Is Stimulant Treatment for ADHD Safe?

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ADHD is most often treated by stimulants like Ritalin, Adderall, and Dexedrine. I’m sure you’ve heard of these medications – but what are they? What do they do?

And most importantly – are they safe?

Are Stimulants Safe?

Stimulants are powerful medications, potentially addictive, and can have very serious side effects.

They’re commonly used because they’re effective.  Up to 70% of people experience significant symptom relief on them.  And the majority of the millions of people who use them are fine.  But they do have common side effects, and can rarely cause some quite nasty things.

The most common issues with stimulant use include increased anxiety, nausea or loss of appetite, and insomnia.

The rarer and very serious side effects?  To quote an ad for Vyvanse, an ADHD medication, “new psychosis, mania, aggression, growth suppression and visual disturbances” are possible.

Heart Damage?

Stimulant use might cause heart damage over time. Stimulants typically increase heart rate by ~3-5 beats per minute and also raise blood pressure.  One study of more than 50,000 children using stimulants showed an 20% increase in risk of emergency treatment for heart problems.

Use of stimulants by someone with a preexisting heart condition is a big no-no, as they may increase risk of cardiac failure or sudden death.

Psychological problems

As mentioned, a rare but serious side effect is that stimulants can cause psychosis, or a break with reality such as paranoia, delusional thinking and hallucinations.  Most psychosis occurs in people who were already at risk – but stimulants can cause psychosis in normal people at normal doses.

Stimulants can also cause serious problems with regulating or controlling mood. They can trigger mania in bipolar patients, and cause extreme mood variation even in people not normally at risk for bipolar.

Stimulants change the brain

Do stimulants cause brain damage?  Maybe.

Studies in rats have shown that extremely high doses of amphetamines given over a short period of time cause serious damage to the production of dopamine and its transport in the brain.  This happens by causing build up of radicals and reactive oxygen species.  Methylphenidate, or Ritalin, does not cause this damage, possibly because it only blocks the receptors for reception of dopamine.

But what about normal use?

The rats did not experience neural changes or damage from doses in the normal range.  The news isn’t all good, though. Baboons and monkeys, however, did experience brain damage at normal doses, showing a significant reduction in natural production and handling of dopamine.

It’s not clear what this means.  Children who take ADHD medication, after all, have larger white brain matter than unmedicated children, indicating a neuro-positive effect.

Remember: use of stimulants in children requires extreme caution and psychological analysis because they are young, more susceptible to side effects, and still developing.

Do stimulants like Adderall and Ritalin stunt growth?

This question is extremely contentious. A number of studies have shown that stimulant use is associated with slightly reduced growth, and, on the other hand, a number have shown that they aren’t.

The evidence, in my opinion, seems to be in favor of a slight reduction in height associated with long term use.

Both sides agree  that stimulant use initially slows growth somewhat; the question is if that delay is made up for in the long run.

Stimulant use is, however, associated with some degree of weight loss in the long run.

Conclusion:

Stimulants are extremely commonly used for a reason. They work. That said, they are potent substances, and often require supportive psychological therapy on the side to achieve best results.

For someone with a history of anxiety or other psychological problems, or someone with cardiac issues, use of stimulants should be exceptionally cautious if at all.  Use in children should also be done with extreme caution and only after appropriate psychological evaluation.

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Sources:

Potential Adverse Effects of Amphetamine Treatment on Brain and Behavior: A Review
Comparative Efficacy of Adderall and Methylphenidate in Attention-deficit/Hyperactivity Disorder: A Meta-Analysis
Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD

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Pharmaceutical analyst who loves blogging about health and medical issues. Has written more than 150 articles and a book on attention deficit disorder. Correctly predicted delayed approval of Bydureon, approval of Provenge by FDA, and the non-approval of Acthar on June 11.

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9 COMMENTS

  1. what do i watch for in my heart and liver what are the signs of it affecting me

  2. i’ve been taking them for about a week and a half i’m taking 15 miligrams They really help but i don’t want to damage m

  3. Dear alexis,

    I am not a doctor so do not take what I say as medical advice.

    That said, the data on these medications seems to say that they are safe in general. That there is a risk increase for general use for heart conditions is not fully accepted, and even if it does exist, it most likely doesn’t apply to the vast majority of uses.

    If your doctor knows your background and understands the issues at hand, their prescribing a stimulant is fairly normal.

    There is always a balance between the benefit of a medication and its potential downsides. Stimulants, by their nature, effect heart rate. The question is whether or not that can cause damage over time. On the one hand, it’s a slight increase.

    On the other, it’s not that much, and the body gets used to new medications over time. Ultimately, it’s the job of an epidemiologist – or an expert in examining data from large groups of people – to decide what’s going on.

    As always, if you’re concerned about your health, continue to see a doctor for routine checkups.

    Thanks for reading, and if there is any subject you’d like to see covered in an article, please let me know!

    Best,
    David

  4. Hope you really go to school for a long time.
    I wrote a reallly long comment on a board before reading the site I am leaving the link to.

    Listen these drug companies r pushing these medications and the doctors and making up new names for old disorders and Im just so glad I dont have to deal with that anymore.

    Teachers are butting into family lives like never before and I am just glad Im done having a fmaily and they are healthy mature adults now

    link to one families sotry abou tmedicating children with those drugs your studying. your just a kid yourself god help us!

    http://www.ritalindeath.com/

    This is th elink to my own story and sorry upfront about some spelling issues I don’t pay to close attention to all that. I have a disorder called left handed typist.

    http://www.topix.com/sports/high-school-football/2009/09/coach-acquitted-of-players-heat-related-death#lastPost

  5. Think about what happens when you exersise. You build up muscle and that muscle becomes hard. Your heart has to be soft and supple and flexible to create proper blood flow.

    If your heart hardens like a muscle it can’t properly do its job. There is data out there that supports these medications cause hardening of the heart.

  6. I really wanted to post on the Vyvanase vs adderall one but it’s closed. I am a 30 yr old mother of 2 and I was diagnosed with ADD in 5th grade. I’ve been on and off meds since then. Every patient responds differently to each medication. For me, plain ol’ Dextroamphetamine has worked the best. It helps in every area such as school, work, homemaking, and social. There are drawbacks. Once in awhile, in order to avoid increasing my dose or becoming dependant, I take a 1 or 2 day break. This reduces my tolerance enough that my current dose is still effective. The drawback to taking a break, though, is that I have a hard time sleeping the next day I take it. This medication has a VERY high risk of abuse due partly to the increasing tolerance and also the fact that if you haven’t slept well, you are relying on it to perk you up!

  7. I WANT MORE OF SUCH STUFF.
    Outstanding commitment.

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