ADHD Drugs and Heart Problems
Nov 8, 2011
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
When I was 13 years old I went at a sleep over at my friend Peters house. There were 4 of us younger boys and Peters older brother, Joseph. Joseph was 4 years older than us. It was January and minus 40 C outside. Joseph convinced us we should have a contest. We would run outside in bare feet with a Styrofoam cup. The first guy would run as far as he could and place the cup in the snow. The next guy would try to get the cup a little farther. We all got cold feet, but when it came to Peters turn, the cup blew away and he spent way too much time chasing it. There were some tears, probably some frost bite and many threats to tell on Joseph to their parents. Thirteen year old boys dont always make the best decisions.
If a young boy is always making poor decisions, it could actually be a medical condition. ADHD or attention deficit-hyperactivity disorder is the most common psychiatric diagnosis in children and adolescents. It affects 8-10% of males < 18 years old and 3-4% of females <18 years old. It can stay with patients into adulthood. If a child has a diagnosis of ADHD, there is a 80% he will have symptoms as a teenager and 60% chance he will have symptoms as an adult. In fact 4.4% of all adults have ADHD. ADHD is most often treated with stimulant medications like methylphenidate or Ritalin. We are often asked by parents if we think they should fill their childs Ritalin prescription. Will anything bad happen if their child doesnt take Ritalin? While it is the parents choice to fill the prescription, research shows patients with untreated ADHD are 3 times more likely to repeat a grade, 4 times more likely to be arrested, nines times more likely to have a teenage pregnancy and 11 times more likely to be put in jail than non-ADHD people. So whether or not to treat a child with ADHD is an important decision that should be discussed carefully with the child, the family and the childs doctor.
Treating ADHD is important and the most common treatments are the stimulant medications like Ritalin. Although these stimulant medications can work very well to help the child concentrate, there have always been concerns about how these medications affect the heart. Stimulant medications can make the heart beat faster and raise blood pressure. The worry was if a child had an undiagnosed heart problem and you gave them a stimulant drug, the heart problem would get worse and cause the child harm or even death.
There was a large study published in a November 2011 edition of the New England Journal of Medicine by Cooper et al. The study says these stimulant drugs may not be as dangerous as we thought. Although this was not a double blind placebo controlled trial, the researchers looked at a large group. They examined the medical records of 1,200,438 children and young adults between the ages of 2 and 24 years and including 373,667 person-years of current use of ADHD drugs. They looked for heart problems including heart attacks and strokes. They didnt find any more heart problems in the children taking ADHD medications than in those that did not take them. That was reassuring news for me as a pharmacist and should be reassuring for parents who have children taking ADHD medications.
What does it mean when we say a child has ADHD? ADHD has three main symptoms doctors look for. They look for: inattention, hyperactivity and impulsivity. Every child or adult has problems with these once in a while. To be diagnosed with ADHD, these symptoms must cause significant problems in the childs life. Other things the doctor will be looking for is if the symptoms have lasted more than 6 months, if the child has these symptoms in different settings such as problems in school, at home and when playing hockey, and if the symptoms are caused by other problems. Symptoms of inattention include: careless mistakes, difficulty sustaining attention, no follow-through, cant organize, easily distractible and forgetful. Symptoms of hyperactivity/impulsivity include: squirming & fidgeting, cant wait their turn, on the go all the time, seems driven by a motor and blurting out answers. The exact type of symptoms will determine the diagnosis. The symptoms can also change over time. The child can have hyperactivity when they are young and as they age they can become impulsive and as they become an adult they can become inattentive.
Many parents ask if ADHD is a real diagnosis. The answer is yes. Scientists have looked at pictures of the brains of people with ADHD. There are actually parts of the brain that are 10 % smaller in people with ADHD than in people without it. When scientists look at an ADHD brain with an fMRI, parts of it dont light up the way a non-ADHD brain would.
We recently went to a talk about ADHD given by a child psychiatrist. The psychiatrist showed us picture of an ADHD brain on Ritalin. It has always confused me why we give a stimulant to a hyperactive child and the child calms down. In these brain scans, parts of the ADHD brain didnt use glucose very efficiently. Glucose is fuel for the brain. So the ADHD brain tries to concentrate on something it gets tired very quickly. So then the ADHD brain loses attention. When you add Ritalin, the ADHD brain uses the glucose more efficiently and the brain can concentrate longer.
The good news is the medications we have to treat ADHD work well and the new study out in the NEJM shows they are quite safe. And be kind to your 13 year old boys when they make poor decisions. For the record, I learned from my mistake and have never ran in the snow bare foot again.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance - www.caddra.ca
Cooper et. al study in New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1110212