WEBVTT - The world's largest study into ADHD meds

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<v Speaker 1>Already and this is the Daily This is the Daily

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<v Speaker 1>oas oh, now it makes sense. Good morning and welcome

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<v Speaker 1>to the Daily OS. It's Wednesday, the ninth of April.

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<v Speaker 1>I'm Emma Gillespie.

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<v Speaker 2>I'm Zara Zeidler.

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<v Speaker 1>A new study out this week has found the overall

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<v Speaker 1>benefits of taking ADHD medications outweigh the risks. The team

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<v Speaker 1>of international researchers involved in the study took a close

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<v Speaker 1>look at ADHD medications, both stimulant and non stimulants, and

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<v Speaker 1>it comes off the back of growing concerns around the

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<v Speaker 1>potential cardiovascular impact of these medications. In today's deep dive,

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<v Speaker 1>we're going to unpack these findings and take a closer

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<v Speaker 1>look at the world of ADHD treatment where things are

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<v Speaker 1>out here in Australia as well as around the world.

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<v Speaker 2>M I want to start by just providing a bit

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<v Speaker 2>of a lay of the land. We have heard a

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<v Speaker 2>lot about ADHD, both in the news, you know online.

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<v Speaker 2>Can you just give us a bit of an understanding

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<v Speaker 2>on what we need to know about ADHD?

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<v Speaker 1>Yep So, Attention deficit hyperactivity disorder ADHD is a neurodevelopmental

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<v Speaker 1>condition and other examples of neurodevelopmental conditions include things like autism,

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<v Speaker 1>spectrum disorder, dyslexia, motor disabilities like cerebral palsy. But what

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<v Speaker 1>a neurodevelopmental condition really means is that a person with

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<v Speaker 1>ADHD has a brain that has developed differently compared to

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<v Speaker 1>a neurotypical person's, and that's because of how their nervous

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<v Speaker 1>system has developed. So think of the nervous system like

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<v Speaker 1>a network of cables. It sends messages to and from

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<v Speaker 1>your brain to other parts of our body. A neurodevelopment

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<v Speaker 1>refers to how these networks are formed during early brain development.

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<v Speaker 1>When that development is disrupted, as it is for people

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<v Speaker 1>with ADHD, we see a whole range of impacts on

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<v Speaker 1>their daily lives, their ability to function, things like their

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<v Speaker 1>communication behavior, emotional regulation, fine motor skills, cognitive function. These

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<v Speaker 1>symptoms of ADHD do usually present in childhood, and that

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<v Speaker 1>can manifest in things like difficulty concentrating or controlling impulses.

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<v Speaker 1>But we do know it so much more than that.

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<v Speaker 1>Of course, people with ADHD can also be extremely creative.

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<v Speaker 1>They can be good problem solvers or extremely productive if

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<v Speaker 1>they're in a hyper focus.

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<v Speaker 3>So that's a very kind of top line ADHD.

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<v Speaker 2>One oh one for you, okay, brilliant, And so before

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<v Speaker 2>we deep dive into this study, I do think that

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<v Speaker 2>it would be helpful to understand more of that scale

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<v Speaker 2>point that I mentioned earlier. What are the numbers when

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<v Speaker 2>it comes to ADHD.

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<v Speaker 1>Yes, So there are around one point three million Australians

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<v Speaker 1>estimated to be impacted by ADHD.

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<v Speaker 3>That's about one in twenty of US.

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<v Speaker 1>But it is a really hard number to determine because

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<v Speaker 1>seeking a formal diagnosis is quite intense. It's a rigorous

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<v Speaker 1>process that requires a thorough behavioral assessment by a psychiatrist.

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<v Speaker 1>The irony being if you have ADHD, it might be

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<v Speaker 1>especially difficult for you to seek that evaluation. Not to

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<v Speaker 1>mention wait times and costs and things like that, but

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<v Speaker 1>in terms of how diagnoses have increased, we can track

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<v Speaker 1>that by looking at PBS data, so the Pharmaceutical Benefit Scheme,

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<v Speaker 1>and that tells us the number of people being prescribed

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<v Speaker 1>ADHD medications in Australia. So when we look at that data,

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<v Speaker 1>we can see the number of Aussies who are taking

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<v Speaker 1>medication to treat or manage the ADHD is around four

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<v Speaker 1>hundred and seventy thousand people. So that's about thirty six

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<v Speaker 1>percent of the population of people who have been diagnosed

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<v Speaker 1>with ADHD in Australia, so more than one in three.

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<v Speaker 1>But that figure has more than doubled in the five

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<v Speaker 1>years to twenty twenty two.

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<v Speaker 2>Interesting and what do we attribute that significant increase too.

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<v Speaker 1>Yes, so there are a range of issues and many

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<v Speaker 1>that will be debated. Medical experts though, have really emphasized

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<v Speaker 1>that more diagnoses should not be taken for an actual

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<v Speaker 1>increase in the prevalence of ADHD, but that this is

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<v Speaker 1>a jump in a kind of a correction of decades

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<v Speaker 1>of underdiagnoses, particularly of women. We know that the kind

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<v Speaker 1>of diagnostic criteria for ADHD was designed around men young

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<v Speaker 1>boys in particular, Women are socialized differently. There's a lot

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<v Speaker 1>of kind of reasons for that underdiagnoses. But in August

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<v Speaker 1>last year, the Australian Psychological Society President, doctor Katrina Davis

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<v Speaker 1>McCabe said, quote, there's not necessarily a large influx of

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<v Speaker 1>people who suddenly have ADHD, but there is an influx

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<v Speaker 1>of people who are willing to present, she said, largely

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<v Speaker 1>thanks to this growing awareness, including awareness online, but you

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<v Speaker 1>know also within medicine, within schools and education, less stigma

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<v Speaker 1>more conversation at a policy level. And also you know

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<v Speaker 1>the demands of modern society and how they can expose

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<v Speaker 1>impairments or can expose symptoms like ADHD.

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<v Speaker 2>And so we have more people who are being diagnosed

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<v Speaker 2>than ever before. What follows from a diagnosis we're talking

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<v Speaker 2>today about treatments. What can you tell us about some

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<v Speaker 2>of the treatments available to those who have ADHD.

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<v Speaker 1>So one treatment option is medication, and ADHD medications fall

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<v Speaker 1>into two categories, So there are stimulants and non stimulant medications,

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<v Speaker 1>and in most cases medication for ADHD is only prescribed

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<v Speaker 1>by psychiatrists, pediatricians and neurologists. Each state and territory in

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<v Speaker 1>Australia does have different laws about prescribing ADHD medicines, but

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<v Speaker 1>generally they are incredibly tightly regulated. So here in New

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<v Speaker 1>South Wales, for example, a specialist has to obtain approval

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<v Speaker 1>from this ste governments Ministry of Health to prescribe or

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<v Speaker 1>supply stimulants for ADHD treatment to an individual, and there

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<v Speaker 1>are also rules for pharmacies. In New South Wales they

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<v Speaker 1>can't dispense a script for a stimulant for someone with

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<v Speaker 1>ADHD unless that prescription shows an approval number issued by

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<v Speaker 1>New South Wales Health, so lots of checks and balances there.

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<v Speaker 1>I think it is important to note though, that when

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<v Speaker 1>we're talking about the levels of dosage for ADHD treatment,

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<v Speaker 1>there is no evidence that the use of stimulant medications

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<v Speaker 1>leads to substance abuse or dependency. But there have been

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<v Speaker 1>concerns about the safety of these medications surrounding their cardiovascular impacts,

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<v Speaker 1>and that's exactly what has prompted this study that we're

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<v Speaker 1>talking about today, which was led by the University of

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<v Speaker 1>Southampton in the UK AT handed down its findings this week.

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<v Speaker 2>So can you just explain a bit more about those

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<v Speaker 2>concerns that prompted the study. You said it was around

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<v Speaker 2>the cardiovascular health of the participants.

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<v Speaker 3>Yep.

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<v Speaker 1>The study notes that some ADHD medications stimulate the nervous system,

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<v Speaker 1>some ADHD medications work by slowing it, and so this

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<v Speaker 1>explains why some people will experience increases and decreases in

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<v Speaker 1>things like their blood pressure their heart rate after they

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<v Speaker 1>start taking treatment. So it's essentially those fluctuations in impulse

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<v Speaker 1>and blood pressure that have the medical world asking how

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<v Speaker 1>significant are those changes, what are the long term impacts

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<v Speaker 1>of those fluctuations. What does that all mean for a

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<v Speaker 1>person's health outcomes?

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<v Speaker 2>And just quickly you mentioned there that there are different

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<v Speaker 2>types of ADHD medications. Did this study specifically look at

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<v Speaker 2>one medication form of medication or did it look at

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<v Speaker 2>a range of them.

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<v Speaker 1>So one of the interesting aspects of this study is

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<v Speaker 1>that it was extremely comprehensive in that it studied the

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<v Speaker 1>effects of several ADHD medications, including a range of stimulants

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<v Speaker 1>like listex amphetamine and methyl fenodate are sold, for example,

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<v Speaker 1>under brand names like Vivance and Riddlin, and non stimulants

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<v Speaker 1>like atomoxetine and clonidine, which are sold under brand names

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<v Speaker 1>you might have heard like Sandos and Catapress. And so

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<v Speaker 1>what they did for this study is researchers analyzed data

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<v Speaker 1>from nearly twenty three thousand participants from around the world

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<v Speaker 1>from randomized controlled trials. Now, these are considered the most

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<v Speaker 1>rigorous type of clinical study because they assess medication effects

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<v Speaker 1>and compare the results of treated and non treated participants,

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<v Speaker 1>so placebo participants. Also, interestingly, among that twenty three thousand

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<v Speaker 1>participant number, nearly sixty percent were children and adolescents, and

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<v Speaker 1>there was a fairly even gender split, a range of

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<v Speaker 1>ages upwards of five years old, so a broad kind

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<v Speaker 1>of set of participants and researchers tracked changes to the

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<v Speaker 1>blood pressure and heart rate of these participants over a

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<v Speaker 1>one year period. So the data set looked at outcomes

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<v Speaker 1>around the twelve week, twenty six week, and fifty two

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<v Speaker 1>week mark after they had started ADHD medication. It's actually

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<v Speaker 1>the largest and most comprehensive analysis of its kind, and

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<v Speaker 1>it was funded by the British government's National Institute for

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<v Speaker 1>Health and Care Research.

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<v Speaker 2>I am really curious that it was a one year study.

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<v Speaker 2>I'd be really keen to understand, you know, whether they

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<v Speaker 2>will be continued tracking after that one year period, Yeah,

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<v Speaker 2>because perhaps some of the concerns might materialize after that

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<v Speaker 2>one year period.

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<v Speaker 3>Yeah.

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<v Speaker 1>And the study was really honest about a gap overall

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<v Speaker 1>in this field of research when it comes to long

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<v Speaker 1>term studies. So there are limitations on our overall understanding

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<v Speaker 1>of these long term cardiovascular effects because the studies don't exist,

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<v Speaker 1>The research doesn't exist. So this is one study, but

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<v Speaker 1>the authors of it have called for more funding to

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<v Speaker 1>facilitate that research to provide more important insights into the future.

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<v Speaker 3>But you know, in lieu of that we have these.

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<v Speaker 1>Findings from this comprehensive data set in the meantime, I suppose, so, do.

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<v Speaker 2>You want to just talk us through what those key

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<v Speaker 2>findings actually were.

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<v Speaker 3>Yes.

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<v Speaker 1>So the findings were published in the Lancet Psychiatry Journal,

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<v Speaker 1>and they show that quote all ADHD medications were generally

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<v Speaker 1>associated with overall small effects on blood pressure, heart rate,

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<v Speaker 1>and other cardiovascular parameters. Which isn't that surprising given that

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<v Speaker 1>we know there is this decrease or increase associated to

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<v Speaker 1>the nervous system from some of those medications that we

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<v Speaker 1>discussed earlier. But it found that for the majority of

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<v Speaker 1>children taking ADHD medications, researchers recorded a quote small increase

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<v Speaker 1>in blood pressure and pulse, which is an interesting finding

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<v Speaker 1>given concerns around young people taking these medications. There was

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<v Speaker 1>one exception, a medication called guanficine, which researchers found leads

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<v Speaker 1>to decreased blood pressure and heart rate, a more notable

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<v Speaker 1>fluctuation than any of the other medications in the study.

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<v Speaker 1>This one I've found really interesting as a finding. No

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<v Speaker 1>significant differences were found between stimulant and non stimulant types

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<v Speaker 1>of ADHD medications, so I think a lot of people

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<v Speaker 1>can feel a bit of a struggle or a battle

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<v Speaker 1>in determining what is the right medication for them stimulants

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<v Speaker 1>vers non stimulants, and so that.

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<v Speaker 2>Was in the specific concern around cardiovascular response.

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<v Speaker 1>Exactly yes, yep, so no significant difference between stimulants and

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<v Speaker 1>non stimulants, and overall research has said that the data

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<v Speaker 1>shows the benefits of taking ADHD medications outweigh the health risks. However,

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<v Speaker 1>researchers did say that practitioners should continue to monitor blood

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<v Speaker 1>pressure and pulse in patients that they are treating for ADHD.

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<v Speaker 2>It's really interesting, em and this study certainly ignited a

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<v Speaker 2>lot of conversation in our comment section, as this topic

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<v Speaker 2>generally tends to do. What has the response been to

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<v Speaker 2>these findings?

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<v Speaker 1>So the studies lead author, Professor Samuel Coortesi said that

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<v Speaker 1>this risk benefit ratio, this assessment that the benefits outweigh

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<v Speaker 1>the risks is reassuring for people taking ADHD medications, and

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<v Speaker 1>he also said that the findings should be particularly relevant

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<v Speaker 1>for practitioners, not just patients, because he said, there is

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<v Speaker 1>this group of practitioners who might assume that only stimulants

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<v Speaker 1>have a negative effect on the cardiovascular system, or who

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<v Speaker 1>might kind of have a preference between stimulants versus non stimulants,

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<v Speaker 1>or prejudices around those medications. But there is that gap

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<v Speaker 1>in long term studies that we talked about and the

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<v Speaker 1>limitations of that. The studies authors also have recommended that

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<v Speaker 1>people with heart conditions consult a cardiologist before starting ADHD medication.

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<v Speaker 1>So I think that's an important note. But before we

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<v Speaker 1>wrap up, when we're talking about the risk benefit ratio,

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<v Speaker 1>when we're talking about the benefits out weighing the health risks,

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<v Speaker 1>I think that everyone will have a different relationship to

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<v Speaker 1>what that benefit might look like.

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<v Speaker 3>But for some.

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<v Speaker 1>People taking ADHD medication might be the difference between holding

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<v Speaker 1>down a job or not, might be the difference between

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<v Speaker 1>showing up for the people that they care about or not,

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<v Speaker 1>or controlling their impulses if they have addiction or substance

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<v Speaker 1>abuse issues. I want to quote Royal Australian College of

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<v Speaker 1>General Practitioners President doctor Nicole Higgins, who in a statement

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<v Speaker 1>last year emphasized that there are many effective ADHD treatments.

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<v Speaker 1>It's not only about medication. She has ADHD herself and said, quote,

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<v Speaker 1>we all have brains that work differently and with the tools,

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<v Speaker 1>which may be medication or skills, training or counseling, people

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<v Speaker 1>develop ways of managing and coping as they talk about

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<v Speaker 1>their positive experiences. It takes away the shame, the stigma,

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<v Speaker 1>and fear around exploring, Okay, why is my brain a

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<v Speaker 1>little bit different? She said, You can't tell who has ADHD.

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<v Speaker 1>It could be the person next to you. It might

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<v Speaker 1>be your doctor, your tea, teach your child, your friend.

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<v Speaker 3>What works for one person might not work for another.

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<v Speaker 1>In essence, as always, if you have concerns, questions, queries

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<v Speaker 1>about ADHD medication, please please consult a health practitioner, a professional.

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<v Speaker 3>They will be able to steer you in the right direction.

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<v Speaker 2>M thank you for explaining that study the findings. It

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<v Speaker 2>is as you said, just the beginning. There is so

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<v Speaker 2>much research that needs to be done into this space,

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<v Speaker 2>so certainly one that I'm sure will be speaking a

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<v Speaker 2>lot about in the months and years to come. But

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<v Speaker 2>thank you so much, thank you, and thank you for

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<v Speaker 2>joining us for another episode of the Daily Ods. We'll

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<v Speaker 2>be back later today with the headlines, but until then,

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<v Speaker 2>have a great day.

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<v Speaker 3>My name is Lily Madden and I'm a proud Arunda

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<v Speaker 3>Bunje lung Chalcutin woman from Gadigol country. The Daily os

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<v Speaker 3>acknowledges that this podcast is recorded on the lands of

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<v Speaker 3>the Gadighl people and pays respect to all Aboriginal and

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<v Speaker 3>Torres Strain island and nations. We pay our respects to

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<v Speaker 3>the first peoples of these countries, both past and present