Boon for ADHD drug research
As we’re becoming more aware of the increased number of us that are being diagnosed with neurodivergent conditions, awareness around the thing that can often come with that — treatment — is also on the rise. Good.
Research published this August in the British Medical Journal (BMJ) — a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group, wholly owned by the British Medical Association — links ADHD medication to reduced rates of suicidal behaviour, substance misuse and criminal activity.
The study, supported by the Swedish Research Council and the NIHR (National Institute for Health and Care Research), found that after taking medication as part of neurodivergent treatment, suicidal behaviour dropped by 17 per cent, criminality by 13 per cent, and substance abuse by 15 per cent.
Significant.
New factors, reviewed
According to the research team at the Karolinska Institutet (KI), a leading medical university in Sweden renowned for its research and medical education, ADHD (attention deficit hyperactivity disorder) affects about 5 per cent of children and 2.5 per cent of adults.
The condition is associated with increased rates of suicide, criminality and accidents.
Up until now, ADHD medications had been subjected to trials that tested their ability to alleviate the core symptoms of the condition, but none had tested their effect on these other factors: suicidality, criminality, and substance abuse.
Compelling evidence after two years of observations
Using data from Sweden’s national registers between 2007 and 2020, the researchers analysed approximately 85,000 individuals with ADHD who started drug treatment. Of this group, 88.4 percent were prescribed methylphenidate, the most common prescribed drug treatment for ADHD.
Using a technique called target trial emulation, which applies the principles of randomised control trials to observational data, the researchers were able to assess the presence of these behaviours (suicidality, criminality, and substance abuse) in the two years after diagnosis and treatment.
The compelling outcome is that, of those who had repeated experiences of such behaviour, a 25 per cent reduction in risk of substance abuse and criminality was observed.
The WHO should take note, says Professor
The research team say that reduced impulsivity, likely attributed to increased executive functioning ability and capacity in the prefrontal cortex afforded to ADHD individuals from drug treatment may partially explain this change in outcomes.
“Studies such as this one should inform the debate and decisions at the global level, including whether ADHD medications should be included in the WHO’s (World Health Organisation’s) list of essential medicines.” Professor Samuele Cortese, from the University of Southampton, said.
“So in terms of the implications, we think that our results should inform first the debate on the effects and safety of ADHD medications… this is a quite controversial issue, but oftentimes, when we consider controversy, [the] evidence base is not taken into account. So I think when we look at the solid evidence such as this one, facts are quite clear. We need to let our patients know that if left untreated, there will be some, unfortunately, some risk. And now we have evidence that medication can reduce these risks. This is very important to consider.” he added.
Professor Ian Maidment of Aston University, who was not associated with the research, said: “This study builds on existing research that found that treatments for ADHD reduce the risk of criminality, suicidality behaviour… The databases [used in this research] have detailed information on dispensing, but we don’t know whether or not the patient took the medication. The study also couldn’t assess the impact of different doses, and ethnicity is not reported. However, overall the study adds to our understanding of the potential benefits of these drugs.”
Citations
British Medical Journal — ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials
Listed authors — Le Zhang, Nanbo Zhu, Arvid Sjölander, Mikail Nourredine, Lin Li, Miguel Garcia-Argibay, Ralf Kuja-Halkola, Isabell Brikell, Paul Lichtenstein, Brian M D’Onofrio, Henrik Larsson, and Samuele Cortese.
