The totality of the available data on the short term effects of ADHD stimulant is relatively consistent: these medications are safe and result in significant improvement in symptoms, especially for children with severe forms of the disorder. However, little previous research on the long term effects of these medications has been used by critics of psychiatric medications to argue against the use of these drugs. Fortunately, as children who participated in the initial ADHD medication clinical trials (and similar studies) become young adults, a series of studies are finally providing much needed data on the long term safety and effects of stimulant use.

In the latest issue of Pediatrics, a team led by Dr. Joseph Biederman from Harvard Medical School published an examination of the association between ADHD medication and future psychiatric conditions. For this study, the researchers followed 112 children age 6 to 17 for approximately 10 years. All of these children had a diagnosis of ADHD. 73% of these children had a life time use of stimulant medication and 27% had never used the medication. The authors compared the probability of having a co-morbid psychiatric disorder 10 years after the start of the study among kids who had used medication against those who never used medication.

The results:

  1. Those taking the medication were significantly LESS likely to develop Major Depression than those who were medication free. Specifically the life time risk (up to age 21) for major depression among kids with ADHD who never took medication was 69%, compared to only 24% for those who took medication.
  2. Medication users were less likely to develop Conduct Disorder when compared to medication free kids. Specifically, the risk to develop Conduct Disorder for those who never took medication was 67%, compared to only 22% for those who took medication.
  3. Similar effects were observed for Anxiety (no medication users risk 60% vs. 7% for medication users), Oppositional Defiant Disorder (no medication users risk 88% vs. 40% for medication users).
  4. Children who took ADHD medication were also less likely to repeat a grade (26% risk) when compared to those who never took ADHD meds (63% risk)
  5. ADHD medication did not have a statistical significant impact on the risk of developing bipolar disorder.

This study is very compelling and it is unique because of the very long follow up period (10 years). This provides credible evidence of the potential long-term effects (and in this case benefits) of medication use. I was surprised at the consistency of the findings for multiple psychiatric disorders. Honestly, I was expecting to see the opposite results, mostly because medication is now commonly used among the most severe cases. Therefore, long term examinations of outcome could show more detrimental outcomes among those who use medications, but not because of the medication, but because these children have more severe disorders than those who are not prescribed the medication. But the results of the study show that even in the face of this possible confound, the beneficial effects of these medications overrode the effects of having more severe ADHD at the initiation of the study. However, there is no indication that this was the case in this particular study. That is, although those who took the medication were significantly younger than medication-free kids at the start of the study (possibly suggesting a more severe type of ADHD), it is unclear whether these kids had more severe ADHD at baseline. Yet again, if this had been the case, then the results are even more striking because they indicate that when compared to ‘no medication’, medication use results in a greater reduction of the risk of future psychopathology, even when the kids that take the medication have a more severe form of ADHD.

Unfortunately, Dr. Biderman has recently been the source of some controversy because of his involvement as a consultant for some pharmacology companies. This is likely going to be used by critics of medication use to discredit these findings. However, from a purely scientific perspective, the results are compelling and the science strong. Despite the relatively small sample size and other minor methodological limitations (diagnoses were based on DSM-III criteria), it is rare to see such a longitudinal study expanding 10 years that included complete psychiatric evaluations during the follow up periods.

Disclaimer: I have never worked as a consultant for any Pharmaceutical company.

Biederman, J., Monuteaux, M., Spencer, T., Wilens, T., & Faraone, S. (2009). Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study PEDIATRICS, 124 (1), 71-78 DOI: 10.1542/peds.2008-3347

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8 Responses to ADHD medication use may prevent future psychiatric disorders

  1. Maggie says:

    I don’t understand why this is so surprising. Living with untreated ADD is horrible. You feel stupid, you can’t do anything as well as your peers, you have this constant feeling that you should be doing everything BETTER than you are. Everything is a constant struggle for control. You can never focus, you’re constantly in trouble, you try and try but nothing is ever good enough. Living with unmedicated ADD is MISERABLE and living your entire childhood like that is just plain traumatic.

  2. Sami Moran says:

    The previous commenter is right on — one “side effect” of living with ADD is the increased risk for other emotional issues resulting from embarrassment/shame of being unable to meet adult and peer behavior expectations. It would make sense that people who receive appropriate treatment for the ADHD would have a lower risk of having the ADHD trigger secondary emotional difficulties.

  3. Becky says:

    “those who took the medication were significantly younger than medication-free kids at the start of the study”

    Were these kids followed until the same age, or for the same amount of time? Is it possible that the fact that the kids were younger would affect the rates of diagnosis of other disorders?

    And what would you say about the article and information cited here,, which seem to imply few long term benefits?

  4. Parksy says:

    What they also seem to gloss over is the high addiction rate for kids on ADHD medications. Perhaps the depression is warded off by the fact that these kids are on amphetamines, which, last time i checked, are a huge stimulant. Follow these kids another twenty years, and see how the drugs are effecting the brain after such an extended period of time.
    The sad part is that in twenty years it will be too late for many other kids.

    • Actually Parksy, among kids with ADHD, the risk for addiction is lower for those treated with ADHD meds when compared to those not treated with meds. The medications actually reduce the risk for addiction. See Wilens, T. E., Faraone, S. V., Biederman, J., & Gunawardene, S. (2003). Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature. Pediatrics, 111(1), 179-185. doi: 10.1542/peds.111.1.179. Also Wilens J Clin Psychiatry 2004;65[suppl 3]:38–45.

  5. paige says:

    I have add and have been taking medications since I was nine, i have taken every kind imaginable and they seem to work but i will always wonder what i would be like without them. when i was little i dont remember feeling stupid or unable to focus my parents decided for me and know i feel a dependence on them to succeed. i just think parents should try non medicated treatments before they jump to prescriptions.

  6. Coral says:

    I took ADHD medications from 7-18. When I became a teenager by that time I was addicted to the drug. I had insomnia, anorexia, anxiety, mood swings, and I was VERY paranoid of others. My doctors and parents completely failed at recognizing the impending symptoms of my over-stimulant usage. I ended up dropping out of high school because it was just too stressful. Getting the grade had never been the problem, I’m very intelligent even if frequently distracted and prone to interrupting and procrastinating. Being on the drugs had been a nightmare, and the only reason I kept taking them had been because I was so stressed out I enjoyed the feeling of having my brain feel boxed, and I enjoyed starving myself easily. I didn’t realize the drugs had caused all the problems, and my parents thought I was just plain crazy, and even I thought so.

    I am 22 now, and today I am learning how to focus and stay on tasks on my own without medications. Sometimes it is difficult, but I don’t make excuses. I am in college now and have all As. I still have all the symptoms of ADHD. I am not addicted to other drugs.

    There is something WRONG with this drug and something WRONG with how the culture medicating and diagnosing children view the world.

    I’d like to see a study where someone is actually asking the people taking the medication how they feel about it. They might not tell you though, because chances are last time they told someone what they thought the response was ‘I think you ought to take more drugs.’

  7. Mimi Simeonova says:

    My 11 years old son was diagnosed with ADHD since the age of five. He used to go to private school where they simply couldn’t cope with him. He has a severe ADHD and he has been on and off medication. His mood can swing from one to another. He is a very inteligent boy but I feel that teachers and schools are not well educated how to deal with this type of kids. It breaks my heart how missunderstood they are. I am putting all my energy to educate myself and T.A. how to manage ADHD at school. My son is briliant in music, he plays, piano and trumpet and he already talks how much he wants to work in business. ADHD children are full with energy… When it’s put into the right way, they can be very successful. I will be countinuing to support my son troughout school and I believe that there is a light in the end of the tunnel.

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