The safety of stimulants

The safety of taking stimulants for inattentive ADD is a question that haunts parents.  Not all people with Inattentive ADD will respond to treatment with behavioral modifications, coaching, cognitive training or caffeine. Stimulants must be considered for Inattentive ADD treatment in children and adults who suffer from the disabling symptoms of inattention despite the use of these other treatment methods but are they safe?

Parents of children with Inattentive ADD as well as parents of children with the other subtypes of ADHD have long worried about the risks of taking the stimulant medications that are the gold standard treatment for ADHD. The most concerning risks associated with Methylphenidate's (Ritalin, Concerta) and Amphetamine's (Adderall, Vyvanse) are the risks of potential cardiac problems and the risks of weight and height problems.

The good news on both the cardiac and the stature front is that there appears to be no increased danger for either of these problems. Special care, however, should be taken when treating Inattentive ADHD, and the other subtypes, in people with a history or a family history of cardiac disease.

A prospective study out of England that looked at thousands of kids that were on ADHD treatment using stimulants, watched these children for 14 years found that there was no increased risk of cardiac problems reported in this group. Most physicians agree that children with any potential cardiac problems should be screened with a baseline EKG prior to starting stimulants.

Stimulant use can occasionally cause QRST interval changes that are seen in healthy athletic types or in people with anxiety disorder. This QRST finding is considered a common and benign electrocardiographic pattern. That is all good except for the fact that these EKG findings were recently found to be prevalent among patients with idiopathic ventricular fibrillation, a potentially life threatening condition. This is the reason why anyone with a known history of heart disease of with a family history of heart disease should have a complete cardiac screened prior to starting stimulant therapy.

The concerns regarding permanent height and weight changes in children treated with stimulants have been studied for many years. Published studies from as far back as the 1980s reported transient changes in height and weight that were associated with the initiation of stimulant treatment for ADHD, both Inattentive ADD and the other subtypes of ADHD. These changes however did not persist and the children treated with stimulants continued on their expected growth trajectories after an initial height/weight delay.

Stimulant therapy is safe and can make a huge difference in the life of people with symptoms of Inattentive ADHD who have not responded to other non-medication treatment measures. Stimulant treatment should and must be considered for these people.

Mortality associated with attention-deficit hyperactivity disorder (ADHD) drug treatment: a retrospective cohort study of children, adolescents and young adults using the general practice research database. 
McCarthy S, Cranswick N, Potts L, Taylor E, Wong IC.