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ADHD Drug Persistence Lower Than Expected
More than half of teens, young adults, and adults prescribed medication for attention-deficit/hyperactivity disorder (ADHD) stop taking it within the first year, according to a multinational study of more than 1.2 million patients published in The Lancet Psychiatry.
“It’s unlikely that so many people discontinue their treatment because their ADHD symptoms have remitted, meaning that the high rate of early discontinuation may be a major barrier to effective treatment,” said corresponding study author Zheng Chang, PhD, a senior researcher at the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden. “We haven’t been able to analyze the direct causes in this study, but common reasons for discontinuing ADHD medication are adverse reactions and lack of effect.”
Related: Long-term ADHD Med Use May Hike CVD Risk
The retrospective, observational study analyzed prescription data from Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the United Kingdom, and the United States. Researchers focused on patients who had initiated ADHD medication between 2010 and 2020 and stratified data by age at medication initiation: children aged 4 to 11, adolescents aged 12 to 17, young adults aged 18 to 24, and adults aged 25 and older.
Discontinuation of ADHD medication across countries was highest in young adults and adolescents and lowest in children, according to the study. The highest rate of discontinuation occurred at between 18 and 19 years of age, a time when patients are likely transitioning from child and adolescent psychiatry to adult psychiatry.
“We need to improve the transition to adult psychiatry and spread knowledge about the fact that problems associated with ADHD often persist over time,” said Isabell Brikell, PhD, research coordinator at the department of medical epidemiology and biostatistics at Karolinska Institutet.
Rates of ADHD medication persistence within 1 year of initiation were 39% in young adults, 47% in adolescents, and 48% in adults, researchers reported. In children, 1-year persistence rate was 65%.
When researchers accounted for reinitiation of medication, persistence rates were higher, the study found. At 5 years, between 50% and 60% of children and 30% and 40% of adolescents and adults were receiving drug treatment in most countries.
“Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups,” researcher wrote. “This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use.”
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