The effects of stimulant and non-stimulant medications on the autonomic nervous system (ANS) functioning in people with ADHD: A systematic review and meta-analysis

Idrees, Iman; Bellato, Alessio; Cortese, Samuele; Groom, Madeleine J.

doi:10.1016/j.neubiorev.2022.104968

Cited by 10 publications

(3 citation statements)

References 136 publications

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“…AMPH has been safely used chronically in children and adults, including older adult populations, for more than 50 years; thus, our studies presented here may offer the potential for an important treatment option to preserve or improve cognition during aging (Christie et al., 2017 ; McMaster et al., 2018 ). However, AMPH's effects on the autonomic nervous system (Idrees et al., 2023 ) and particularly the cardiovascular system (Sassi et al., 2019 ) require that such an approach to age‐related cognitive decline be taken with regard to the cardiovascular condition of the recipient and also with regard to other drugs being used concurrently.…”

Section: Discussionmentioning

confidence: 99%

Restoration of norepinephrine release, cognitive performance, and dendritic spines by amphetamine in aged rat brain

Scognamiglio,

Aljohani,

Olson

et al. 2024

Aging Cell

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Age‐related dysfunctions in specific neurotransmitter systems likely play an important role in cognitive decline even in its most subtle forms. Therefore, preservation or improvement of cognition via augmentation of neurotransmission is a potential therapeutic strategy to prevent further cognitive deficits. Here we identified a particular neuronal vulnerability in the aged Fischer 344 rat brain, an animal model of neurocognitive aging. Specifically, we demonstrated a marked impairment in glutamate‐stimulated release of norepinephrine (NE) in the hippocampus and cerebral cortex of aged rats, and established that this release was mediated by N‐methyl‐D‐aspartate (NMDA) receptors. Further, we also demonstrated that this decrease in NE release is fully rescued by the psychostimulant drug amphetamine (AMPH). Moreover, we showed that AMPH increases dendritic spine maturation, and importantly shows preclinical efficacy in restoring memory deficits in the aged rat through its actions to potentiate NE neurotransmission at β‐adrenergic receptors. Taken together, our results suggest that deficits in glutamate‐stimulated release of NE may contribute to and possibly be a determinant of neuronal vulnerability underlying cognitive decline during aging, and that these deficits can be corrected with currently available drugs. Overall these studies suggest that repurposing of psychostimulants for age‐associated cognitive deficits is a potential avenue to delay or prevent cognitive decline and/or frank dementia later in life.

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Section: Discussionmentioning

confidence: 99%

Restoration of norepinephrine release, cognitive performance, and dendritic spines by amphetamine in aged rat brain

Scognamiglio,

Aljohani,

Olson

et al. 2024

Aging Cell

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“…This study examined a heterogeneous group of children and young adults. Other factors to consider include cognitive demands, the method of measurement or patient medication status (Idrees et al., 2023), which varied across studies. It is interesting to note that we found differences in pupil size when comparing participants with ADHD under medication with stimulants to those without medication, suggesting that stimulants may increase pupil diameter, which is in accordance with previous studies (Fainberg et al., 2022; Wainstein et al., 2017).…”

Section: Discussionmentioning

confidence: 99%

Impact of stimulant treatment on refractive errors and pupil diameter in attention deficit hyperactivity disorder

López‐Hernández,

Miquel‐López,

García‐Medina

et al. 2024

Acta Ophthalmologica

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PurposeThe relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake.MethodsA cohort of 100 participants, including 50 individuals with ADHD and 50 age‐ and sex‐matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non‐cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings.ResultsWe observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2(2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non‐cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049).ConclusionsOur study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter.

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“…Atomoxetine mainly acts as a highly selective norepinephrine reuptake inhibitor that inhibits the presynaptic norepinephrine transporter, thereby preventing the reuptake of norepinephrine throughout the brain 10 11. Comparing between methylphenidate and atomoxetine, Idrees et al in their review found that the ‘administration of stimulants, and to a lesser degree, non-stimulants, increased heart rate and blood pressure in people with ADHD’ 12. Nonetheless, from the data of 2 240 774 children with ADHD and 326 221 children with ASD, there was no evidence of increased serious cardiovascular risk in children and adolescents with ADHD or ASD exposed to ADHD medications 13…”

Section: Discussionmentioning

confidence: 99%

Methylphenidate-associated chest pain in a child

Masiran,

Ilias,

Yubbu

2023

BMJ Case Rep

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A young child was diagnosed with autism spectrum disorder with comorbid attention-deficit/hyperactivity disorder. His hyperactivity, impulsivity and absence of awareness towards danger increased his risk of harm and hence methylphenidate was indicated. Unfortunately, he developed chest pain eight months after the treatment initiation. We then stopped the stimulant and changed his treatment to atomoxetine, after which he no longer had chest pain. In the following illustrated case, we will discuss the cardiac side effect of methylphenidate.

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The effects of stimulant and non-stimulant medications on the autonomic nervous system (ANS) functioning in people with ADHD: A systematic review and meta-analysis

Cited by 10 publications

References 136 publications

Restoration of norepinephrine release, cognitive performance, and dendritic spines by amphetamine in aged rat brain

Restoration of norepinephrine release, cognitive performance, and dendritic spines by amphetamine in aged rat brain

Impact of stimulant treatment on refractive errors and pupil diameter in attention deficit hyperactivity disorder

Methylphenidate-associated chest pain in a child

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