ADHD Drugs and Long Term Cardiac Risks
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- Опубліковано 17 жов 2024
- In this commentary I discuss the recent study that made headlines concerning possible long-term risks from using ADHD medications. I then discuss a more thorough review and meta-analysis of these risks that found no signals of long-term cardiac risks from ADHD medication use. These two studies are:
Long-term risk of cardiovascular side-effects following attention-deficit hyperactivity disorder treatment with sympathomimetic amines
A Holt, JE Strange, PV Rasmussen, N Nouhravesh… - European Heart Journal, 2023
academic.oup.c...
Zhang, L et al. (2022). Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity DisorderA Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(11):e2243597. doi:10.1001/jamanetworkopen.2022.43597
I'd rather die with a cardiac condition than going back to my life before meds. I was practically disabled and unemployed for 20 years because of ADHD. After my late diagnosis and treatment I could even talk like an adult and finally got a job. It was like having a second chance to live.
Same. Rather this as a known risk than same result but due to stress or (in my case) being overweight/oxidative stress due to forgetting to drink or eat (to counter all the binge eating) 😅
My meds actually helped resolve my heart palpitations. I would get them everyday when stressed about work, meetings, etc.
I agree.
I was taken off my medication for a week (rather flippantly IMO).
- I didn't add things to my calendar
- I misplaced my calendar
- I lost 3 reusable water bottles
- I lost my work pass
- I brushed my teeth about 20% of the time
- I would impulsively text people and annoyed them with over texting
- I over indulged in addictive things like tiktok, video games, caffeine and alcohol.
- my room got messier
- I didn't dot my i's or cross my t's at work. Not a huge deal objectively speaking.
- the only positive things I managed to do for myself were appointments I set up while on Adderall.
- the straw that broke the camels back was forgetting to put on my deodorant
I just cried. I sank to the floor and wallowed in the shame, in the knowledge of how much I suck at taking care of myself.
Eventually, I picked myself up, wiped the tears from my face, and left for work.
I realized hours later that I forgot to put on the deodorant again.
I can be proactive about my heart health on the medication. But I can't compensate for the shitty parts of my frontal lobe off meds. It's the easiest choice.
100%!!! I was diagnosed at 50 and getting on meds completely change my life for the better.
Me too. Life before meds was hardly a life at all. Not worth living with this disability unmedicated
Thank you for everything you do for us Dr Barkley. My understanding of my ADHD is night and day since I found your channel. I'm glad you point out that these peoples overall health is a huge factor aside from the meds.
Dr. Barkley, thanks for making videos like this! There are so many benefits from what you do - you help people with ADHD, help keep the public AND experts alike informed, and it gives me something to watch 😁
I love hearing your analysis of these studies. It's so much easier to be informed, especially when you share digging into the details. Thank you!
Another useful video, thanks. Cardiac risk is something I am worried about as both of my parents have hereditary arrhythmias (different types though) and I might start taking methylphenidate soon.
Congratulations on reaching 50 000 subscribers!
Did you start methylphenidate?
Thanks Dr. Barkley. I have been wondering about this question.
I'm sure tons of people leave comments like this but I just wanted to let you know how much I appreciate your work, doc. I was diagnosed after 30 but I feel now that my mom also suffered from untreated ADHD her whole life - she passed away after complications from a massive stroke made her an easy target for COVID at only 55. Her lifestyle was the problem and I think stimulants (and blood pressure management) could have saved her life.
Thank you so much for these updates!
Really helps me improve my understanding of ADHD and its treatment.
Can you zoom into the page with the browser? It's always very small and almost impossible to read at it's current scale.
🎯 Key Takeaways for quick navigation:
00:00 🌅 *Overview of Weekly Research Updates*
- Weekly research update by Russ Barkley.
- Brief introduction, dad joke, and explanation of the format.
- Mentions the selection of noteworthy research papers from the week.
01:21 📊 *Study on Long-Term Cardiovascular Risks of Stimulant Treatment*
- Discusses a Danish study on the long-term cardiovascular risks of stimulant treatment.
- Study uses a large-scale health records database to analyze risks associated with stimulant medications.
- Identifies a slightly higher risk of heart attack and stroke in the high-dose group compared to low-dose and discontinuation groups.
03:25 🧐 *Analysis of Study Findings*
- Explains the 30% increased risk in the high-dose group over a 10-year period.
- Emphasizes the importance of considering absolute numbers, not just relative risk.
- Raises concerns about the study's design, including the lack of control for the severity of ADHD, a possible confounding factor.
05:10 🌍 *Contextualizing Study Results*
- Highlights the limitations of the study, as it represents only one country, Denmark.
- Compares the Danish study findings with a meta-analysis involving 3.9 million people from six different countries, which found no increased risk associated with stimulant medications.
- Points out the potential confounding factor of severity of ADHD in the study and its relevance to coronary risk.
07:53 ⚖️ *Consideration of ADHD and Cardiovascular Risk*
- Discusses how ADHD alone is linked to an elevated risk of coronary heart disease.
- Cautions against taking the Danish study too seriously and emphasizes the need for further research.
- References a meta-analysis from a year ago that found no increased risk associated with stimulant medications on a larger scale.
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Thank you for this video - it would be great to see a video on if there are any long term side effects of stimulant medication - people always tell me there is but I can see info on this!
Great timing with this. Recently went to my doctor because I believe I have adhd. I was born with trans position of the great arteries so before my doctor prescribes me anything he has me going for a stress test and Echocardiography since I haven't had a checkup in so long. Thank you for all the information your putting out to help people.
Hi, many thanks for this, very helpful indeed.
Do you think you might be able to say something about the following study
"Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases"?
which appears in JMA Psychiatry, it was published in November 2023. I think that's a year after the Meta-analysis that you mention?
It would be particularly helpful if you could interpret some of these figures in what seems to me to be a very large, and as such potentially significant, study.
Thanks again.
Thanks for this. The longer term studies run headlong into the confounds from ADHD correlates. As a 60+ year old whose sister (probs also ADHD) died recently of a heart attack this is definitely a hard one. I suspect that meds may have reduced her smoking and general frantic approach to everything
Hi Russ, I think you already posted this video before. Pterodactyl joke was bad enough the first time!
You're right - the November 18th research update. My guess is this was a partial re-upload under this title so it would be more easily found and noticed by those looking for information on this topic. I think the research update video had a couple other topics in it and had the usual generic title.
Thank you for confirming that I'm not crazy.
Wouldn't the high dose group be more likely to have more severe ADHD symptoms? Also the Zang (2002) notes only two studies had sufficient follow up to not the long term risk of CVD. So the Danish study seem pretty compelling for increased risk
약물 복용 1년이 되니 BP 160/100 HR 105로 나타나서 검색하다 보게 되었습니다. 번역되는게 모국어 같이 부드럽지 않지만, 이런 영상를 볼 수 있음에 감사드립니다. 약물복용을 중단하기에는 삶의 질이 떨어질 것 같고... 계속 복용하면 심장질환으로 쓰러질 것 같아 무섭습니다. 해결방법이 있으면 좋겠네요. 영상 올려주셔서 감사합니다😊
Thank you
WHAT ARE THE DOSE LEVELS OF THE HIGH DOSE VS LOW DOSE??
The dosing parameters would more or less tell us the severity of the AdHd in the sample group.
Great content as always! Could you share your thoughts on Transcranial Direct Current Stimulation (tDCS) for adults with ADHD? It would be great to see a review of the latest research on this. Thanks!
I got myself the Whoop 4.0 fitness tracker when i got diagnosed and started the treatment with medication. It shows clearly how the medication influences my HRV HRF and recovery and sleep quality. It helps to manage
Another oversight is controlling for underlying heart issues being a cause for diagnosis of ADHD due to confused symptom attribution, such that when low doses of medications doesn't help, doses are increased and maintained until the impending heart failure manifests.
What is considered low dose vs high dose, generally?
It's great that you've put this into perspective with the correlation of ADHD with coronary heart disease, I must have missed that video. I have a family history of high blood pressure and heart attacks, and everyone over 50 is on blood pressure medication. I'm the first to get diagnosed and treated for ADHD. I'd rather take stimulants now and enjoy my quality of life, and if I eventually do develop high blood pressure, I don't believe it will be because of medication.
Why do seagulls fly over the sea?
Because if they flew over the bay, they'd be baygulls 🥯
Have you done a similar review of whether stimulants may suppress growth? I've looked before and found mixed results.
Thanks for explaining the implications and subtelties as thoroughly as you did. I find the general public has a pretty bad understanding of statistics and variables.
How many mg were considered low dose?
okay i freaking love the dad jokes lol
10 year risk in young people would usually be uninteresting, but 30% is large and if it's 30% in young people, what would that mean in life long risk?
yeah this discussion really didn't convince me of anything. of course young people have more resilient hearts. what happens when these young people keep taking the drugs til retirement? (another 30 or 40+ years)
@@TwampGod Exactly. People should be told about the long term impacts of taking these meds through adulthood, but all the studies seem to be across just ten years. How can we make informed choices about our care without this information?
What about pts with high bp? I see pts at the hospital who need stimulants but I get weary because some have untreated high bp 160/100 or less
This is a reupload, right? Im confused
Thanks!
Thank you!
I started 35mg Methylphenidate about a month ago, here on Isle of Man. I am 51 and only diagnosed with moderate ASC, ADHD, Social Anxiety Disorder and with chronic depression. After 2 weeks I needed to stop because my heart rate shot up from about 85bpm pre medication to over 135 and I was involuntarily clenching my jaw, which I'd never done in my life.
I am desperate to try non-stimulant medication but they keep extending the month they will become available. As an adult I have no chance of getting meds on our health service and I spend at least £85 a month for meds privately. It means it isn't possible for me not to work even though I know it is destroying my health. I am a Registered Nurse by the way😢...
have you tried lower dose? 5-10mg works a lot better for me
Are you talking about these non stimulant medications are Clonidine, Guanfacine and Atomoxetine
@RAM_845The major non-stimulant medications are Clonidine, Guanfacine and Atomoxetine
Can you review the Leonard Sax article on if ADHD stimulant drugs cause brain damage in minors
Btw my friend, that shirt suits you wonderfully!
So I'm a bit confused. What has the severity of ADHD has to do with the dosage/risks? I know people who have severe ADHD and can't take them. Loads of them actually: lots of side effects. And vice versa. I'm on a high dosage and it feels like it does nothing for me (although I do get dumber (careless mistakes) and my impulsiveness shifts: driving gets better, shopping and impulse spending gets worse for instance)
I assume this is because the severity of your ADHD relates to your dosage, where, as your dosages increases, you’re more likely to have a higher risk.
@@JC-Alan yes, thank you. That, I get. But from what I've seen those don't correlate in real life. As I said above, loads of people who have the hyper active variant most of the time and can't take meds. I'm combined but lean more towards the inattentive variant and need a minimum of 15mg dex every 4 hours and it still falls flat. I'm thinking comorbidities play a role too, so I'm not sure correcting for severity would result in more reliable numbers. I'm wondering why Russell would think otherwise and if there's research that shows severity IS a factor that needs to be considered, not just the dosage.
@@Varenyam86 well, your anecdotal evidence is why I would lean more on the meta-analysis. There are always going to be statistical outliers. Did you watch to the end?
@@JC-Alan I did. But I forgot already 😆
@@Varenyam86 I was gonna make the joke but you did it for me 😂😂😂
Well, that meta-analysis could only account for events in a median follow-up time of 1.5 years (the range was from 0.25 to 9.5 years). It's probably useful to remember that.
I hope we soon get longer follow-up studies, beyond 10 years... more like 20 years.
people are basically popping amphetamines like candies and they dont think that gonna hurt eventually their health and cardiovascular system?
Yeah, I read a case study of a man just 32 who needed a heart transplant after cardiac arrest, he'd been taking stimulants since age 6 or something. And a woman in a similar situation, she was taking them for narcolepsy and had heart failure in her 30s. I want to know, if I start taking stimulants age 40, what's that going to mean in 30 years? What state is my heart going to be in when I'm 70?
Going to be riding the high from that Dad joke all morning. 😂
Chances of me dying of heart problems are high and adhd meds are gonna make it higher, I don’t know what to do. adhd is killing me
Circadian lifestyle and nervous system regulation!
@@juliettehannah7721 Please elaborate. Thanks
@@juliettehannah7721could you please elaborate more?
What is a high dose?
Low: 30 mg Vyvanse
High: 60 mg or 70 mg
Saturday?
The non-stimulants medication’s the new ones are probably good for older ADHD suffers.
Love the pee joke!
Comment section could be a lot helpful if people refrain from expressing their unnecessary admirations. If you like the video, there is a like button. Leave the comment section to others who bring something to the table and those who have questions
Agree 1000%. Trying to look for informative comments vs. the I LOVE YOU, over and over again is maddening.
I don't see how there's no increased risk to cardiovascular disease. Sustained high blood pressure increases your risk full stop. Also sustained high blood pressure isn't healthy even if it doesn't lead to cardiovascular disease. If you're taking stimulants every day, even if your risk is only increased marginally it's still not healthy on the cardiovascular system. Interesting point about the increased risk even without taking stimulants, I didn't know that!
This is why we run these trials and meta-analyses. Sometimes our intuition on the causal relationship between a risk factor and negative outcome is flawed or the cause is simply not as impactful as we expect it to be, prior to seeing the data.
Just get regular checkups. my bp is 120/80 and my hr is 60bpm. The benefits outweigh the risks.
@@aarongabriel5749 and yet all the data is showing higher risk. so our intuition isn't flawed. Barkley really tried to put a nice spin on this, yet these studies both showed higher CVD risks and they were in young people who only took them 10 years. I'm in my 30s, already taken these drugs 15 years. Where's the proof that another 30 years of being on these won't ruin my heart?
May I speculate about the other way around?
What if some presentations of hypertension might be one of the adhd causes?
I mean, hypertension leads to small artery remodeling. That can cause vascular dementia overtime.
These people might have less elastic small arteries since their birth, which would not just explain the development of hypertension in their 30s, but also would explain the adhd presentation in early life due to less oxygen availability for the brain development and could explain vascular dementia in later life in case of poorly treated hypertension.
Honestly, his points here are pretty weak. First off he's positing that the higher dosed patients might have "stronger" symptoms of ADHD and that could be why there's higher heart disease. He admits that he doesn't know if that's the case, but in this discussion it sure seems like he's made up his mind to convince is the study is bs.
Secondly, he then says that medication is shown to improve ADHD symptoms. Then why wouldn't the higher dosed group show significant improvement in ADHD symptoms which would reduce his so-called lifestyle risks? They are taking higher dose of the medication right?
Thirdly, these studies only show 10 years of use. As someone who has been on these drugs for 16 years already and only in my 30s, why isn't there any studies on 20 or 30 years of use? I could be taking these drugs til retirement if I went by this guy's advice. And he has no idea or evidence what these would do to us after 40 years of use.
people are basically popping amphetamines like candies and they dont think that gonna hurt eventually their health and cardiovascular system?
Yep and no one wants to talk about it. I was prescribed dexamfetamine and I have become to psychologically addicted to it! Currently switched to vyvanse so then I can slowly come off of this eventually but far out its a long road. It helps until it eventually starts hurting you.... was it worth it I will never know
russ can be an honorary zoomer