Neurological and Psychiatric Adverse Effects of Long-Term Methylphenidate Treatment in ADHD: A Map of the Current Evidence

Neurological and Psychiatric Adverse Effects of Long-Term Methylphenidate Treatment in ADHD: A Map of the Current Evidence

Krinzinger H, L Hall C, Groom MJ, T Ansari M, Banaschewski T, Buitelaar JK, Carucci S, Coghill D, Danckaerts M, Dittmann RW, Falissard B, Garas P, Inglis SK, Kovshoff H, Kochhar P, McCarthy S, Nagy P, Neubert A, Roberts S, Sayal K, Sonuga-Barke E, Wong ICK, Xia J, Zuddas A, Hollis C, Konrad K, Liddle EB; ADDUCE Consortium.

Neurosci Biobehav Rev. 2019 Sep 20. pii: S0149-7634(19)30235-0.

doi: 10.1016/j.neubiorev.2019.09.023.

Commentary* by Dr. Margaret Weiss: Are there any long term side effects? This is one of the most common questions patients asked when introduced to stimulants. This article is helpful in providing a response.

ABSTRACT

Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes. We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a “traffic light” system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as “Unclear”. Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse. We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention.

* Abstracts are selected for their clinical relevance by Dr. Margaret Weiss, Director of Clinical Research, Child Psychiatry, Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion.  It is not approved or necessarily representative of the CADDRA board.