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Managing high blood pressure requires more than just getting a prescription; it means taking medication consistently, day after day, often for years. For people with ADHD, that kind of routine can be genuinely difficult. In our new study, published in BMC Medicine, we set out to understand just how much ADHD affects whether people stick with their blood pressure medication, and whether ADHD treatment itself might make a difference.
Why This Question Matters
Hypertension affects nearly a third of adults worldwide and is one of the leading drivers of heart disease and stroke. At the same time, ADHD, long thought of as a childhood disorder, affects around 2.5% of adults and is increasingly recognized as a risk factor for cardiovascular problems, including high blood pressure. Yet no large-scale study had ever examined whether having ADHD affects how well people follow through with their blood pressure treatment. We wanted to fill that gap.
What We Did
We analyzed health records from over 12 million adults across seven countries, Australia, Denmark, the Netherlands, Norway, Sweden, the UK, and the US, who had started antihypertensive (blood pressure-lowering) medication between 2010 and 2020. About 320,000 of them had ADHD. We tracked two things: whether they stopped their blood pressure medication entirely within five years, and whether they were taking it consistently enough (covering at least 80% of days) over one, two, and five years of follow-up.
What We Found
Across nearly all countries, adults with ADHD were more likely to stop their blood pressure medication and less likely to take it consistently. Overall, those with ADHD had about a 14% higher rate of discontinuing treatment within five years, and were 45% more likely to have poor adherence in the first year, a gap that widened to 64% by the five-year mark. These patterns were most pronounced in middle-aged and older adults.
Interestingly, young adults with ADHD were actually slightly less likely to discontinue treatment than their peers without ADHD, a finding we think may reflect the fact that younger people with ADHD are often more actively engaged with healthcare systems, especially given the cardiovascular monitoring that comes with ADHD medication use.
Perhaps the most encouraging finding was this: among people with ADHD who were also taking ADHD medication, adherence to blood pressure treatment was substantially better. Those on ADHD medication were about 38% less likely to have poor adherence at one year, and nearly 50% less likely at five years. While we can't establish causation from this type of study, one plausible explanation is that treating ADHD, reducing inattention and impulsivity, makes it easier to maintain the routines that consistent medication use requires. It's also possible that people on ADHD medication simply have more regular contact with healthcare providers, which keeps other health problems better monitored and managed.
What This Means in Practice
The core ADHD symptoms of inattention and poor organization are precisely the traits that make long-term medication adherence difficult. Add in the complexity of managing multiple disorders and medications, and it's easy to see why people with ADHD face extra challenges. Our findings suggest that clinicians treating adults with ADHD for cardiovascular disorders should be aware of these challenges and consider tailored support strategies, things like regular follow-up appointments, patient education, and tools that help with routine and organization.
There's also a broader message here about the potential ripple effects of treating ADHD well. Supporting someone in managing their ADHD may not just improve their attention and daily functioning; it may also help them take better care of their physical health, including disorders as serious as hypertension.
Future research should explore which specific support strategies are most effective, and whether these findings hold in lower- and middle-income countries where the data don't yet exist.
Yao H, Zhou Y, Li L, Gillies MB, Brikell I, Gao L, Wimberley T, Xie T, Zhang-James Y, Astrup A, Dalsgaard S, Semark BD, Engeland A, Faraone SV, Klungsøyr K, Larsson H, Man KKC, Snieder H, Wong ICK, Yuen ASC, Zoega H, Hartman C, Chang Z. ADHD and adherence to antihypertensive medication treatment: a multinational cohort study. BMC Med. 2026 Feb 20;24(1):122. doi: 10.1186/s12916-026-04714-1. PMID: 41721349; PMCID: PMC12930603.
With the growth of the Internet, we are flooded with information about attention deficit hyperactivity disorder from many sources, most of which aim to provide useful and compelling "facts" about the disorder. But, for the cautious reader, separating fact from opinion can be difficult when writers have not spelled out how they have come to decide that the information they present is factual.
My blog has several guidelines to reassure readers that the information they read about ADHD is up-to-date and dependable. They are as follows:
Nearly all the information presented is based on peer-reviewed publications in the scientific literature about ADHD. "Peer-reviewed" means that other scientists read the article and made suggestions for changes and approved that it was of sufficient quality for publication. I say "nearly all" because in some cases I've used books or other information published by colleagues who have a reputation for high-quality science.
When expressing certainty about putative facts, I am guided by the principles of evidence-based medicine, which recognizes that the degree to which we can be certain about the truth of scientific statements depends on several features of the scientific papers used to justify the statements, such as the number of studies available and the quality of the individual studies. For example, compare these two types of studies. One study gives drug X to 10 ADHD patients and reported that 7 improved. Another gave drug Y to 100 patients and a placebo to 100 other patients and used statistics to show that the rate of improvement was significantly greater in the drug-treated group. The second study is much better and much larger, so we should be more confident in its conclusions. The rules of evidence are fairly complex and can be viewed at the Oxford Center for Evidenced Based Medicine (OCEBM;http://www.cebm.net/).
The evidenced-based approach incorporates two types of information: a) the quality of the evidence and b) the magnitude of the treatment effect. The OCEBM levels of evidence quality are defined as follows (higher numbers are better:
Non-randomized, controlled studies. In these studies, the treatment group is compared to a group that receives a placebo treatment, which is a fake treatment not expected to work.
It is possible to have high-quality evidence proving that a treatment works but the treatment might not work very well. So it is important to consider the magnitude of the treatment effect, also called the "effect size" by statisticians. For ADHD, it is easiest to think about ranking treatments on a ten-point scale. The stimulant medications have a quality rating of 5 and also have the strongest magnitude of effect, about 9 or 10.Omega-3 fatty acid supplementation 'works' with a quality rating of 5, but the score for the magnitude of the effect is only 2, so it doesn't work very well. We have to take into account patient or parent preferences, comorbid conditions, prior response to treatment, and other issues when choosing a treatment for a specific patient, but we can only use an evidence-based approach when deciding which treatments are well-supported as helpful for a disorder.
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Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is commonly treated with stimulant medications such as methylphenidate and amphetamines. However, not all patients respond well to these stimulants or tolerate them effectively. For such cases, non-stimulant medications provide an alternative treatment approach.
Recent research by Brancati et al. reviews the efficacy and safety of non-stimulant medications for adult ADHD. Atomoxetine, a well-studied non-stimulant, has shown significant effectiveness in treating ADHD symptoms in adults. The review highlights the importance of considering dosage, treatment duration, safety, and the presence of psychiatric comorbidities when prescribing atomoxetine.
Additionally, certain antidepressants, including tricyclic compounds, bupropion, and viloxazine, which possess noradrenergic or dopaminergic properties, have demonstrated efficacy in managing adult ADHD. Antihypertensive medications, especially guanfacine, have also been found effective. Other medications like memantine, metadoxine, and mood stabilizers show promise, whereas treatments like galantamine, antipsychotics, and cannabinoids have not yielded positive results.
The expert opinion section of the review emphasizes that while clinical guidelines primarily recommend atomoxetine as a second-line treatment, several other non-stimulant options can be utilized to tailor treatments based on individual patient needs and comorbid conditions. Despite these advancements, the authors call for further research to develop and refine more personalized treatment strategies for adults with ADHD.
This review underscores the growing landscape of non-stimulant treatment options, offering hope for more personalized and effective management of ADHD in adults.
A Chinese research team performed two types of meta-analyses to compare the risk of suicide for ADHD patients taking ADHD medication as opposed to those not taking medication.
The first type of meta-analysis combined six large population studies with a total of over 4.7 million participants. These were located on three continents - Europe, Asia, and North America - and more specifically Sweden, England, Taiwan, and the United States.
The risk of suicide among those taking medication was found to be about a quarter less than for unmediated individuals, though the results were barely significant at the 95 percent confidence level (p = 0.49, just a sliver below the p = 0.5 cutoff point). There were no significant differences between males and females, except that looking only at males or females reduced sample size and made results non-significant.
Differentiating between patients receiving stimulant and non-stimulant medications produced divergent outcomes. A meta-analysis of four population studies covering almost 900,000 individuals found stimulant medications to be associated with a 28 percent reduced risk of suicide. On the other hand, a meta-analysis of three studies with over 62,000 individuals found no significant difference in suicide risk for non-stimulant medications. The benefit, therefore, seems limited to stimulant medication.
The second type of meta-analysis combined three within-individual studies with over 3.9 million persons in the United States, China, and Sweden. The risk of suicide among those taking medication was found to be almost a third less than for unmediated individuals, though the results were again barely significant at the 95 percent confidence level (p =0.49, just a sliver below the p = 0.5 cutoff point). Once again, there were no significant differences between males and females, except that looking only at males or females reduced the sample size and made results non-significant.
Differentiating between patients receiving stimulant and non-stimulant medications once again produced divergent outcomes. Meta-analysis of the same three studies found a 25 percent reduced risk of suicide among those taking stimulant medications. But as in the population studies, a meta-analysis of two studies with over 3.9 million persons found no reduction in risk among those taking non-stimulant medications.
A further meta-analysis of two studies with 3.9 million persons found no reduction in suicide risk among persons taking ADHD medications for 90 days or less, "revealing the importance of duration and adherence to medication in all individuals prescribed stimulants for ADHD."
The authors concluded, "exposure to non-stimulants is not associated with a higher risk of suicide attempts. However, a lower risk of suicide attempts was observed for stimulant drugs. However, the results must be interpreted with caution due to the evidence of heterogeneity ..."
The Background:
Over the past two decades, diagnostic rates for adult ADHD have roughly doubled, and stimulant prescriptions in the United States skyrocketed by more than 50% between 2012 and 2023, particularly among girls and women. While these medications help many individuals manage their symptoms, a landmark 2026 article published in European Neuropsychopharmacology tackles an important question that is rarely discussed: When should doctors and patients consider stopping them?
The Discussion:
To answer this, the American Society of Clinical Psychopharmacology (ASCP) gathered a task force of 45 international experts spanning 12 countries. Through a rigorous evaluation process, they reached an overwhelming agreement on a framework for "deprescribing", the planned, supervised reduction or cessation of a medication. Here are the core insights from these ground-breaking guidelines and what they mean for adults navigating long-term ADHD treatment.
When the Treatment Isn’t Yielding Benefits
One of the most straightforward reasons to consider stopping a stimulant is if it simply isn’t doing its job. The task force agreed that if a patient does not experience an optimal response, measured by actual symptom reduction, improved daily functioning, and a better quality of life, even after trying a high, optimized dose, it may be time to step back and look at alternative options.
Sometimes, the issue goes back to the initial evaluation. The criteria for diagnosing ADHD have expanded over the years, and brief psychiatric evaluations can occasionally lead to diagnostic inaccuracies. If a thorough reevaluation reveals that the original ADHD diagnosis was incorrect, the expert consensus is clear: stimulant deprescribing is appropriate unless another stimulant-responsive condition is evident. Furthermore, if a patient develops a persistent tolerance to the drug that cannot be resolved by safe dose adjustments, a temporary taper or drug holiday may be recommended.
When the Risks to Health Outweigh the Rewards
Our bodies and health needs naturally shift over time, meaning a medication that worked safely years ago might pose a threat to your health today. The experts concluded that deprescribing should be heavily considered if stimulants exacerbate a concurrent medical or psychiatric illness. For example, although rare, stimulants can unintentionally trigger mania or psychosis in adults with unstable or unrecognized comorbid bipolar disorder.
Physical health developments are equally critical. If an adult develops a newly arising or unstable cardiovascular condition, such as a cardiac arrhythmia, ischemia, or cardiomyopathy, the risk-benefit balance changes dramatically. Additionally, if severe side effects occur that cannot be managed by reducing the dosage, or if dangerous new drug-drug interactions emerge, stopping the medication under medical supervision protects the patient's long-term well-being.
Addressing Misuse and the Complex Role of Cannabis
Because stimulant medications target brain reward and wakefulness circuitry, they can foster a propensity for misuse. Studies indicate that more than 1 in 5 adults prescribed stimulants have misused them, and 1 in 6 have diverted their medication to others. The task force emphasizes that deprescribing is warranted if a patient persistently takes doses higher than prescribed against medical advice, uses the medication purely for unauthorized performance enhancement, or has an untreated, coexisting substance use disorder.
And what about cannabis? This topic sparked the most debate among the experts, falling just short of an official consensus with 71% agreement that regular cannabis use alone shouldn't automatically trigger a stimulant stoppage. Recognizing the complexity, such as how chronic cannabis use can overlap with ADHD executive function deficits, the task force proposed a structured monitoring approach instead of an immediate cutoff. Clinicians are encouraged to track the patient every 1 to 3 months using standardized symptom tools and random urine drug screens to verify whether cannabis use is actively neutralizing the stimulant's therapeutic benefits.
The Path Forward: Safe Tapering and Lifestyle Support
If you and your doctor decide that stopping a stimulant is the right path, it shouldn’t happen overnight. The task force strongly recommends that medications be gradually tapered off at a rate tailored to the individual to minimize potential disruptions and distinguish between transient withdrawal and a true return of ADHD symptoms.
Crucially, stopping a medication doesn't mean stopping treatment. The experts highlight that the success of any deprescribing plan is significantly enhanced when patients focus on optimizing modifiable lifestyle factors. Prioritizing sleep hygiene, staying physically active, and implementing structured behavioral strategies can support executive functioning and help sustain your cognitive gains even as the medication is reduced or eliminated.
The Takeaway:
The decision to continue or stop an ADHD medication is a deeply personal one that requires balancing real-world efficacy, safety, and individual health changes. These new consensus recommendations provide an essential roadmap to help adults navigate their long-term mental health journeys safely and effectively.
Are you or a loved one currently evaluating your long-term relationship with ADHD medication? Consider scheduling a check-in with your healthcare provider to discuss whether your current treatment plan still perfectly matches your health needs today.
Girls are diagnosed with ADHD at less than half the rate of boys, but this gap closes significantly by adulthood. ADHD also looks different in females than in males, with distinct patterns in symptoms, development, functional impairment, economic impact, and long-term outcomes. Despite this, sex differences in how ADHD relates to physical health have been poorly studied.
Prior research has established that both children and adults with ADHD face elevated risk for a range of physical health conditions. But that work has been hampered by small samples, retrospective designs, and limited population coverage.
The Study:
Denmark's single-payer national health system makes it possible to conduct truly population-wide research. This study drew on Danish national registers to follow more than 825,000 individuals, born between 1984 and 1995, from birth through adolescence and into young adulthood, tracking them across 13 categories of physical disease. Only individuals free of a relevant physical diagnosis at birth were included, and ADHD diagnosis was treated as something that could be acquired over time rather than a fixed characteristic.
The Results:
Across both sexes, people diagnosed with ADHD consistently showed higher disease risk than the general population, with cancer being the one notable exception. The absence of a meaningful cancer signal is expected, given that cancer predominantly affects older age groups than those captured in this study.
For most other disease categories (including infectious, endocrine, metabolic, respiratory, digestive, musculoskeletal, and genitourinary diseases), elevated risk emerged in early adolescence. For the remaining categories, elevated risk was present at all ages studied.
The magnitude of these risks was often substantial:
By early adulthood, individuals with ADHD showed at least 20% greater risk across every disease category except cancer, regardless of sex.
Sex Differences Shift With Age
One of the study's more nuanced findings concerns how sex interacts with ADHD diagnosis over time. In the general population, females tend to have higher physical disease risk from the teenage years onward, while males show higher risk in early childhood. ADHD diagnosis disrupted these patterns unevenly, amplifying risk in some groups and age windows more than others.
Perhaps most notably, the transition into young adulthood appeared to reduce the ADHD-associated gap between the sexes for endocrine, nutritional, and metabolic diseases (from a ninefold female-to-male disparity down to roughly 4.5-fold). The authors suggest this may reflect ADHD's influence on sex hormone activity during this developmental period.
Takeaway
This large, population-representative study confirms that an ADHD diagnosis is associated with meaningfully elevated risk across nearly all categories of physical disease, and that this relationship is neither uniform across sexes nor static across the lifespan. The findings underscore the need for sex-sensitive, developmentally informed approaches to the physical healthcare of people with ADHD.
Antidepressants are the primary drug treatment for depressive disorders, which affect 15–20% of pregnant women. They are among the most widely prescribed medications worldwide, and their use has increased in recent decades. Understanding their reproductive safety is critical to support informed, evidence-based prescribing during pregnancy.
A new meta-analysis sheds important light on one of the most debated concerns: whether children born to mothers who took antidepressants during pregnancy face a higher risk of ADHD.
The Study:
Pooling 14 studies covering more than 14 million participants, the analysis found that prenatal antidepressant exposure was associated with a 35% higher rate of ADHD in offspring compared to no exposure. A separate look at SSRIs (the most widely prescribed class of antidepressants, including Prozac and Zoloft) across 11 studies and over four million pregnancies found an even higher apparent risk (44%) after correcting for publication bias. On the surface, these are striking numbers.
Both associations came with an important caveat: enormous variation between individual studies, a statistical red flag suggesting the results may not reflect a true underlying effect. More tellingly, the apparent risk evaporated entirely when researchers applied a more rigorous method — comparing siblings within the same family, where one child was exposed to antidepressants in the womb, and another was not.
This sibling-comparison design is particularly powerful because it automatically controls for factors that run in families: shared genes, household environment, parenting, and socioeconomic conditions. When those influences are held constant, the link between antidepressant exposure and ADHD disappears. The same pattern held for SSRIs specifically.
Two other antidepressant classes, SNRIs (serotonin norepinephrine reuptake inhibitors) and tricyclics, showed no significant association in any analysis.
“Confounding by Indication”:
The probable driver of the initial association is what researchers call confounding by indication. The very condition being treated (depression) is itself a risk factor for ADHD in offspring, independently of any medication. Mothers with more severe depression are also more likely to be prescribed antidepressants, meaning the drug and the underlying illness are difficult to disentangle in standard analyses. Sibling studies cut through this problem cleanly.
The Take-Away:
The authors concluded that the association between antidepressants and ADHD risk was non-significant across all analyses designed to account for these confounding factors. This doesn’t mean antidepressants are without any reproductive considerations, but it does suggest that ADHD risk, at least, is driven by heritable and family-level factors rather than medication exposure itself.
For clinicians and patients weighing the risks of treating or not treating depression during pregnancy, this distinction matters considerably.
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