April 02, 2020
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Discontinuation of ADHD medications may decrease quality of life for children, adolescents

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Children and adolescents with ADHD who discontinued medication experienced a small but statistically significant decrease in quality of life, according to results of a systematic review and meta-analysis published in Journal of Clinical Psychiatry.

However, adults with ADHD who discontinued medication did not experience this decrease.

“Recently, the National Institute for Health and Care Excellence committee has considered that quality of life is one of the critical outcomes for evaluating the potential effects of discontinuing pharmacologic treatment for ADHD,” Noa Tsujii, MD, PhD, assistant professor in the department of neuropsychiatry at Kindai University in Japan, and colleagues wrote. “Thus, changes in quality of life could be an important outcome indicator in decisions regarding continuation or discontinuation of medications for individuals with ADHD, beyond changes in ADHD symptoms.”

Pharmacologic interventions benefit patients with severe ADHD, according to current clinical guidelines. Recommended medications for this patient population include nonstimulants and psychostimulants, with current literature showing limited safety and short-term efficacy of these medications for improving ADHD symptoms among pediatric, adolescent and adult patients. Research has shown that quality of life serves as a construct that relates to, but is distinct from, ADHD symptoms because improvement in symptoms correlates moderately, but not perfectly, with improvement in quality of life.

Tsujii and colleagues sought to compare the impact of continuing and discontinuing medications on quality of life of patients with ADHD. They searched three databases using generic terms for ADHD, pharmacotherapy, continuing, discontinuing and randomized controlled trials without language or date restrictions. They screened 3,672 studies, of which nine met the predefined inclusion criteria on patients with ADHD. Of these nine studies, the investigators included five in the meta-analysis because they measured quality of life and were randomized, double-blind, placebo-controlled withdrawal trials of ADHD medications. The included studies reported on 1,463 patients, of whom 894 were children and adolescents and 569 were adults.

Results showed that discontinuation of medications significantly worsened quality of life score among patients with ADHD (standardized mean difference [SMD] = 0.19; 95% CI, 0.08-0.3) compared with continuation. Further, discontinuation worsened this score among children and adolescents with ADHD (SMD = 0.21; 95% CI, 0.06-0.36) but not among adults with ADHD (SMD = 0.02; 95% CI, 0.46 to 0.5).

“Regular assessments regarding the overall quality of life after discontinuing medication may assist in making decisions regarding continuing the withdrawal or resumption of medications for patients with ADHD,” the researchers wrote. “We believe that our results will help clinicians in considering the potential risks and benefits of discontinuing medications and optimizing individualized treatments for patients with ADHD.” – by Joe Gramigna

Disclosures: Tsujii reports personal fees from GlaxoSmithKline, Janssen, Mitsubishi Tanabe, Otsuka, Shionogi, Sumitomo Dainippon, Takeda and Yoshitomi. Please see the study for all other authors’ relevant financial disclosures.