A consultant psychiatrist reflects on the long‑term cardiovascular risks of ADHD medication after a previously healthy patient suffered a cardiac arrest. The author reveals that clinical trials supporting these drugs are short, while new research links prolonged use to increased heart disease and hypertension. The piece also highlights diagnostic criteria changes that have broadened ADHD diagnoses and notes that many new adult patients are already on antidepressants. It calls for adherence to NICE guidelines emphasizing non‑pharmacological interventions before resorting to medication, arguing that the system is too quick to medicate life's challenges.
Last year a patient of mine suffered a cardiac arrest while on holiday in Spain. He was in his forties and perfectly fit. He had no history of heart problems and neither did anyone in his family.
In other words, it came totally out of the blue. He was very lucky to survive. Returning home he saw a cardiologist, who scoured his medical history looking for clues.
Then he picked up on something that would never have occurred to me. My patient had been on medication for ADHD for many years and the cardiologist wondered whether it might have played some part. I have a very good relationship with this patient, and so when he mentioned it to me I had to confess I wasn't able to shed any light on the issue. I went home that evening feeling faintly ashamed of myself.
I have done courses and training in ADHD assessment and treatment. I'm a consultant psychiatrist and prescribe this medication, and yet I couldn't have told him what 30 years of taking it does to your heart. So I looked into it. What I found shocked me and changed the way I practise.
The average clinical trial of ADHD medication lasts just 75 days. That is the evidence-base on which we hand these drugs to schoolchildren and keep them on them for decades. I wasn't taught about the long-term effects on the heart at medical school or during my specialist training because, until recently, there was next to nothing to teach. That changed in 2024, when Swedish researchers followed 278,000 people with ADHD for up to 14 years.
They found that the longer someone was on the medication, the greater their risk of heart disease. After five years, the risk had climbed by almost a quarter. The risk of high blood pressure was up by 80 per cent. And the higher the dose, the worse it got.
Yet despite all this, we've somehow convinced ourselves that these are harmless little pills. I hear it constantly, from patients and from colleagues.
'No harm in giving them a go, they might help. ' I have even heard it said about people who don't come close to meeting the criteria for ADHD. They are not vitamins. Methylphenidate and lisdexamfetamine, two of the most commonly prescribed medications for ADHD, are Schedule 2 controlled drugs, which puts them in the same category as morphine and fentanyl.
That places them in the same category as morphine and fentanyl, drugs the law accepts have a medical use but treats as seriously open to abuse and which are therefore subject to tight controls. But, at the same time, we're continuing to dish them out to ever-growing numbers. Prescribing to British women over 25 has risen more than 20‑fold since 2010. Why?
Because of something in medicine known as 'diagnosis creep'. In 2013 the diagnostic manual for ADHD was rewritten. The number of symptoms an adult needed to be diagnosed dropped from six to five. This change might not seem like much, yet when researchers tested this on university students, 12.7 per cent met the old threshold and 21 per cent met the new one.
Taking away a single symptom produced 65 per cent more people with ADHD. The age by which symptoms had to have appeared shifted from seven to 12, while the requirement that those symptoms had actually caused the child any problems was quietly dropped altogether. We didn't get better at diagnosing ADHD, we simply lowered the bar.
And here's another deeply troubling fact: of British adults over 25 starting on ADHD medication, more than 70 per cent had already been taking antidepressants. That figure stopped me in my tracks. These aren't people whose lifelong condition has finally been recognised, they're people who have been round the houses in their search for answers. One label didn't fit, so here's another.
That pill didn't work, try this one. I'd wager nobody asked about other factors: stress at work, trouble in their relationships, poor sleep - and how many hours a day they spend staring at a screen. Increasingly, we are viewing life's challenges as a problem to be medicated. What makes me so angry is that NICE, the body responsible for clinical guidelines, already states plainly how to proceed.
For adults, and for children over five years old, medication should only be offered if symptoms are still causing significant impairment after environmental modifications have been tried and reviewed. And what are these environmental modifications? Move a desk, reduce noise, try headphones, take proper breaks - all common‑sense stuff. But moving a desk for a child would mean liaising with the school.
For an adult it could involve HR at work. Both might take a while to resolve. Filling in the prescription pad, takes minutes. Of course, for people who truly have profound ADHD that makes their lives a misery and stops them functioning, these drugs can be transformative. I have seen it in my own patient
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