Prescribing trends of attention‐deficit hyperactivity disorder (ADHD) medications in UK primary care, 1995–2015

Abstract

AIMThe aim of the present study was to describe the prescription of medications for attention-deficit hyperactivity disorder (ADHD) in the UK between 1995 and 2015. METHODSUsing the Clinical Practice Research Datalink (CPRD), we defined a cohort of all patients aged 6-45 years, registered with a general practitioner between January 1995 and September 2015. All prescriptions of methylphenidate, dexamphetamine/lisdexamphetamine and atomoxetine were identified and annual prescription rates of ADHD were estimated using Poisson regression. RESULTSWithin a cohort of 7 432 735 patients, we identified 698 148 prescriptions of ADHD medications during 41 171 528 person-years of follow-up. Usage was relatively low until 2000, during which the prescription rate was 42.7 [95% confidence interval (CI) 20.9, 87.2] prescriptions per 10 000 persons, increasing to 394.4 (95% CI 296.7, 524.2) in 2015, corresponding to an almost 800% increase (rate ratio 8.87; 95% CI 7.10, 11.09). The increase was seen in all age groups and in both sexes but was steepest in boys aged 10-14 years. The prescription rate in males was almost five times that of females. Methylphenidate remained the most prescribed drug during the 20-year study period, representing 88.9% of all prescriptions in the 6-24-year-old group, and 63.5% of all prescriptions in adults (25-45 years of age). CONCLUSIONSPrescription rates of ADHD medications have increased dramatically in the past two decades. This may be due, at least in part, to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of those patients treated with medication. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children. WHAT THIS STUDY ADDS• Prescription rates of ADHD medications have increased dramatically in the UK in the past two decades, particularly in children and adolescents.• This increase is likely to relate to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of patients treated with medications. Longer duration of use of ADHD drugs, as well as more frequent off-label use, may also contribute to the increasing prescription rates. IntroductionAttention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in school-aged children, characterized by symptoms of inattention, impulsivity and hyperactivity [1]. Symptoms may persist beyond childhood and some individuals are not diagnosed with ADHD until adulthood [2].In the past few decades, an increased prevalence of ADHD and use of ADHD medications has been observed in several countries [3][4][5][6][7][8][9], including the UK [10], raising concerns about possible overdiagnosis and inappropriate prescription of ADHD medications. In this context, in July 2013 the National Institute for Health and Care Excellence (NICE) issued a reminder to avoid methylphenidate in children and young people with moderate...

Patterns and profiles of methylphenidate use both in children and adults

“…Since 2000, the dispensing of methylphenidate (MPH), a prescription stimulant medication commonly used in the treatment of attention deficit hyperactivity disorder (ADHD), has significantly increased worldwide in children and adults [1][2][3][4][5][6][7][8], the concern actually are for efficacy and safety of the long term use for all the users (principally for young people where MPH is authorized in ADHD; and the use for young children (<6 years) and adults for whom MPH isn't authorized (only for narcolepsy in adults). To established and assess the patterns of this increase, numerous studies have been performed across a wide range of countries, with the aim of estimating the prevalence of MPH use and associated factors (European countries [2,5,6,8,[10][11][12][15][16][17][18], United States [3,13,14], and Australia [14]).…”

Placental Complications Associated With Psychostimulant Use in Pregnancy

“…1–3 Despite increasing use, there are limited safety data on stimulant use in pregnancy. While discontinuing treatment may be a viable option for some, women with severe symptoms may benefit from continued use of stimulants during pregnancy since severe, untreated ADHD can result in anxiety and aggressive behaviors that can disrupt family relationships and newborn care.…”

Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st century

“…Several very large studies, for example, have now found that children relatively younger in age compared to their classmates (i.e., born later in the year) are at greater risk of being diagnosed with ADHD because the metric that teachers and parents judge them by is calibrated to children at slightly later stages of development (Caye et al, ; Karlstad, Furu, Stoltenberg, Håberg, & Bakken, ; Root et al, ). This provides clear evidence that this diagnosis, at least at times, pathologizes child behaviors that clearly fall within the normal spectrum, and that the skyrocketing use of powerful stimulants and other drugs to treat ADHD “symptoms” (Renoux, Shin, Dell'Aniello, Fergusson, & Suissa, ) requires a rethink.…”