotransmitter dopamine, while non-stimulants target norepinephrine^[3]. Stimulants are thought to be more beneficial, able to treat 70-80% of cases successfully.

By managing symptoms, medication can help:

• Improve academic performance: Medications help with focus^[4], attention to detail, and task completion. These outcomes help to lower troublesome behaviors in the classroom and improve the child's ability to learn and do well in school.^[5]
• Enhance work productivity: The same focus and time-management skills honed through medication improve work output. This means less procrastination, increased reliability in meeting deadlines, and a better ability to manage complex projects – all crucial for career success.
• Reduce impulsivity: Medications help curb impulsive behaviors^[6] such as interrupting others, making rash decisions, or engaging in risky activities. Improved impulse control promotes better decision-making, fosters healthier choices, and can impact overall safety.
• Improve emotional regulation: Better emotional regulation means ADHD-related mood swings, irritability, and frustration become less frequent or less intense^[7]. This leads to a greater sense of personal control and an improved ability to cope with life's stressors.
• Strengthen relationships: Reduced impulsivity and improved emotional control often lead to less conflict and more positive social interactions, with benefits extending to improving interpersonal relationships.

Many studies reviewing the benefits of ADHD medications assess short-term benefits. More research is necessary to understand the long-term effects of ADHD medication.

Risks and Side Effects of ADHD Medication

While ADHD medication may have potential benefits, it is vital to consider the risks and side effects. Like any prescription drug, ADHD medication can have side effects, including^[8]:

• Decreased appetite and weight loss: This can be a concern, especially for children. It is crucial to monitor their growth and weight.
• Difficulty sleeping: If this is a problem, talk to your doctor about adjusting the medication dosage or timing.
• Rebound effect: This refers to a surge of symptoms that can happen when the medication wears off. This is manageable by working with your doctor to find the right medication and dosage.
• Anxiety, depression, or tics: While stimulant medications typically do not cause these conditions, they can sometimes make existing ones worse. Be sure to talk to your doctor if you experience a worsening of these conditions.
• Minor growth delay: This is a concern for children but typically does not affect their final adult height.
• Upset stomach, changes in blood pressure, and heart rate: These are usually mild. Talk to your doctor if you have any concerns.

Working with a healthcare professional is crucial to find the proper medication and dosage for each individual. Non-stimulant medications may work better for some cases of ADHD.

Regular check-ins and monitoring can minimize the risk of side effects and ensure the medication works effectively.

Untreated ADHD and Health Risks

Individuals with ADHD are at a greater risk for various health problems:

• Increased risk of accidents and injuries: Impulsivity and inattention, hallmark features of ADHD, can lead to a higher risk of accidents, such as car crashes, falls, or unintentional injuries^[9].
• Substance abuse and addiction: Individuals with untreated ADHD are at a higher risk of turning to substances like alcohol, tobacco, or illicit drugs as a way to self-medicate or cope with the difficulties associated with ADHD. This has the potential to pave a path toward addiction.
• Mental health issues like depression and anxiety: ADHD often co-occurs with depression and anxiety disorders. Untreated ADHD can exacerbate these conditions due to feelings of failure, low self-esteem, and the struggle to manage daily life.
• Cardiovascular problems: The chronic stress caused by untreated ADHD and unhealthy lifestyle choices that may stem from it (like poor diet or lack of exercise) can elevate the risk of heart disease, high blood pressure, or stroke. A review published in World Psychiatry revealed that amongst more than 5.3 million individuals, those with ADHD were 15.52% more likely to acquire a cardiovascular disease diagnosis on average. ADHD was also more closely associated with cardiac arrest, stroke, and atherosclerosis.
• Unhealthy lifestyles: Difficulties with focus, organization, and self-regulation^[10] can make it harder to maintain healthy habits like balanced eating, sufficient sleep, and regular exercise. This increases the risk of smoking, obesity, and other health concerns.
• Earlier mortality: Individuals with untreated ADHD may have a shorter lifespan. Studies like one published in JAMA Pediatrics have highlighted an increased risk of premature death linked to factors associated with untreated ADHD.^[11]

These factors can contribute to a higher mortality rate among individuals with ADHD.

ADHD Medication in Adults

While ADHD is commonly associated with children, it can also persist into adulthood. Many adults with ADHD go undiagnosed and untreated, which can pose severe outcomes for their health.

The findings from the above study highlight the importance of seeking treatment for ADHD, even in adulthood. By handling symptoms and easing the risk of comorbid conditions, ADHD medication can improve the overall health and well-being of adults with ADHD.

Other Interventions

Medication is not the only available treatment option for ADHD.

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that aims to use the connection between thoughts, feelings, and behaviors to intervene and promote positive change. Recent studies highlight how it is a helpful approach for many individuals with ADHD and that those who made use of CBT required less medication^[12] and had better symptom control^[13] on average than those who did not.

Latest Advancements in ADHD Treatment and Diagnostics

Research into both causes and new treatments for ADHD is rapidly evolving. While a cure is not currently on the horizon, these advancements offer hope for improved interventions and the potential to lessen the negative impacts of ADHD.

Active areas of research include:

Underlying Causes

Genetics: Scientists are investigating specific genes that may share a connection between both ADHD and other health conditions. Understanding this connection could help identify those at a higher risk, allowing for earlier intervention.^[14]

Brain Structure and Function: Neuroimaging studies look closely at differences in brain development and activity in people with ADHD. This research aims to pinpoint brain mechanisms that increase the risks of mental health problems, accidents, and unhealthy behaviors.^[15]

Inflammation: A growing body of research points to potential links between ADHD, chronic inflammation, and health risks. This area of exploration could open doors to new treatment options focused on addressing inflammation.^[16]

Emerging Medications and Treatment Approaches for ADHD

Non-stimulants: There is ongoing development of non-stimulant medications, providing alternatives for people who cannot tolerate stimulants or prefer a different mode of action.

New Formulations of Existing Medications: Researchers are exploring extended-release formulas and various delivery methods for existing ADHD medications. These aim to improve adherence and minimize medication side effects.

Technology-Based Interventions: Technology plays a role in both diagnosis and treatment. Examples include:

• Apps and tools for improving time management, organization, and focus.
• Cognitive behavioral therapy (CBT) delivered through digital platforms.
• Neurofeedback, which uses brainwave readings to help individuals train their attention^[17] and improve focus.

Conclusion

The link between ADHD medication and reduced mortality risk is a significant finding that highlights the importance of proper ADHD treatment and management. While more research is needed to confirm the results and explore potential explanations, the study's findings are promising and provide hope for individuals with ADHD and their loved ones. By understanding the potential benefits of ADHD medication and working together with medical professionals, individuals with ADHD can better their overall health and live longer, healthier lives.

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