From the Guidelines
The long-term use of stimulant medications in adults with ADHD can lead to sustained cognitive improvements, but it also carries potential risks such as cardiovascular effects, tolerance, and psychological dependence, necessitating regular monitoring and dose adjustments as needed. When considering the long-term effects of stimulant medications in adults, it's crucial to weigh the benefits against the risks. For adults with ADHD, medications like methylphenidate and amphetamine salts are often prescribed, with studies suggesting that these medications can provide therapeutic benefits when taken at appropriate doses 1.
Key Considerations
- The response to stimulant treatment in adults with ADHD can vary significantly, with efficacy rates ranging from 23% to 75% 1.
- Higher doses of stimulants, such as 1 mg/kg of methylphenidate, have been associated with more robust effects, with 78% of adults showing improvement compared to 4% on placebo 1.
- Common side effects of long-term stimulant use in adults include loss of appetite, insomnia, and anxiety, which can impact quality of life.
- Regular monitoring, typically every 3-6 months, is essential to assess cardiovascular health, mental health status, and medication effectiveness, and to consider periodic medication holidays to minimize tolerance and reassess necessity.
Potential Risks
- Cardiovascular effects, including small increases in heart rate and blood pressure, are potential risks of long-term stimulant use, particularly in adults with pre-existing heart conditions.
- Psychological dependence is a risk with prolonged use, especially at higher doses, highlighting the need for careful prescribing and monitoring.
- Neurological adaptations, such as changes in the dopamine system, are a subject of ongoing debate, but most research suggests that stimulants are generally safe when properly prescribed and monitored.
From the Research
Long-term Effects of Stimulant Medications in Adults
The long-term effects of stimulant medications in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have been studied in several research papers.
- Studies have shown that stimulant therapy of ADHD has long-term beneficial effects and is well tolerated 2.
- However, there are also potential risks associated with long-term use, including misuse, cognitive impact, and adverse effects such as psychosis, myocardial infarction, cardiomyopathy, and sudden death 3.
- Long-term outcomes of stimulant medication in ADHD have been found to have marginal improvements in adult outcomes following a period of treatment in childhood, with potential benefits including protection against later substance abuse 4.
- The prevalence of long-term concurrent use of stimulants and opioids among adults with ADHD is common, with risk factors including being non-Hispanic white, living in the southern United States, and receiving a diagnosis of substance abuse disorder, depression, anxiety disorder, chronic pain, chronic obstructive pulmonary disease, or cardiovascular disease 5.
- Methylphenidate, a commonly used stimulant medication for ADHD, has been found to be moderately effective in reducing core ADHD symptoms and accompanying emotion regulation deficits, with common adverse events including decreased appetite, dry mouth, heart palpitations, gastrointestinal infections, and agitation/feeling restless 6.
Adverse Effects and Risks
Adverse effects and risks associated with long-term use of stimulant medications in adults with ADHD include:
- Misuse and cognitive impact 3
- Psychosis, myocardial infarction, cardiomyopathy, and sudden death 3
- Weight loss and transient slowing of height velocity 4
- Increased susceptibility to seizures and tics/Tourette syndrome 4
- Decreased appetite, dry mouth, heart palpitations, gastrointestinal infections, and agitation/feeling restless 6
Benefits and Efficacy
Benefits and efficacy of long-term use of stimulant medications in adults with ADHD include: