An update on the safety of psychostimulants for the treatment of attention-deficit/hyperactivity disorder

ABSTRACT

Introduction: Methylphenidate is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate has a well-established evidence base for treating ADHD, its long-term benefits are unclear.

Areas covered: Physical adverse effects, psychiatric adverse events and brain development

Expert opinion: Some physical adverse events have been described (e.g. sleep disturbances, growth reduction, loss of appetite), although most are of transient nature. Psychiatric adverse events seem more related to the diagnosis ADHD itself, and not stimulant treatment. Concluding, short-to-mid-term use (i.e., up to 2 years) stimulants are relatively safe, but much less is known about longer-term efficacy and safety of these drugs.

KEYWORDS:

• ADHD
• stimulant treatment
• methylphenidate
• safety

Article highlights

• Mild adverse events occur frequently, most notably decreased appetite and sleep disturbance.

• Adverse events can severely decrease quality of life, and should be monitored frequently.

• Psychiatric adverse events, such as exacerbating tics, seizures, psychotic symptoms, substance misuse, or mood problems are primarily related to the diagnosis of ADHD itself, and not stimulant treatment.

• Short-to-mid-term use (i.e. up to 2 years) of stimulants is relatively safe, but much less is known about longer-term safety of these drugs, and more longitudinal prospective studies are needed.

• More research is warranted on adverse effects of stimulants on cognition, motivation, dampening of spontaneity/flat affect, mood dysregulation, and increased anxiety/edginess.

This box summarizes key points contained in the article.

Declaration of interest

PJ Hoekstra has received an unrestricted research grant from Shire and has been a paid member of a Shire advisory board. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.