background In most children with ADHD, the disorder has a chronic course into adulthood, leading to continued symptoms and impairment through the lifespan. Treatment with stimulants and atomoxetine has been shown effective in controlled studies in both children and adults. Long-term efficacy and safety studies however are lacking. Based on the lifespan perspective of ADHD, questions have arisen about the impact of the disorder versus the impact of medication treatment in the long term.
aim To contribute to the discussion with the two speakers and the audience about longterm efficacy and safety of medications for ADHD in adults.
method Based on 17 years of clinical experience with the medical and psychological treatment of adults with adhd, comments and experiences will be shared.
results In clinical practice, adults with adhd respond in a similar favourable way to treatment with stimulants and atomoxetine. Based on the long-term follow-up of many individual patients with adhd, the efficacy of especially stimulants is maintained over time. When a patient complains about loss of efficacy of the medication, the medication usually is no longer taken in the right dose or at the right time(s). Concordance to prescribed medications for ADHD seems to be a bigger problem than the efficacy of the medication itself. Regarding the long-term safety of stimulants in adults, this is neither a big issue in clinical practice. From the start, the physician must check risk factors and (relative) contraindications for the medication and later on continue to monitor eventual side-effects, like increased blood pressure, or loss of weight. During adult life, other medical diseases may occur that can complicate continued treatment.
conclusion Decisions about extended treatment in adults with ADHD should be made on a case-by-case base, by the responsible clinician in communication with the patient.