ADHD medications ‘relieve symptoms in the short-term’ but ‘do not improve quality of life’, major study finds
ADHD medicines work in the short term but don't improve the quality of life for adults, according to new research.
It also found talking therapies and brain stimulation are not as effective at treating symptoms as drugs.
Stimulants and another medication called atomoxetine appear to be the best treatment for managing symptoms of the condition, the study suggests.
Attention deficit hyperactivity disorder (ADHD) used to be a condition commonly associated with childhood.
However, health officials estimate that up to four per cent of the adult population in the UK have ADHD.
Several celebs, including I’m A Celebrity’s Ant McPartlin and singer Jessie J have spoken out about only being diagnosed as adults.
Read more on ADHD
The new study, published in The Lancet Psychiatry, pooled together all studies on treating ADHD in adults.
Experts from the University of Oxford and the University of Southampton examined 113 trials involving more than 14,800 people.
They wanted to assess how well symptoms were controlled 12 weeks after a person had started treatment based on both doctor and patient reports.
They found that stimulants, like Ritalin, are the only ADHD treatment in adults which reduces symptoms - but only in the short term.
Another type of drug - Atomoxetine - was also found to effectively reduce symptoms, according to both doctors and patients.
Unlike in kids and teens, the study found ADHD meds don’t boost the quality of life in adults.
People with ADHD can experience challenges in all areas of life, including work, personal relationships and mental wellbeing.
Doctors reported that talking therapies, "cognitive remediation", mindfulness, "psychoeducation", and transcranial direct current stimulation - or brain stimulation - were better than placebo.
However, types of treatments were not as effective as medicines.
The authors warned that ADHD medications are not well tolerated by everyone.
But they cautioned that their findings were based on averages, so for some people, these treatments may be beneficial.
Lead researcher Dr Edoardo Ostinelli, from the University of Oxford, said: "We focused on average effect sizes, average performance of interventions, and especially for pharmacological treatments.
"It could be of course, that specific individuals may prefer some treatment or non-pharmacological treatments, while some others may actually not benefit from them.";
The 9 'hidden' signs of ADHD in adults
ADHD has long been associated with naughty schoolkids who cannot sit still in class.
And that is part of it. Fidgeting, daydreaming and getting easily distracted are all symptoms of the behavioural condition, which is why it is often spotted in children.
However, attention deficit hyperactivity disorder is far more complex than simply having trouble focusing.
Henry Shelford, CEO and co-founder of ADHD UK, says: “If it isn’t debilitating, it isn’t ADHD.”
In recent years, social media has given rise to trends which conflate specific personality traits or single behaviours with ADHD.
You might be thinking, ‘I’m always losing my keys, forgetting birthdays and I can never concentrate at work — I must have ADHD’. But it’s not as simple as that.
Though these may all point to the condition, Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic, says: “The key distinction lies in how much a behaviour impacts a person’s daily life.
“Genuine ADHD symptoms affect multiple areas of life - work, relationships and emotional wellbeing - whereas personality traits are typically context-dependent and less disruptive.”
ADHD UK’s Henry, who has the condition himself, adds: “Having ADHD is hard. One in ten men with ADHD and one in four women with ADHD will at some point try to take their own lives.”
So how can ADHD manifest in someone’s life? While hyperactivity is a common indicator, here are nine other subtle signs:
- Time blindness - losing track of time, underestimating how long tasks will take, regularly being late or excessively early
- Lack of organisation - a messy home, frequently misplacing items, forgetting deadlines
- Hyperfocus - becoming deeply engrossed in activities for hours
- Procrastination - feeling overwhelmed by to-do lists and struggling to determine what needs your attention first so focusing on less important tasks
- Heightened emotions - emotional struggles can manifest in angry outbursts, feeling flooded with joy or shutting down because you feel too much at once
- Being a 'yes man' - agreeing to new projects at work or dinner dates with friends when you're already busy (a desire to please)
- Impatience - interrupting people mid-conversation, finding it painful to stand in a queue, being overly-chatty
- Restlessness - tapping, pacing, fidgeting or feeling restless on the inside
- Easily distracted - by external things, like noises, or internal things like thoughts
The study did not examine the effects of drugs and other treatments when taken as a combination, and did not examine long-term treatment.
But the authors of the review say their analysis is the "most comprehensive" available and should inform future treatment guidelines.
Dr Ostinelli added: "This network meta-analysis is a pivotal step toward optimising ADHD treatment strategies in adults.";
Commenting on the findings, Dr Hannah Kirk, a senior lecturer in the School of Psychological Sciences at Monash University, said: "While stimulants are the only intervention consistently reducing self-reported and clinician-reported ADHD symptoms in the short term, they fail to improve broader outcomes like quality of life.
"Adults with ADHD face challenges that extend beyond core symptoms, highlighting the need for treatments and trials that address functional and emotional well-being."
Rise in diagnoses
An estimated 2.6million people in the UK have ADHD, but that number is on the rise, particularly among adults.
Research by University College London found there was a 20-fold increase in diagnoses in UK adults between 2000 and 2018, and an almost 5,000 per cent rise in prescriptions for men aged 18 to 29.
Andrea Bilbow, chief executive of the National Attention Deficit Disorder Information and Support Service, said: "Here we are today, with a huge number of adults who slipped through the net as children and so I think what we're doing now is playing catch up as there's more awareness raising.
"And yes, social media has a role to play in raising awareness and adults suddenly realising, 'I think this is why I've struggled my whole life and I ought to go and find out if this is what's happening to me'.
"So that's, I think that's what accounts for the huge increase in diagnosis, not just in the UK, but worldwide."
Though some cases may be "misdiagnosed," other experts said.
The NHS in England defines ADHD as "a condition that affects people's behaviour, adding: "People with ADHD can seem restless, may have trouble concentrating and may act on impulse".
In adults, it can impact organization, time management, focus, stress management, and relationships.
ADHD medications include stimulants like methylphenidate (Ritalin), lisdexamfetamine (Elvanse), and dexamfetamine (Amfexa).
These boost brain activity to improve focus and reduce impulsivity.
Atomoxetine, a non-stimulant, increases noradrenaline to aid concentration and impulse control.
The authors stressed that their paper, the largest "network meta-analysis" of treatment for ADHD in adults, did not examine treatment in children.
A similar research project in children, published in 2017, found that medications were effective, but a combination of medication and "parent training behaviour intervention" was even more effective, they added.
'Hardly conclusive'
Commenting on the research, Dr Celso Arango from Hospital General Universitario Gregorio Maranon in Spain, said: "The analysis highlights a clear shortage of research on ADHD in adulthood, particularly regarding medium-term (beyond 12 weeks) and long-term treatment outcomes, consequently, the findings are applicable only to short-term treatment.
"The results suggest that pharmacological treatments are more efficacious than psychological or neurostimulatory interventions alone when compared to placebo, especially when assessed by patients themselves.
"However, in terms of acceptability, atomoxetine and guanfacine demonstrated less favourable profiles.
"One significant limitation is that the combined approach of pharmacological treatment plus psychological or other interventions was not assessed."
Professor Katya Rubia, from Kings College London, added: "It needs to be taken into account that far more studies were available for medication (63 studies) than for non-pharmacological treatments.
"For example, for neurostimulation, only 10 studies were included and on very heterogenous stimulation methods.