Stimulant Drugs and the Risk of Death or Illness
(February 2006)
Update (January 2007): Click here for latest results on the safety and
effectiveness of stimulant drugs for preschoolers.
Recent reports linking stimulants to increased suicidal behaviour in depressed children have been greeted with alarm. Should we be concerned?
What problem is being addressed?
Stimulant medications (including Ritalin, Adderall, Concerta, Methalin and Metadate) have become widely prescribed as a treatment for psychiatric problems in children and youth. The efficacy of these drugs in treating Attention Deficit Hyperactivity Disorder (ADHD) has been particularly well documented.
As with all drugs, there are side effects associated with the use of stimulants, most commonly appetite suppression, which can lead to weight loss. Other side effects can include insomnia, elevated blood pressure, elevated heart rate, abnormal heart beat, tics and twitches, personality changes, loss of creativity and spontaneity, paranoia, headaches, nausea, and sedation.
What are the latest findings being reported?
In early 2006, a U.S. Food and Drug Administration (FDA) panel requested that labels on stimulant medications include a warning that patients on these medications should be closely monitored, and said it is reviewing safety data on the use of antidepressants in children.
The panel based its decision on an FDA report that found 25 children and adults who used stimulant medications for ADHD died suddenly during the years 1999 to 2003.
What is the real scientific evidence?
Between 1999 and 2003, there were 309 deaths of individuals taking stimulant drugs. Of these deaths, 25 showed strong evidence of a relationship to the medications. The deaths were attributed to disturbances occurring in the systems in the heart that keep it beating regularly or to enlargement of the heart due to inborn defects.
When you consider that more than 2 million children in the U.S. take stimulant drugs annually, 25 deaths in a 4-year period means that the risk for heart beat problems is extremely low. Moreover, some of the people who died had a history of heart disease or were taking other drugs, so it is difficult to sort out the real cause of their deaths. It is also important to understand that both children and adults can develop heart beat irregularities leading to death because of an inborn defect in the heart without ever having taken these or other drugs.
Should you stop taking stimulant medications?
The small risks of taking stimulant medications need to be weighed against the very real risk of the return of symptoms that cause serious family, school, and community consequences for the child.
Most doctors and researchers say the side effects of not taking the medications outweigh the risks of taking them, and they do not recommend that the drugs be withdrawn from the market, or even that a so-called “black box” warning, the highest level of caution, be issued.
You should notify your doctor if there is a family history of sudden death at a young age, if your child has a heart condition or you have reason to suspect one, or if the child taking the medication is involved in very strenuous sports. An electrocardiogram (EKG) should be taken on children whom physicians are considering prescribing stimulants, to rule out pre-existing electrical conduction problems in the heart.
And finally, as with all medications, patients should be carefully monitored and the medication adjusted, or discontinued altogether, should side effects warrant.
The preceding report was prepared using information from:
The American Academy of Pediatrics. Questions and Answers: Safety of Pills for Treating ADHD. Posted March 7, 2006 at http://www.aap.org/family/safetypillsadhd.htm
