Already and this is the Daily This is the Daily oas oh, now it makes sense. Good morning and welcome to the Daily OS. It's Wednesday, the ninth of April. I'm Emma Gillespie.
I'm Zara Zeidler.
A new study out this week has found the overall benefits of taking ADHD medications outweigh the risks. The team of international researchers involved in the study took a close look at ADHD medications, both stimulant and non stimulants, and it comes off the back of growing concerns around the
potential cardiovascular impact of these medications. In today's deep dive, we're going to unpack these findings and take a closer look at the world of ADHD treatment where things are out here in Australia as well as around the world.
M I want to start by just providing a bit of a lay of the land. We have heard a lot about ADHD, both in the news, you know online. Can you just give us a bit of an understanding on what we need to know about ADHD?
Yep So, Attention deficit hyperactivity disorder ADHD is a neurodevelopmental condition and other examples of neurodevelopmental conditions include things like autism, spectrum disorder, dyslexia, motor disabilities like cerebral palsy. But what a neurodevelopmental condition really means is that a person with ADHD has a brain that has developed differently compared to a neurotypical person's, and that's because of how their nervous system has developed. So think of the nervous system like
a network of cables. It sends messages to and from your brain to other parts of our body. A neurodevelopment refers to how these networks are formed during early brain development. When that development is disrupted, as it is for people with ADHD, we see a whole range of impacts on their daily lives, their ability to function, things like their
communication behavior, emotional regulation, fine motor skills, cognitive function. These symptoms of ADHD do usually present in childhood, and that can manifest in things like difficulty concentrating or controlling impulses. But we do know it so much more than that. Of course, people with ADHD can also be extremely creative. They can be good problem solvers or extremely productive if they're in a hyper focus.
So that's a very kind of top line ADHD.
One oh one for you, okay, brilliant, And so before we deep dive into this study, I do think that it would be helpful to understand more of that scale point that I mentioned earlier. What are the numbers when it comes to ADHD.
Yes, So there are around one point three million Australians estimated to be impacted by ADHD.
That's about one in twenty of US.
But it is a really hard number to determine because seeking a formal diagnosis is quite intense. It's a rigorous process that requires a thorough behavioral assessment by a psychiatrist. The irony being if you have ADHD, it might be
especially difficult for you to seek that evaluation. Not to mention wait times and costs and things like that, but in terms of how diagnoses have increased, we can track that by looking at PBS data, so the Pharmaceutical Benefit Scheme, and that tells us the number of people being prescribed ADHD medications in Australia. So when we look at that data, we can see the number of Aussies who are taking medication to treat or manage the ADHD is around four
hundred and seventy thousand people. So that's about thirty six percent of the population of people who have been diagnosed with ADHD in Australia, so more than one in three. But that figure has more than doubled in the five years to twenty twenty two.
Interesting and what do we attribute that significant increase too.
Yes, so there are a range of issues and many that will be debated. Medical experts though, have really emphasized that more diagnoses should not be taken for an actual increase in the prevalence of ADHD, but that this is a jump in a kind of a correction of decades of underdiagnoses, particularly of women. We know that the kind of diagnostic criteria for ADHD was designed around men young boys in particular, Women are socialized differently. There's a lot
of kind of reasons for that underdiagnoses. But in August last year, the Australian Psychological Society President, doctor Katrina Davis McCabe said, quote, there's not necessarily a large influx of people who suddenly have ADHD, but there is an influx of people who are willing to present, she said, largely thanks to this growing awareness, including awareness online, but you know also within medicine, within schools and education, less stigma
more conversation at a policy level. And also you know the demands of modern society and how they can expose impairments or can expose symptoms like ADHD.
And so we have more people who are being diagnosed than ever before. What follows from a diagnosis we're talking today about treatments. What can you tell us about some of the treatments available to those who have ADHD.
So one treatment option is medication, and ADHD medications fall into two categories, So there are stimulants and non stimulant medications, and in most cases medication for ADHD is only prescribed by psychiatrists, pediatricians and neurologists. Each state and territory in Australia does have different laws about prescribing ADHD medicines, but
generally they are incredibly tightly regulated. So here in New South Wales, for example, a specialist has to obtain approval from this ste governments Ministry of Health to prescribe or supply stimulants for ADHD treatment to an individual, and there are also rules for pharmacies. In New South Wales they can't dispense a script for a stimulant for someone with ADHD unless that prescription shows an approval number issued by New South Wales Health, so lots of checks and balances there.
I think it is important to note though, that when we're talking about the levels of dosage for ADHD treatment, there is no evidence that the use of stimulant medications leads to substance abuse or dependency. But there have been concerns about the safety of these medications surrounding their cardiovascular impacts, and that's exactly what has prompted this study that we're talking about today, which was led by the University of Southampton in the UK AT handed down its findings this week.
So can you just explain a bit more about those concerns that prompted the study. You said it was around the cardiovascular health of the participants.
Yep.
The study notes that some ADHD medications stimulate the nervous system, some ADHD medications work by slowing it, and so this explains why some people will experience increases and decreases in things like their blood pressure their heart rate after they start taking treatment. So it's essentially those fluctuations in impulse and blood pressure that have the medical world asking how significant are those changes, what are the long term impacts
of those fluctuations. What does that all mean for a person's health outcomes?
And just quickly you mentioned there that there are different types of ADHD medications. Did this study specifically look at one medication form of medication or did it look at a range of them.
So one of the interesting aspects of this study is that it was extremely comprehensive in that it studied the effects of several ADHD medications, including a range of stimulants like listex amphetamine and methyl fenodate are sold, for example, under brand names like Vivance and Riddlin, and non stimulants like atomoxetine and clonidine, which are sold under brand names
you might have heard like Sandos and Catapress. And so what they did for this study is researchers analyzed data from nearly twenty three thousand participants from around the world from randomized controlled trials. Now, these are considered the most rigorous type of clinical study because they assess medication effects and compare the results of treated and non treated participants,
so placebo participants. Also, interestingly, among that twenty three thousand participant number, nearly sixty percent were children and adolescents, and there was a fairly even gender split, a range of ages upwards of five years old, so a broad kind of set of participants and researchers tracked changes to the blood pressure and heart rate of these participants over a one year period. So the data set looked at outcomes around the twelve week, twenty six week, and fifty two
week mark after they had started ADHD medication. It's actually the largest and most comprehensive analysis of its kind, and it was funded by the British government's National Institute for Health and Care Research.
I am really curious that it was a one year study. I'd be really keen to understand, you know, whether they will be continued tracking after that one year period, Yeah, because perhaps some of the concerns might materialize after that one year period.
Yeah.
And the study was really honest about a gap overall in this field of research when it comes to long term studies. So there are limitations on our overall understanding of these long term cardiovascular effects because the studies don't exist, The research doesn't exist. So this is one study, but the authors of it have called for more funding to facilitate that research to provide more important insights into the future.
But you know, in lieu of that we have these.
Findings from this comprehensive data set in the meantime, I suppose, so, do.
You want to just talk us through what those key findings actually were.
Yes.
So the findings were published in the Lancet Psychiatry Journal, and they show that quote all ADHD medications were generally associated with overall small effects on blood pressure, heart rate, and other cardiovascular parameters. Which isn't that surprising given that we know there is this decrease or increase associated to the nervous system from some of those medications that we
discussed earlier. But it found that for the majority of children taking ADHD medications, researchers recorded a quote small increase in blood pressure and pulse, which is an interesting finding given concerns around young people taking these medications. There was one exception, a medication called guanficine, which researchers found leads to decreased blood pressure and heart rate, a more notable fluctuation than any of the other medications in the study.
This one I've found really interesting as a finding. No significant differences were found between stimulant and non stimulant types of ADHD medications, so I think a lot of people can feel a bit of a struggle or a battle in determining what is the right medication for them stimulants vers non stimulants, and so that.
Was in the specific concern around cardiovascular response.
Exactly yes, yep, so no significant difference between stimulants and non stimulants, and overall research has said that the data shows the benefits of taking ADHD medications outweigh the health risks. However, researchers did say that practitioners should continue to monitor blood pressure and pulse in patients that they are treating for ADHD.
It's really interesting, em and this study certainly ignited a lot of conversation in our comment section, as this topic generally tends to do. What has the response been to these findings?
So the studies lead author, Professor Samuel Coortesi said that this risk benefit ratio, this assessment that the benefits outweigh the risks is reassuring for people taking ADHD medications, and he also said that the findings should be particularly relevant for practitioners, not just patients, because he said, there is this group of practitioners who might assume that only stimulants have a negative effect on the cardiovascular system, or who
might kind of have a preference between stimulants versus non stimulants, or prejudices around those medications. But there is that gap in long term studies that we talked about and the limitations of that. The studies authors also have recommended that people with heart conditions consult a cardiologist before starting ADHD medication.
So I think that's an important note. But before we wrap up, when we're talking about the risk benefit ratio, when we're talking about the benefits out weighing the health risks, I think that everyone will have a different relationship to what that benefit might look like.
But for some.
People taking ADHD medication might be the difference between holding down a job or not, might be the difference between showing up for the people that they care about or not, or controlling their impulses if they have addiction or substance abuse issues. I want to quote Royal Australian College of General Practitioners President doctor Nicole Higgins, who in a statement last year emphasized that there are many effective ADHD treatments.
It's not only about medication. She has ADHD herself and said, quote, we all have brains that work differently and with the tools, which may be medication or skills, training or counseling, people develop ways of managing and coping as they talk about their positive experiences. It takes away the shame, the stigma, and fear around exploring, Okay, why is my brain a little bit different? She said, You can't tell who has ADHD.
It could be the person next to you. It might be your doctor, your tea, teach your child, your friend.
What works for one person might not work for another.
In essence, as always, if you have concerns, questions, queries about ADHD medication, please please consult a health practitioner, a professional.
They will be able to steer you in the right direction.
M thank you for explaining that study the findings. It is as you said, just the beginning. There is so much research that needs to be done into this space, so certainly one that I'm sure will be speaking a lot about in the months and years to come. But thank you so much, thank you, and thank you for joining us for another episode of the Daily Ods. We'll be back later today with the headlines, but until then, have a great day.
My name is Lily Madden and I'm a proud Arunda Bunje lung Chalcutin woman from Gadigol country. The Daily os acknowledges that this podcast is recorded on the lands of the Gadighl people and pays respect to all Aboriginal and Torres Strain island and nations. We pay our respects to the first peoples of these countries, both past and present