Attention deficit
Against ADHD, “the drug is useful, but it does not do everything”
Do we prescribe too much ritalin? A study sheds new light on this recurring question. Update with doctor Nader Perroud, ADHD specialist.
When he prescribes a psychostimulant to the person with ADHD, the doctor should in any case propose educational approaches in parallel, underlines Nader Perroud.
Imago
- A study on Swedish data reveals that ADHD medication, such as ritalin, are associated with a decrease in problematic behavior such as involuntary injuries.
- However, the effectiveness of these treatments decreases with the increase in prescriptions. Study authors recommend more research on alternative or complementary treatments.
- In Switzerland, psychiatrist Nader Perroud recognizes the risk of overdiagnosis. But he points out that many patients have diagnostic and treatment deadlines, suggesting an urgent need to improve access to specialized care.
Do we too often prescribe drugs to treat ADHD, or attention deficit disorder with or without hyperactivity? A study on 247,420 Swedish patients (from 4 to 64 years old) under treatment between 2006 and 2020 sheds new light on this constant debate.
Published in “Jama Psychiatry”, she shows that, during this period, the ritual And other psychostimulants is associated with a reduction in self -control behavior, involuntary injuries, road accidents and crimes. However, the magnitude of these profits seems to be diminishing over time, while prescriptions are increasing.
Researchers suggest that this profits could be due to the expansion of the use of treatments to patients with less severe symptoms. They also point out that ADHD medication is associated with undesirable effects, such as loss of appetite, growth retardation or insomnia.
They therefore call for additional research to determine whether certain groups of patients would benefit more alternative or complementary treatments. They also recommend regularly reassess therapeutic guidance directives, in order to reflect the evolution of the patients’ profile.
Professor Nader Perroud, psychiatrist and psychotherapist at the HUG, judges this study “solid and interesting, because she shows that a treatment with a psychostimulant is beneficial if it is well prescribed”. This Swiss ADHD expert answers our questions.
Is there a risk of surprise of drugs for ADHD?
This risk will occur, it is inevitable. From the moment when interest is growing for a pathology that could explain learning or performance difficulties (for the child), this leads to assessment requests. Doctors could too easily diagnose this disorder and choose drug treatment to respond to difficulties that are more societal. But this phenomenon has already occurred, for example, when we have formed the general practitioners in antidepressants. They started to give them to the slightest depression, to the slightest anxious disorder, without this being justified by studies.
With ADHD, what is the situation?
THE prescriptions increase And that will continue, because we have a better knowledge of this disorder, which has never been taught in the faculties so far. Professionals are starting to consider it in their diagnoses. This better diffusion makes it possible to better detect cases, but we see the first signs of a surprise in certain regions. Conversely, there are real Medical deserts in Switzerlandwhere patients must wait until months before being taken care of by a specialist.
The study shows that with the generalization of prescriptions, the beneficial effect of psychostimulants decreases. Is it surprising?
No. Let us resume the example of antidepressants. Initially, they were prescribed to patients with major symptoms. The effects were important. They were then given to less affected people, and the results were lower. We noticed that it was better to recommend social contacts or a little exercise to them. We can bet we will see the same with ADHD.
What are the essential criteria for diagnosing ADHD and deciding on treatment? Are they respected?
The medical criteria have hardly changed for several decades and they seem good to me. They make it possible to assess whether a patient suffers from ADHD severe enough to affect him in his daily functioning. A doctor must follow these criteria, such as when he treats hypertension for example.
How to remedy the shortcomings?
We must train health professionals, make them aware of the application of these criteria. Otherwise, we risk wiping criticism. The problem is that in psychiatry, postgraduate teaching has been a disaster in recent years. This does not only concern ADHD. Other disorders have been left out, such as those of the autistic spectrum, because we focused on depression, burnout and anxious disorders. And all of this was fueled by pharmaceutical boxes that produce antidepressants or neuroleptics.
Do you fear that these errors slow down the management of patients who need such treatment?
Yes. Many people are struggling to benefit from adequate treatment. Some patients are waiting for three years if only to be assessed. Meanwhile, a psychiatrist will give medications that are useless. Neuroleptics, in particular, because they can be prescribed quite easily without it bothering politicians, even if their side effects are much more numerous than those of ritalin. Children end up in school failure, families explode, people lose their work … Three years later, they were told that we could have avoided it if they had been seen earlier. So, I do not deny that there is a risk of surprise. But in my daily life, these are the stories I see. And it’s sad.
How do we assess and communicate the side effects of drugs, especially in patients who are less seriously affected?
Any doctor is forced to announce the side effects of a treatment, whatever it is. According to international recommendations, we must first offer environmental developments if ADHD is not too severe. From a certain intensity, we do it in parallel with a drug treatment.
Are prescription recommendations up to date, or should they be improved?
I can hardly see how international recommendations should be improved. These prescriptions are already very monitored and I do not see too much the interest of adding constraints. In my opinion, the main problem is that these directives are poorly understood.
What are the alternative to drugsand have they proven their effectiveness?
Yes, studies show that skills teaching is quite effective, even if the effects are more important with a drug.
What is it?
We are going to teach the patient to put alarms so as not to forget anything, to spot distractors in the environment. We can help him observe his attention, notably using mindfulness meditation, or teach him strategies to go more easily in bed (people with ADHD often find it difficult to bed in the evening). There are other things, such as alternating pleasant and boring tasks or providing a small reward when you have finished important work. We will also help the patient to communicate with others, to prevent him from being too impulsive.
At this point, you will find additional external content. If you accept that cookies are placed by external suppliers and that personal data are transmitted to them, you must allow all cookies and directly display external content.
Is prescribing a medication sometimes a solution of ease?
The doctor should in any case offer these educational approaches to the patient who is starting to take a psychostimulant. At least he should help him observe how his behavior changes. In general, people are asking for such follow -up, but some practitioners do not necessarily have time. The problem is that if this psychoeducational work is not done, the person will find himself in difficulty. The drug is useful, but it doesn’t do everything.
Is the long-term effects of drugs for ADHD drugs sufficient?
We know that there are few side effects, apart from possible consequences on blood pressure, which must be monitored. On the other hand, we lack studies on the effectiveness of very long -term treatments. We see that it drops, which this publication seems to confirm. We would need thinner research to understand this phenomenon.
Did you find an error? Please report it to us.
