For individuals with ADHD, medications like Adderall or Ritalin are a complete game changer. These drugs help most people focus, concentrate on important tasks, and regulate emotions. But the pros aren’t without the cons of side effects depending on the ADHD medication. These can include decreased appetite, difficulty sleeping, or changes in blood pressure and heart rate.
Now, according to a study published Wednesday in the journal JAMA Psychiatry, ADHD medications may be implicated in one’s long-term risk for cardiovascular disease. Researchers in Sweden and Indiana University Bloomington looked at health data from over 278,000 individuals with ADHD living in Sweden between 2003 and 2020. They found that there was a four percent increased risk for cardiovascular disease for each year someone was on ADHD medications. However, the risk seemed to be more pronounced in the first three years as it didn’t grow dramatically afterward.
“These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions about long-term ADHD medication use,” the researchers write in their study. “Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment.”
Increased risk with certain meds
The gold standard treatment for ADHD is often pharmaceutical intervention with drugs that fall into two major categories: stimulants like amphetamines (which includes Adderall) and methylphenidate (such as Ritalin) — both increase the amount of the neurotransmitter dopamine available in the brain — and non-stimulants like antidepressants.
There’s always been concern that ADHD medications may increase one’s risk for cardiovascular disease, in particular stimulants, since they can act on the body in ways that increase heart rate and blood pressure. However, studies searching for that connection have been mixed but also challenging since many, for a large part, haven’t looked at the long-term use of ADHD medications, Samuele Cortese, a professor of child and adolescent psychiatry at the University of Southampton in the UK, who was not involved in the study, writes in an accompanying editorial.
In the new study, the researchers sought to answer this troubling question by combing through Swedish nationwide healthcare databases containing information on folks diagnosed with ADHD, what medications they were prescribed, and any causes of death. They specifically focused on any individuals between the ages of six and 64 residing in Sweden who received an ADHD diagnosis or were on medication specifically for ADHD between January 2007 and the end of December 2020.
The study found the longer someone was on ADHD medications, the higher the associated risk of cardiovascular disease, particularly for hypertension and artery disease. There was no associated risk for other conditions like arrhythmias (aka irregular heartbeats), heart failure, or diseases that affect blood flow to the heart or brain.
The risk of cardiovascular complications rose quickly during the initial three years of taking ADHD medication before leveling off. The average risk was about four percent for every year someone took an ADHD medication; the cumulative risk for the first three years was around 8 percent. This risk rang true for both children and adults, whether male or female.
Breaking it down further by type of ADHD medication, the long-term cardiovascular risk appeared to be greater for methylphenidate and a type of drug that turns into an amphetamine in the body called lisdexamphetamine. A non-stimulant medication known as atomoxetine only increased one’s risk during the first year. The increased risk only occurred above certain average doses per day: 45 milligrams for methylphenidate and lisdexamphetamine, 22.5 milligrams for amphetamines, and 120 milligrams for atomoxetine.
Should you ditch your meds?
For many individuals with ADHD, medications are the only treatment that effectively helps improve their focus and manage other symptoms, benefitting them not only academically but also preventing harm from motor vehicle crashes, physical injury, and substance use disorders, as some studies find.
Cortese says these findings don’t necessarily mean you should ditch your Adderall, especially as it's only one study and others have found ADHD medications of the stimulant kind were safe even if someone had underlying congenital heart issues.
Instead, the new paper offers the chance to reevaluate how prescribing ADHD medications should be weighed against someone’s physical or family history, whether non-stimulants should be considered a first-line defense over stimulants, and the need to rigorously monitor for conditions like hypertension or other cardiovascular complications.
“[These findings] should remind us that clinical decision-making is often based on tricky trade-offs that should be considered at the individual patient level, rather than straightforward one-size-fits-all recommendations,” writes Cortese.