Alberto Ortiz Lobo
Doctor of Medicine and Psychiatrist at the Carlos III Day Hospital - La Paz University Hospital (Madrid)
This is a comprehensive review of the adverse cardiovascular effects (and not other harms) of drugs used in the treatment of ADHD and highlights several important issues.
The first is that the research reviewed has been conducted in the short term, i.e. we know about the harms of these drugs in a window of about seven weeks, whereas in standard treatment they are prescribed for years, sometimes for much of a person's life.
The second is that the studies do not focus on assessing the adverse effects of these drugs but on their possible efficacy, so they only measure increases in blood pressure and heart rate, but we do not know about their impact on cardiac conduction as assessed through electrocardiograms, for example.
The third issue is that all the drugs assessed, and not only stimulants, increase haemodynamic parameters, with the health risk that this may entail for many patients.
The review is pertinent because the diagnosis of ADHD is dramatically increasing in recent years, mainly in children, but also in adults. The only perspective offered on this problem is a cerebral one, without considering the environmental determinants that influence the fact that it is currently a fashionable diagnosis. Within this individual and biomedical understanding of problems, typical of our current Western culture, success and academic and occupational competitiveness are highly valued, so that lower performance or performance that does not adequately conform to current social norms can be interpreted as the result of a neurological disorder.
The extraordinary increase in the prescription of these drugs with cardiovascular side effects, which is proving so profitable for the pharmaceutical companies, should make us question the lightness of the diagnosis of ADHD and open the focus to the social, cultural, familial and academic context that is driving this phenomenon.