What’s driving demand for ADHD drugs like Adderall

For at least the past six months, Adderall – the stimulant drug commonly used to treat attention deficit/hyperactivity disorder (ADHD) –was in short supply In the United States, this seems to be partly due to the fact that demand increases as more and more people are diagnosed with ADHD, a condition that can make it difficult to concentrate, remember details, control impulses or stillness. In the United States, about 8% more people filled a prescription for stimulants in 2021 compared to 2020, according to federal data. Other studies suggest ADHD diagnoses are increasing in all age groups.

For what? And is this apparent spike in diagnoses cause for concern?

Some experts worry the rise reflects lax diagnostic standards during the COVID-19 pandemic and a growing tendency for people to be convinced they have ADHD because of the content they see on social media. But at the same time, some experts say the increase could be a long-awaited sign that people in historically undertreated groups for ADHD are getting the care they need.

“There is a risk of underdiagnosis and a risk of overdiagnosis,” says Dr. Lidia Zylowska, associate professor of psychiatry and behavioral sciences at the University of Minnesota School of Medicine and an expert in adult ADHD. . It is not yet clear which, if any, occurs with ADHD.

A perfect storm

According to federal estimates, approximately 10% of American children And 8% of American adults aged 18 to 44 have been diagnosed with ADHD in their lifetime.

ADHD diagnoses increased for decades, and some data suggests there has been a further increase since the start of the pandemic. A recent analysis from health records company Epic found that 0.6% of the millions of US patients in its database were diagnosed with ADHD in 2022, up from about 0.4% in 2019. An analysis by the research company on healthcare Trilliant Health also revealed that more adults aged 22 to 44 sought care for ADHD in 2021 compared to 2020, and that 15% more adults in this age group had an Adderall prescription in mid-2021 compared to a year earlier.

For some people, the pandemic may have been a tipping point between manageable concentration problems and ones that needed professional help, says Margaret Sibley, an associate professor at the University of Washington School of Medicine and an ADHD specialist. . Many people have been forced out of their normal work and school routines, stressed, sleeping less and scrolling through social media more—a perfect storm of distraction which may have exacerbated symptoms in some people.

The pandemic has also opened up new avenues for getting an ADHD diagnosis. Thanks to relaxed regulations on both telehealth and remote prescribing of controlled substances, it has become easier than ever to be diagnosed and treated online for ADHD. Many people have benefited from this increased access to care, but it has also raised concerns about overtreatment and overdiagnosis, especially when teletherapy startups began writing so many stimulant prescriptions that federal investigators have sounded the alarm. (Many teletherapy services have stopped prescribing stimulants like Adderall.)

ADHD content on social media has only added to concerns about overdiagnosis. Some startups offering remote ADHD care have advertised their services on platforms like TikTok, adding to a chorus of social media posts (much misleading, according to a 2022 study) on common signs of ADHD, such as forgetfulness and difficulty concentrating.

For some people, these videos led to proper diagnoses. But since almost everyone has experienced problems with concentration, memory or attention at some point, it’s easy to slip into a self-diagnosis that may not be correct, says Dr. Jessica Gold, assistant professor of psychiatry at Washington University School of Medicine. in Saint-Louis which has studied ADHD diagnostic trends. “It’s okay if you take this information to a doctor who feels comfortable analyzing it,” she says, but not all clinicians are familiar with ADHD detection.

To diagnose ADHD, clinicians usually rely on the patient’s description of their symptoms at different stages of their life, on reports from people they know, or, more rarely, on neuropsychiatric tests. Not all clinicians are properly trained to perform this assessment, which goes back to a long misunderstanding of what ADHD is and who it affects.

A misunderstood condition

“If you ask a person to close their eyes and picture someone with ADHD, I’d bet nine times out of 10 they’ll think of a little boy running through a classroom, making a lot of noise and squirming. getting into trouble,” says Julia Schechter, co-director of the Duke Center for Girls and Women with ADHD.

But the reality, says Schechter, is that people of all ages and genders suffer from ADHD. It’s just that girls and adults have always been missed.

While boys typically exhibit hyperactive symptoms of ADHD, including impulse control and excess energy, girls are more likely to exhibit internal symptoms, such as trouble concentrating or listening, which are more difficult to notice. Adults with ADHD can fall through the cracks for similar reasons, Zylowska says: Hyperactivity tends to improve as someone ages, but inattentiveness and other symptoms can persist.

Many mental health professionals aren’t comfortable diagnosing these issues, in some cases because they’re nervous about prescribing stimulant medications, Zylowska says. Stimulants can be abused and have potential side effects, including insomnia, loss of appetite, nausea, and headaches. They can also make anxiety worse, which is important because anxiety can accompany or be confused with ADHD, Gold notes.

Sibley says this is one of his main concerns about a potential misdiagnosis of ADHD: the possibility that people have other conditions that are missed. Many mental and physical conditions can lead to problems with concentration or behavior that resemble ADHD, and many clinicians aren’t ready to sort out the differences.

That’s partly because ADHD has received less research funding than other mental health conditions over the years, Sibley says, so clinicians simply know less about it. In 2022, the National Institutes of Health awarded $78 million for the ADHD study, versus $655 million for depression.

“Historically, adult psychiatrists have had no training in ADHD because for decades it was considered just a childhood disorder,” says Sibley. “They don’t even ask the right questions.”

That’s starting to change: Epic’s analysis found nearly twice as many women ages 23 to 49 received new ADHD diagnoses from 2020 to 2022, and diagnosis rates have also increased among girls during the last years. People of color are also diagnosed more often. These trends suggest that clinicians are getting better at detecting ADHD among more diverse patient groups, Schechter says.

For someone whose symptoms have been minimized or ignored for years, finally getting an accurate diagnosis can be a “life-changing experience,” Schechter says. “To find out that the difficulties they have had all their life are due to a biological condition is such a relief.”

In that regard, Sibley agrees, the rise in diagnoses can be a good thing, a signal that people are finally getting the care they need, but it’s hard to say for sure because it’s unclear how many people have been correctly versus inappropriately. diagnostic.

“It’s a weighing of the pros and cons,” she says. “Which is the lesser of two evils: misdiagnosing ADHD or missing someone who should be diagnosed with ADHD?”

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Write to Jamie Ducharme at [email protected].

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