On March 30th, 2015, Health Canada released an alert emblazoned with the headline “ADHD drugs may increase risk of suicidal thoughts and behaviours in some people; benefits still outweigh risks.” Since the release hit the newswires and the media outlets, our clinic has been contacted by patients and their families who are justifiably concerned and in some cases quite alarmed. I’d like to take a moment to do what I can, as a medical doctor and as a Child and Adolescent Psychiatrist specializing in the field of ADHD, to answer those questions and calm any fears you may have.
Let me state clearly and for the record, that Health Canada warnings are not a cause for panic. They’re meant to raise awareness of “possible” risks associated with medications, whether they be for ADHD, high blood pressure, or any other medical condition. They are meant to make patients aware so they can then better manage their condition with the help of their doctors and their families. In terms of ADHD specifically, however, this release gives us the opportunity to address and examine the important issues, facts and misconceptions surrounding ADHD treatments.
What they said…
The main points made in the Health Canada release address the increased possibility of a patient having suicidal thoughts when medication is started, when the dosage is changed, or when it is stopped all together. The warnings about suicidal ideation and mood swings, which until now had only applied to Strattera (atomoxetine), have now been applied to all ADHD medications.
Now, let’s break it down a bit, starting with the science…
There is no evidence that ADHD medications actually cause suicidal ideation…
While it’s important to note that there is no evidence that ADHD medications actually cause suicidal ideation, it should be mentioned that people with ADHD often suffer from co-existing conditions, like depression, which in turn can potentially increase the risk of suicidal thoughts.
In other cases, people with ADHD, especially with the hyperactive form, can at times act impulsively, and this can lead them to react to stress with suicidal behaviours. Furthermore, ADHD itself, especially when untreated, can cause low self-esteem and demoralization, also factors which can lead to suicidal thoughts and acts.
That being said, there are indeed cases where ADHD medications can increase depressed mood and cause restlessness; again, factors that can increase the risk of suicidal thoughts. For that reason, I believe the Health Canada warnings should be noted until the connection between ADHD and suicidal ideation is clarified. I think, however, that it’s just as important that these warnings not lead patients with ADHD to overlook medications as one of the safe and effective treatment options available to them.
The Health Canada release reinforces the need for close treatment of ADHD and demonstrates the seriousness of ADHD and its complications. The diagnosis and treatment of ADHD should only be performed by a medical specialist who is well acquainted with differentiating ADHD from other psychiatric and medical conditions; a professional who is familiar with both medical and non-medical treatments. Monitoring by a medical professional is especially important when medications are started or dosages are changed.
Having a support system in addition to a physician is also very important. Family, friends, teachers and coworkers play a key role in monitoring the patient’s day to day response to medications and being aware of potential side effects.
Ignoring ADHD can be potentially more dangerous…
While there are risks that go along with taking ADHD medications, untreated ADHD has its own potential consequences. Low self-esteem, reduced school and social performance, depression, and anxiety that can accompany ADHD can themselves be very dangerous to a person’s wellbeing.
It’s important to speak to a professional about all your treatment options. Medications offer a safe and effective treatment for many people. There are also a number of effective behavioural and educational strategies that should always be considered, whether used with medications or without. Therapists and coaches can help you or your child develop these strategies, leading to better coping skills when life stresses are encountered. The team members at Possibilities believe that an integrated, comprehensive approach to ADHD treatment is most effective.
We know you have many questions and this post only touches the surface. The Possibilities Clinic will soon be offering a public talk on these issues. Look here and on our social media pages for the announcement or click here and ask us to add you to our mailing list.