ADHD medication: are the benefits worth the risk?

Methylphenidate, a stimulant similar to amphetamine and cocaine, is one of the most prescribed types of medication for ADHD, a behavioural disorder believed to affect between 5-10% of schoolchildren in the UK.  Figures recently released by the NHS indicate that there was a fourfold increase in prescriptions for methylphenidate in a decade, from 158,000 in 1999 to 661,463 in 2010. Between 2006 and 2010 there was a 65% increase in NHS spending on drugs to treat childhood ADHD, with a cost to the taxpayer of £31 million [1] annually. 

ADHD drug prescriptions are on the rise: should medical professionals be exploring other options?

Unsurprisingly, there is concern that many GPs are prescribing medication with known side effects without considering safer, possibly cheaper, effective alternatives and that parents and sufferers themselves are frequently unaware of such alternatives to conventional drug-based therapy.

Whilst it must be acknowledged that this class of medication that is available in Canadian drug store and pharmacies, has helped many children with ADHD, its many side effects often outweigh the benefits to the user.  With nervousness and sleeplessness affecting around 10% of patients, and less common side effects (such as headache, loss of appetite, weight loss, drowsiness, dizziness, nausea and vomiting, dry mouth, palpitations, rash development, itching, fever and  joint pain) affecting around 1% of users, it is no wonder that there are growing concerns regarding its use in children.  Furthermore, there is a treatment ‘gap’ whereby a proportion of children do not respond to medication; where benefits are seen, studies have brought into question whether the effects are sustained long-term. The National Institute for Clinical Excellence (NICE) states that children of six years and under should not be prescribed stimulants and yet, according to The Association of Educational Psychologists, there has been a substantial increase in the number of children aged under the age of six, and in some cases as young as three, being prescribed ADHD drugs.

Methylphenidate is not the only drug prescribed for young children, however. Other stimulant drugs such as Dexamphetamine, sedatives like Imipramine and antidepressant drugs such as Prozac are routinely prescribed for young children and teenagers, to treat numerous conditions including attention and hyperactivity problems, obsessive-compulsive disorder, phobias, depression, anxiety, anger and aggression, bed-wetting, and insomnia.  Concerns about the increasing use of pharmaceutical drugs by children hit the headlines in 2003 when health officials issued warnings that the antidepressant drug Seroxat might increase the risk of hostility, mood swings, aggression, and suicide in children and adolescents.

The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK government agency responsible for ensuring that medicines work and are acceptably safe; they had been monitoring the safety of Seroxat since the early 1990s when it was first licenced by manufacturer GlaxoSmithKline (GSK).  An investigation by the BBC programme Panorama in 2002, however, highlighted public concerns about suicidal behaviour among children using Seroxat.  GSK were then forced to submit the full data from the clinical trials in children to the MHRA.[2] These studies demonstrated that significant side effects occurred in at least 2% of users.  These side effects included decreased appetite, tremor, sweating, hyperkinesia, hostility, agitation and a range of most severe symptoms including suicidal thoughts, attempted suicide, mood swings and self-harm. The Seroxat controversy has certainly drawn attention to the issue of safety that surrounds the prescribing of drugs to both adults and children, and yet it is still being prescribed.

A 2011 study published in the journal Drug Safety on ADHD drugs reported adverse drug reactions (ADR) to Ritalin medication (containing the active ingredient methylphenidate), lasting up to three years in some cases.2 The study asked parents of 578 children (3-16 years of age) receiving pharmacological therapy for ADHD and attending a child and adolescent clinic in the UK to complete an ADR questionnaire to elicit information on possible ADRs associated with their child’s medication use.  A total of 81 of these invited returned completed questionnaires reporting 134 different ADRs for Ritalin monotherapy, with the most frequently reported being loss of appetite (34.3%), headache (17.9%), mood and emotional problems (14.9%), stomach upset (14.9%), sleep disturbance (10.4%), and rash and other skin problems (5.2%). Professor Peter Helms, a professor of child health at Aberdeen University who was involved in the study stated: “the effects on people who have been on the drugs for years is a potential problem.”

Not surprisingly, the interest in alternative methods and add-on therapies for treating ADHD is growing at a rapid rate.  Chiropractic techniques, physical activity and behaviour therapy help promote discipline and focus.  Diet is also known to exacerbate or improve symptoms; choosing the right foods and cutting out the wrong foods is a proactive way that parents can help reduce the symptoms of the condition.  With appetite suppression one of the most common side effects of ADHD medications, however, it is not surprising that nutritional deficiencies are common in children with the disorder.  Deficiencies of micro- and macro-nutrients known to be involved in neurotransmitter function may further exacerbate many of the symptoms related to ADHD.   The use of dietary supplements to counteract specific deficiencies have been documented, and trials using magnesium,[3] iron,[4] zinc[5] and especially the omega-3 long-chain fatty acid eicosapentaenoic acid (EPA) [6],[7] have shown remarkable improvements in behaviour and academic learning.  Such findings are, unsurprisingly, opening channels of investigation for the use of such supplements either as add-on treatments or in children known to be drug-resistant.[8]



[3] Tobaiqy M, Stewart D, Helms PJ, Williams J, Crum J, Steer C, McLay J. (2011) Parental reporting of adverse drug reactions associated with attention-deficit hyperactivitydisorder (ADHD) medications in children attending specialist paediatric clinics in the UK. Drug Safety. 34:211-9.

[4]Starobrat-Hermelin B, Kozielec T. (1997) The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res. 10:149-56.

[5] Konofal E, Lecendreux M, Deron J, Marchand M, Cortese S, Zaïm M, Mouren MC, Arnulf I. (2008) Effects of iron supplementation on attention deficit hyperactivity disorder in children. Paediatric Neurology. 38:20-6.

[6] Bilici M, Yildirim F, Kandil S, Bekaroğlu M, Yildirmiş S, Değer O, Ulgen M, Yildiran A, Aksu H. (2004) Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Progress in Neuro-Psychopharmacology Biological Psychiatryis. 28:181-90

[7] Bloch MH, Qawasmi A. (2011) Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry.50:991-1000.

[8] Perera H, Jeewandara KC,  Seneviratne S &  Guruge C. (2012) Combined Omega-3 and Omega-6 supplementation in children with attention deficit hyperactivity disorder refractory to methylphenidate treatment: a double-blind placebo-controlled study.  Journal of Child Neurology 27:747-753.

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