The ADHD Conundrum, Part II: The Medication

adhd medicationIn our last post, “The ADHD Conundrum, Part I: The Diagnosis,” we discussed the impact of poorly treated ADHD for society and the potential new changes to the diagnostic criteria. In our continuing discussion on ADHD, we are taking a look at the role medication plays in treatment and the pharmaceutical options available to those struggling with the disorder.

In recent years, there has been much controversy over the medications used to control ADHD symptoms. Stimulants have been the traditional type of drug used for hyperactivity disorders, as they have the opposite effect of a stimulant on ADHD patients, calming their systems instead of amping them up. However, in the last few years, the question of cardiovascular risks has surrounded these medications as well as the concern of abuse of these drugs in ADHD patients whose chemistry changes as they age. In addition, off-label use of antipsychotics has increased in popularity among practitioners attempting to treat multiple psychiatric illnesses simultaneously. Few large-scale studies have analyzed the effectiveness and safety of this approach.

Do Stimulants for ADHD Pose a Greater Risk Than Benefit?

As of late, concerns over sudden death surrounding the use of stimulant medications had been brought to light. With the escalated use of stimulant medications over the last decade, the American Heart Association and FDA decided it was necessary to release guidelines for the use of these meds that became extremely controversial once revealed to the public. These guidelines were repealed after extensive discussions with professional organizations made up of physicians.

Upon further investigation, the current recommendations state that in the absence of cardiovascular health concerns, stimulant prescriptions are safe for use. On the other hand, those with cardiovascular symptoms need an in-depth workup from a cardiologist to determine the safest treatment plan for their individual symptoms. Also, because many stimulant medications are taken for long periods of time, intermittent cardiovascular health checkups are recommended.

Is the Off-Label Use of Antipsychotics Appropriate for ADHD?

Affective and conduct disorders that produce both aggression and anger often occur in individuals who also carry a diagnosis of ADHD. For patients with both affective disorder and ADHD, research shows that the use of antipsychotics simultaneously with stimulants may be the best route of treatment. For other comorbid diagnoses with ADHD, the use of antipsychotic prescriptions has not been supported by research thus far. Therefore, outside of affective disorders, clinicians must weigh the pros and cons carefully for the use of antipsychotic medications in individuals exhibiting either impulsive or aggressive behaviors along with ADHD.

Next, in “The ADHD Conundrum, Part III: Lifestyle Changes,” we will investigate different dietary and exercise recommendations that may help to improve ADHD symptoms without the worry of harmful side effects.

What is your feeling regarding “off-label” use of prescription medications for mental health disorders in teens? Share your opinion below.

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