A growing number of ADHD diagnoses and prescriptions for stimulant medications are raising concerns among some medical professionals about the potential long-term health risks for patients. Dr. Max Pemberton, a psychiatrist, has highlighted a lack of comprehensive information provided to patients about the potentially serious side effects of these drugs, particularly concerning cardiac health.
Pemberton's concerns were amplified after a patient in his forties, with no prior history of heart issues, suffered a cardiac arrest while on holiday. A subsequent investigation by a cardiologist revealed the patient had been taking ADHD medication for many years. This incident prompted Pemberton to examine the evidence base for ADHD medications.
He notes that the average clinical trial for ADHD medication lasts only about 75 days, which he argues is insufficient for understanding long-term effects. Pemberton points to a 2024 study by Swedish researchers who tracked nearly 278,000 individuals with ADHD for up to 14 years. The study found that prolonged use of ADHD medication correlated with an increased risk of heart disease, with risk rising by nearly a quarter after five years. The risk of high blood pressure also increased by 80 percent. The study also indicated that higher doses were associated with greater risk.
Methylphenidate and lisdexamfetamine, two common ADHD medications, are classified as Schedule 2 controlled drugs, placing them in the same legal category as morphine and fentanyl. Despite this classification, Pemberton observes a significant increase in their prescription, particularly among adults.
This rise in diagnoses and prescriptions is partly attributed to "diagnosis creep." Pemberton references changes made to the ADHD diagnostic manual in 2013, which lowered the threshold for diagnosis by reducing the number of required symptoms and altering age of onset criteria. He suggests these changes have led to more individuals being diagnosed without necessarily having a more accurate assessment of the condition.
Furthermore, Pemberton notes that over 70 percent of British adults over 25 starting ADHD medication had previously been taking antidepressants. He suggests this indicates a pattern of individuals seeking answers for life challenges, with ADHD medication being prescribed as a subsequent option after other treatments have not yielded desired results. He also questions whether factors like stress, relationship issues, poor sleep, or excessive screen time are adequately considered before medication is prescribed.
While acknowledging that these medications can be transformative for individuals with severe ADHD, Pemberton stresses the importance of transparency regarding potential risks. He notes that the Royal College of Psychiatrists has previously stated it found no increase in heart problems in adults on ADHD medication. However, Pemberton reports that none of his patients on these medications have been informed about the potential long-term cardiac effects, despite his inquiries since his patient's cardiac arrest.