Is the treatment with psychostimulants in children and adolescents with attention deficit hyperactivity disorder harmful for the dopaminergic system?

Abstract

A major concern regarding psychostimulant medication (amphetamine and methylphenidate) in the treatment of children and adolescents with attention deficit/hyperactivity disorder (ADHD) are the potential adverse effects to the developing brain, particularly in regard to dopaminergic brain function. The present review focuses on the pharmacology of these psychostimulants, their mode of action in the human brain and their potential neurotoxic effects to the developing brain in animals, particularly concerning DA brain function. The potential clinical significance of these findings for the treatment of ADHD in children and adolescents is discussed. Studies on sensitization to psychostimulants' rewarding effects, which is a process expected to increase the risk of substance abuse in humans, are not included. The available findings in non-human primates support the notion that the administration of amphetamine and methylphenidate with procedures simulating clinical treatment conditions does not lead to long-term adverse effects in regard to development, neurobiology or behaviour as related to the central dopaminergic system.

Response Inhibition and Interference Control in Obsessive–Compulsive Spectrum Disorders

“…Nevertheless, current evidence suggests that ADHD can be seen as a hypo dopaminergic disorder, whereas OCD, TTM, and TS can be regarded as hyper dopaminergic disorders (Buse et al, 2013). This is also consistent with the currently available pharmacological treatments, whose neurobiological mechanism is thought to rely on restoring dopamine to physiological levels (Abi-Dargham and Laruelle, 2005; Gerlach et al, 2013). Even SSRI’s and tricyclic antidepressants, the first line pharmacological treatment of OCD, may normalize dopamine levels by upregulation of serotonin signaling, that has an inhibitory effect on dopamine (Boureau and Dayan, 2010).…”

National time trend changes in psychotropic medication of child and adolescent psychiatric inpatients across Finland

“…In addition to short term side‐effects, there has been concern about potential adverse effects on the developing brain and dopaminergic brain function. Although available findings suggest that long‐term adverse of this kind are unlikely, the evidence is incomplete (Briars & Todd, ; Gerlach, Grumblatt, & Lange, ).…”

Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

“…In the case of methylphenidate, there is only retrospective evidence of effectiveness beyond two years of long-term use (Barbaresi et al, 2014), but prescription in clinical practice often extends beyond this duration. Long-term methylphenidate treatment has led to concerns about the risk of altering children's personality, but also about adverse effects on sleep, appetite and growth, as well as potential draw-backs regarding the nervous and cardiovascular systems (Gerlach et al, 2013;Germinario et al, 2013;Murray et al, 2013;Awudu and Besag, 2014; see ADDUCE project below). Lastly, these criticisms are often part of an ideological view centred around the concepts of ecology, sustainability, environmental concern and healthy natural remedies, ultimately purporting the damaging effects of anything "artificial" or "man-made"on human health.…”