Ritalin, Adderall, and other stimulant medications that some doctors prescribe to treat attention deficit/hyperactivity disorder (ADHD) have been shown to cause significant side effects, including weight loss, nervousness, tics, and difficulty sleeping. More seriously, they can lead to fatal complications in children with heart problems. Yesterday, the American Heart Association took steps to ensure the safety of children taking stimulant medication. In a report, they recommended ways to improve heart screenings among children with ADHD.
The report, which was published online in the American Heart Association's journal, Circulation, advises that all children diagnosed with ADHD undergo a physical evaluation and discuss their medical and family history. Physicians normally take these steps before prescribing medication, but because the symptoms of heart problems can be vague (heart palpitations or fainting), the report also recommends that children with ADHD receive an electrocardiogram (ECG). A measure of electrical activity in the heart, ECGs are considered effective tools for uncovering cardiac abnormalities that are often missed by a physical exam. The report advises that physicians continue to monitor patients taking these medications for signs of cardiac problems, and, if problems arise, refer patients to a pediatric cardiologist.
Stimulant medications can have serious effects on the body, increasing blood pressure and heart rate, and while these outcomes are not normally harmful to healthy children, they can be fatal for children with undiagnosed heart problems. For these children, stimulants can increase the risk for sudden cardiac death (SCD), which occurs when abnormal heart rhythms prevent the heart from pumping blood. Awareness of the health risks associated with ADHD medications has increased over the past decade, and this report furthers previous efforts by the FDA to address these problems. At a conference in 2006, FDA officials reported that between 1999 and 2003, 25 people, 19 of whom were children, died suddenly while taking stimulant medication, while 43 people, including 26 children, experienced other heart problems, such as stroke or cardiac arrest. Warnings for individuals with heart problems were added to the labels of these medications in 2006, and in 2007 the FDA asked that drug manufacturers create Medication Guidelines explaining the risk for patients and their loved ones.
The committee behind the American Heart Association's report stresses the necessity of further research on the subject. Inconsistent data has prevented researchers from accurately identifying the rate of SCD associated with ADHD medication, and researchers continue to question whether the rate is higher in children with ADHD taking stimulants compared with rates found in the general population. However, in the current report, head author Dr. Victoria Vetter maintains that screenings for children with ADHD would save lives. In a study she presented at the American Heart Association's 2007 Scientific Sessions, 1,100 healthy children were given ECGs, and 2 percent were found to have previously unknown heart problems. In addition, some studies have indicated that children with heart problems may have a higher risk of developing ADHD, and heart evaluations may help physicians and mental health professionals determine most appropriate treatment plans.
Stimulant medications can carry great risks, but they remain a treatment option for those with ADHD, and its important for patients and their doctors to weigh the benefits as well as the risks. Individuals dealing with ADHD, or parents of children with the disorder, may want to consult their treating physician or psychiatrist to find out more about non-stimulant medication options, of which Strattera is a prominent option. The authors of this report emphasize the importance of treating the symptoms of ADHD while reducing the risks associated with medication, and with better screening practices in place, individuals with ADHD may receive the most effective and appropriate forms of treatment.
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