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.
- 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.
- 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.
- 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).
- 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)
- 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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