The prescription of drugs to treat the deficit disorder of attention with or without hyperactivity (ADHD) progresses in France, between real benefits and fears of drifts around this disorder of neurode development long unknown in the country.
Known as Ritalin, methylphenidate, psychostimulant used to regulate it, saw its prescriptions jump by 154% in France between 2020 and 2024, according to the health insurance databases analyzed by AFP.
Classified in the drug category, these drugs stimulate the central nervous system by controlling the main symptoms of this disorder: attention deficit, hyperactivity and impulsivity.
For the teacher of child psychiatry Olivier Bonnot, who presided over a dedicated working group, at the High Authority for Health (HAS), “they are among the most effective drugs that exist”.
Better and better detected thanks to better recognition of neurodevelopmental disorders, ADHD would affect around 6% of the under 18 and 2.5% of adults worldwide, with symptoms that can vary throughout life.
“It is not like a virus that we catch or not, but rather as too high tension: when the symptoms reach a certain level, they must be treated,” said AFP the president of the World ADHD Federation, the American professor Stephen Faraone.
– “I live very well with” –
In the United States, where diagnostics and ADHD treatments are more frequent, votes have been raised to criticize an overly medicalized approach.
About half of the young (3-17 year olds) diagnosed were diagnosed received drug treatment in 2022, according to a national health survey of children, against 10% in France, according to the High Authority for Health.
“There was an amalgamation with the American situation which helped to demonize ritalin. Parents have been accused of driving up their children and some still suffer reflections from pharmacists,” said Claudine Casavecchia, president of the Hypersupers – TDAH France association.
But in recent years, the progression of screening, the reimbursement of the methylphenidate extended to the adult in 2022, and the need to improve care have lifted brakes.
Patients testify to the benefits of psychostimulants. Vanessa, a 51 -year -old teacher diagnosed in 2021, found “extraordinary to be able to watch a series without lifting every five minutes”. But she nuances: “It is not a miracle molecule”.
Alexandre (amended first name), 26, has taken concerta (another methylphenidate -based drug) from childhood. “I was not Bart Simpson to run everywhere, but just distracted, all the time lose my things,” he recalls. “The treatment helps me on a daily basis. I am followed by a psychiatrist, and I live very well with my ADHD,” says this young engineer.
Conversely, Thibault, 33, keeps a bad memory of the ritalin, taken around the age of eight: “I had the impression of being under a bell, as a sedated”. “It was the war, I calated the cachet against my cheek so as not to swallow it. My mother watched me until I swallowed,” he said.
– New molecule –
Loss of appetite, sleep disorders, mood, slight growth delay, headache …: “generally mild”, side effects “can be set by changing the dose or medication”, according to the World ADHD Federation, which is based on a consensus of international experts.
“The data are reassuring. In the long term, there is a slight increase in tension and heart rate, it is to be watched,” said Sébastien Weibel, psychiatrist at the Strasbourg University Hospital.
Today, ADHD specialists are welcoming recent marketing in France of a new molecule, the lisdexampartamin – under the name of Xurta -, an amphetamine already sold elsewhere in Europe. Like ritalin, it acts on dopamine and noradrenaline, involved in motivation and learning, but via a different action mechanism.
“His arrival required a work of pedagogy,” said Hugo Prunier, psychiatrist at the Vinatier, because “the word + amphetamine + is scary in France, with prejudices shared both by caregivers and patients”.
Especially since in the United States, other amphetamines -based drugs such as Adderall – prohibited in France – to treat ADHD, have been diverted from their therapeutic indication.
In this country, students can take ritalin or addrall to “stay awake and study” or in a festive framework, explains Professor Faraone, the president of the World ADHD Federation.
– Lack of data –
These products also arouse the fear of potential dependence, people with ADHD are more at risk of developing addictive behavior.
“Being well treated upstream can limit this risk thereafter, in particular by better managing the symptoms of impulsivity”, reassures Louise Carton, pharmacologist and psychiatrist-addictologist to the Lille University Hospital.
Little data exists in France on the misuse or the duration of the drug treatments of ADHD, long marginal, which most adolescents take for less than a year according to an international study. “Two years on average for the adult,” said Sébastien Weibel, who analyzed data from the Strasbourg CHU.
Most of the time, patients develop compensation strategies to live with this disorder in parallel, avoiding, for example, installing their desktop in front of a window, source of distraction, or by being repeated at the time of an examination.
“The supply of management widens and is enriched” in France, rejoices Eric Acquaviva, psychiatrist of the child and the adolescent at the Robert-Debré Hospital (AP-HP), with in particular alternatives to drug treatments, such as psychoeducation.
