New research published in the Journal of Child Psychology and Psychiatry and reviewed in a recent online Medscape article suggests that long-term use of stimulant medications to treat attention-deficit/hyperactivity disorder (ADHD) does more harm than good.
This research came from The Multimodal Treatment Study (MTA) which started as a 14-month randomized controlled clinical trial of medication and behavioral treatments in 579 children (7–10 years of age) diagnosed with ADHD. From there, the protocol transitioned into a long-term observational follow-up study of 515 subjects (289 with and 258 without ADHD).
The results showed that children treated with ADHD medications and who continue that treatment into adulthood experience a suppression of height as adults without benefitting from any ongoing reductions in symptoms.
Moreover, the MTA study demonstrated that children with ADHD who consistently received treatment into adulthood experienced no differences in symptom relief compared to those who took medication holidays or who stopped treatment all together.
The investigators calculated that for patients who continue to receive treatment, the cumulative d,l-methylphenidate equivalent (ME) doses may exceed 100,000 mg. According to the study’s lead author, James M. Swanson, PhD, director of the Child Development Center and professor of pediatrics at the University of California, Irvine:
“Childhood-onset ADHD is a chronic disorder with persistence of symptoms into adulthood...and extended use of stimulant medication from childhood through adolescence is associated with suppression of adult height but is not associated with reduced symptom severity."
The team found no significant difference in average symptom scores between the negligible, inconsistent, and consistent medication use groups, indicating that ongoing medication use did not reduce symptom severity over the long haul.
With respect to adult height, it was determined that participants in the overall ADHD group were shorter by a significant 1.29 ± 0.55 cm than those in the comparison group who did not use stimulant medication (P < .01).
Moreover, individuals in the consistent/inconsistent groups were significantly shorter than those in the negligible group, at an average height reduction of 2.55 ± 0.73 cm (P < .0005). Those in the consistent group were on average 2.36 ± 1.13 cm shorter than those in the inconsistent group, a difference that was again significant (P = .04).
According to Medscape reporter Liam Davenport, Dr. Swanson observed that even when stimulant medication was continued, there was "no clear benefit" when compared to children who never took it or who stopped taking it.
The results of this well designed study, while not without limitations, support what I have observed clinically for many years: prescription stimulant medications for ADHD often do not work over the long run. A major reason for this, in my opinion, is that the main mechanism (re-uptake inhibition of dopamine and norepinephrine) of such agents does not address the root cause of ADHD symptoms - low levels of phenylethylamine (PEA). Stimulants work, for the most part, by slowing down the rate at which your brain takes back up (reuptake) dopamine and norepinephrine into the neurons that made and released them. The theory is that in so doing these medications can temporarily mask the clinical consequences of low levels of dopamine, norepinephrine, and PEA. They do not, however, replenish the supply of these key neurotransmitters. Indeed, there is evidence suggesting that stimulants over time may even accelerate the rate at which you burn through your already dwindling reserve of dopamine, norepinephrine, and PEA. Hence, the findings from the study discussed above: long-term use of stimulant medications does more harm than good.
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*These statements have not been evaluated by the Food and Drug Administration. Cogniben is not intended to diagnose, treat, cure, or prevent any disease.Back