Young Adults, Adolescents Discontinue ADHD Medication More Than Children

Isabell Brikell, PhD

Credit: Karolinska Institutet

Young adults and adolescents are the age groups most likely to discontinue ADHD medication within 5 years, according to a new study.¹

Discontinuation of ADHD medication is common. Patients may discontinue their ADHD medication due to unpleasant adverse events like decreased appetite, headaches, sleepiness, irritability, anxiety, insomnia, or mood changes.² About 80% of people who take stimulant ADHD medication experience decreased appetite.³ Other side effects can include making already present tics more noticeable, minor growth delay, upset stomach, and changes in blood pressure and heart rate. Or they may discontinue for other reasons—not understanding how medication helps ADHD, improper dosing, the medication not improving symptoms, and lack of insurance coverage.²

Meanwhile, discontinuing ADHD medication can cause a patient to become more fatigued during the day and to become extremely hungry. Energy levels often return to normal in a few days, but it could take a few weeks for appetite to return to normal.

Due to the lack of cross-national estimates of discontinuation, a new study wanted to determine the rate of ADHD medication discontinuation across the lifespan.1 Led by Isabell Brikell, PhD, from the department of global public health and primary care at University of Bergen in Bergen, Norway; the department of medical epidemiology and biostatistics at Karolinska Institutet in Stockholm, Sweden; and the department of biomedicine at Aarhus University from Aarhus, Denmark, the new retrospective, observational study pulled data from population-based databases. Databases came from Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, United Kingdom, and the United States.

The investigators selected prescription data to find new users of ADHD medication. Individuals were ≥ 3 years old who had started taking ADHD medication between 2010 – 2020. The investigators examined treatment discontinuation within 5 years of starting the medication.

The investigators stratified age groups as: children (4 – 11 years old), adolescents (12 – 17 years old), young adults (18 – 24 years old), and adults (≥ 25 years old). They also stratified by sex.

The study included 1,229,972 individuals, with 60% males (n = 735,503) and 40% females (n = 494,469) and a median age of 8 – 21 years old.

Young adults and adolescents had the highest rates of discontinuing ADHD medication after 1 – 5 years, while children had the lowest rates. Moreover, within a year of starting medication, only 65% (95% CI, 60 – 70) of children, 47% (95% CI, 43 – 51) of adolescents, 39% (95% CI, 36 – 42) of young adults, and 48% (95% CI, 44 – 52) of adults continued the treatment.

Young adults aged 18 – 19 years old had the highest rates of ADHD medication discontinuation. Also, more people were likely to continue treatment up to 5 years in countries who considered re-initiation of medication. After 5 years in most countries, 50 – 60% of children and 30 – 40% of adolescents and adults persisted treatment. The investigators noted similar findings for both males and females.

“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,” the investigators 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.”

^References

1. ^{Brikell I, Yao H, Li L, et al. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet Psychiatry. 2024;11(1):16-26. doi:10.1016/S2215-0366(23)00332-2}
2. ^{Stopping Medications When You Have Adult ADHD. Edge Foundation. https://edgefoundation.org/stopping-medications-when-you-have-adult-adhd/. Accessed January 2, 2024}
3. ^{ADHD Medication. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/11766-adhd-medication. Assessed January 2, 2024}