Q: I’m a fairly healthy 52-year-old man. For many years, I’ve felt like I have ADHD. A recent work-up confirmed my suspicion. My doctor suggested I take Ritalin. Is that OK for the heart?
A:Although this condition has been identified in children for decades, there’s no reason to believe that it is limited to youngsters, or that ADHD symptoms simply disappear after adolescence.
Mental health professionals are seeing more and more adults, including many in their 40s, 50s, and even 60s, who have chronic difficulty with organization, have trouble remembering appointments or obligations, or feel fidgety or compelled to do things, as if they were driven by a motor. We are learning that ADHD in adulthood can contribute to tremendous occupational, personal and financial strain and loss.
Many adults can trace their symptoms back to childhood. Yet they seek help only later in life because they are no longer able to work around them — or work with them — because of a new job, a divorce or other stressors or changes.
Ritalin is one of the oldest medications used to treat ADHD. Although it is a stimulant, it has a calming effect on people with ADHD. It appears to work by stimulating specific areas in the brain that help people with this condition sit still, focus on tasks, and control impulses. Other stimulants used to treat ADHD include methylphenidate-type stimulants (Concerta, Ritalin LA, Daytrana, Focalin, Metadate) and amphetamine-type stimulants (Adderall, Dexedrine, Vyvanse). Atomoxetine (Strattera) is the first non-stimulant to receive FDA approval for treating ADHD. Note that while a number of medications have been shown to be effective in adults, at this time only Strattera, Focalin XR, and Adderall XR have specifically been approved by the FDA for treating adult ADHD.
While ADHD medications are generally well tolerated, they can mildly increase the heart rate and blood pressure. For healthy people, there is no evidence to date that this poses medical problems. In clinical trials of these medications with healthy adults, no serious cardiac events occurred and there were no worrisome changes on electrocardiograms. However, in older adults or those with high blood pressure, atherosclerosis or other cardiovascular conditions, small elevation in blood pressure or heart rate could increase the risk of cardiovascular trouble. The U.S. Food and Drug Administration has examined a small number of serious, even fatal cardiac problems associated with ADHD medications. In most — but not all — cases they occurred in people whose hearts already had structural problems or who had pre-existing cardiovascular disease.
From the evidence we have so far, these drugs appear to be safe and effective for people with generally healthy cardiovascular systems. So your doctor’s recommendation to take Ritalin is reasonable.
In addition to contemplating using a medication, look into behavioral or organizational strategies. These might include using a calendar, reminder notes or other props to keep on track, and creating a special place for keys, bills and other daily essentials. A therapist might also help you focus on other experiences or habits that contribute to the problem.
If you decide to begin an ADHD medication, you and your doctor should regularly monitor your heart rate and blood pressure once treatment has begun. Make sure you share this information with all of your health-care providers.
Dr. Paul G. Hammerness, assistant professor of psychiatry, Massachusetts General Hospital and Harvard Medical School.
