Reconsidering the Safety Profile of Stimulant Medications for ADHD

Stimulant medications (e.g., Ritalin) are considered a relatively safe first-line treatment for attention deficit hyperactivity disorder (ADHD), the most common neuropsychiatric diagnosis among children. This study explores the prevalence of side-effects and risks of stimulants, as perceived by 218 Israeli young adults with ADHD who used stimulants. Participants completed questionnaires that addressed representative side-effects (eight side-effects copied from the patient leaflet of Ritalin, as approved by the Israel Ministry of Health, and five additional side-effects), medication dependence, and substance use. Results indicated that almost all side-effects were extremely common – significantly and substantially more than the leaflet’s estimates. “Mood changes such as depression” for example, were observed among 66%, compared with the reported “1 in 10,000 users.” Suicidal thoughts, which are mentioned as “side-effect that occurred with other medications that contain same ingredient,” were observed among 3.2%. Side-effects not mentioned in the leaflet, such as “zombie-like sensation” (72.5%) and “alterations in sense-of-self” (39.4%), were also very common. Most participants tried quitting the medications (some even resisted taking them as children), mainly to disengage from their medication dependence and cease their adverse-effects, however many struggled coping without the medications and experienced withdrawal reactions, such as decreased mood or motivation as well as increased stress and anxiety. Notably, stimulant use frequency significantly correlated with alcohol and drug use. Although the observational nature of the study limits its generalizability, its findings suggest that the safety profile of stimulants requires further consideration, especially today with the large increase in diagnoses and medication use among millions of children.