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The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder

Peter Gallagher

Brian Moore

Department of Psychiatry, University of Newcastle upon Tyne, Newcastle upon Tyne, NE1 4LP, UK

Children who have taken psychostimulants long term for attention deficit/hyperactivity disorder (ADHD) are now presenting at adult psychiatry clinics at an age at which bipolar disorder and schizophrenia may first appear and at which pregnancy is a possibility. Doctors who may have little experience in the management of ADHD or use of psychostimulants are faced with decisions on whether to continue or withdraw medication. A literature search conducted to clarify these issues revealed that, although psychostimulants are generally efficacious in ADHD, the risks of withdrawal reactions and of possible long-term effects such as drug addiction, psychosis and depression, or effects in pregnancy, have not been adequately investigated. In particular, there is little information on the effects of withdrawal and no firm guidelines on methods of psychostimulant discontinuation. There is a need for further research to clarify the pharmacological issues involved in the drug treatment of ADHD and for overlapping arrangements between child and adult psychiatry clinics in the management of ADHD.

Key Words: attention deficit/hyperactivity disorder • ADHD • psychostimulants • methylphenidate • dexamfetamine • long-term effects • withdrawal

This version was published on September 1, 2006

Journal of Psychopharmacology, Vol. 20, No. 5, 602-610 (2006)
DOI: 10.1177/0269881106061710


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