Home Medizin Die Behandlung von ADHS mit Medikamenten ist mit einer geringeren Gesamtmortalität verbunden

Die Behandlung von ADHS mit Medikamenten ist mit einer geringeren Gesamtmortalität verbunden

von NFI Redaktion

New data show that the initiation of pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with a significantly lower overall mortality, especially in cases of deaths caused by accidental poisoning, suicide, or accidental injury.

„ADHD medications can reduce the risk of unnatural mortality by alleviating the core symptoms of ADHD and its psychiatric comorbidities, leading to improved impulse control and decision-making, ultimately reducing the occurrence of fatal events, especially those attributed to accidental poisonings,“ wrote the researchers, along with lead author Lin Li, PhD, from the Karolinska Institutet in Stockholm, Sweden.

The results were published online on March 12 in JAMA.

The most common neurological developmental disorder globally

ADHD is the most common neurological developmental disorder, affecting approximately 65% of adolescents and 33% of adults worldwide. However, estimates indicate that the prevalence in the United States is nearly 10% in children and adolescents and 45% in adults, the researchers noted.

Studies have shown that pharmacological treatment effectively alleviates the core symptoms of the disorder and reduces the risk of negative outcomes, including accidental injuries and criminality. However, there are concerns regarding the cardiovascular safety of ADHD medications, especially in the long term, which could potentially increase mortality.

Prior studies examining the potential link between ADHD medications and mortality had significant limitations and yielded mixed results, the authors noted. A „critical knowledge gap,“ not consistently addressed in these previous studies, is the potential impact of ADHD medications on mortality in adults with this disorder, they added.

Using national Swedish registers, the researchers investigated whether the initiation of medications for the treatment of ADHD was associated with mortality in children, adolescents, and adults.

The primary endpoints were overall mortality and cause-specific mortality during a two-year follow-up period. Specific causes of death were categorized into natural and unnatural causes of death.

The researchers identified all individuals aged 6 to 64 with an incident diagnosis of ADHD between 2007 and 2018 who were medication-naive before the diagnosis.

They followed a cohort of 148,578 individuals (mean age 17 years; 59% male) from the ADHD diagnosis until death, emigration, two years after study initiation, or the end of 2020, whichever occurred first. Sensitivity and subgroup analyses also assessed five-year mortality as well as gender- and age-specific associations.

Prescribed ADHD medications included methylphenidate, amphetamine, dexamphetamine, lisdexamfetamine, atomoxetine, and guanfacine.

Lower mortality

Overall, 630 participants with ADHD died during the shorter two-year follow-up period and 1,400 during the five-year follow-up period.

After 2 years, the initiation of ADHD medication was associated with a 21% lower overall mortality (hazard ratio [HR], 0.79; 95% CI, 0.70–0.88) and a 25% lower risk of unnatural death (HR, 0.75; 95% CI, 0.66–0.86). There was no association between groups regarding mortality from natural causes.

Interestingly, the use of ADHD medication in female participants was associated with a reduced risk of mortality from natural causes, but not from unnatural causes (HR: 0.64; 95% CI: 0.45 to 0.90).

The study shows an association, not a causal relationship, the researchers noted, and pointed out that there were no data on lifestyle factors that may have contributed to these correlations.

„Remarkable findings“

In an accompanying editorial, Francis Levin, MD; Mariely Hernadez, PhD; and John Mariani, MD; from the Department of Psychiatry at Columbia University, New York, NY, noted that the study supports previous research findings that appropriate prescription of ADHD medications can significantly reduce mortality.

However, despite evidence from this and other studies showing that medications improve morbidity and mortality, ADHD „remains frequently underdiagnosed and undertreated, especially in adults with concurrent substance use disorders and in marginalized groups, including immigrants,“ the authors wrote.

It is unclear how these „remarkable findings“ will translate into clinical practice, they added.

The study was conducted in Sweden, where there is a universal government-supported healthcare system that lacks some of the barriers to healthcare access found in the United States and elsewhere, the editors noted.

„Inadequate treatment of ADHD does not go without consequences,“ they wrote, adding that more targeted training on screening, diagnosing, and treating ADHD is needed.

The study was funded by the Swedish Research Council for Health, Working Life and Welfare and the European Union’s Horizon 2020 Research and Innovation Programme. Levin reported grants from the National Institutes of Health, Substance Abuse and Mental Health Services Administration, National Center for Advancing Translational Sciences, and US World Meds; non-financial support from Indivior Medication and research support from Aelis Pharmaceutical; licensing fees from the American Psychological Association, and consulting fees from MLB. Additional disclosures are noted in the original article.

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