How stimulant treatment prevents serious outcomes of ADHD
July 23, 2019
Science Daily/Massachusetts General Hospital
An analysis of three previous studies of children and young adults with attention-deficit hyperactivity disorder (ADHD) quantifies for the first time the extent to which stimulant treatment reduces the development of mood disorders, school problems, conduct disorders, substance use disorders and other problems. The study led by Massachusetts General Hospital investigators is being published online in the Journal of Adolescent Health.
"Our study documents that early treatment with stimulant medication has very strong protective effects against the development of serious, ADHD-associated functional complications like mood and anxiety disorders, conduct and oppositional defiant disorder, addictions, driving impairments and academic failure," says Joseph Biederman, MD, chief of the Pediatric Psychopharmacology and Adult ADHD Program at MGH and MassGeneral Hospital for Children. "In quantifying the improvement seen with stimulant treatment, it measures its potency in mitigating specific functional outcomes."
Previous studies of stimulant treatment for ADHD have had limitations, such as only investigating outcomes in boys or not calculating the magnitude of the protective effects of treatment. The current study determined the number needed to treat (NNT) statistic, often used to show the effectiveness of an intervention. As the title indicates, NNT reflects the number of individuals receiving a medication or other treatment needed to prevent a specific unwanted outcome -- the lower the NNT, the more effective the treatment.
The investigators analyzed data from three separate studies they had previously published to calculate the NNT needed to prevent specific outcomes. Two of these were long-term, prospective studies of children with and without ADHD -- one of boys, one of girls -- some of those diagnosed with ADHD were treated with stimulants, some were not. The third study was a randomized, double blind study of young adults with ADHD that compared their performance on a driving simulation upon entering the study with their performance after six weeks of treatment with either a stimulant medication or a placebo. Participants in the long-term studies averaged age 11 upon study entry and 20 at follow-up, and the current investigation focused only on those with ADHD. Participants in the driving study were ages 18 to 26.
The NNTs for the outcomes of interest were found to be quite low:
· three participants with ADHD needed to be treated to prevent one from repeating a grade or developing conduct disorder, anxiety disorders or oppositional-defiant disorder.
· four participants with ADHD needed to be treated to prevent one from developing major depression or experiencing an accident during the driving simulation.
· five participants with ADHD needed to be treated to prevent one from developing bipolar disorder, six to prevent one from smoking cigarettes, and ten to prevent one from developing a substance use disorder.
Adjustments for the sex of participants and several other factors did not change the impact of treatment on those outcomes, except that the protection against substance use disorders was stronger in younger participants.
"Now we have the evidence allowing us to say that stimulant treatment of ADHD prevents the development of several very serious functional outcomes," says Biederman, a professor of Psychiatry at Harvard Medical School. "However, the impact on other serious outcomes -- such as post-traumatic stress disorder, traumatic brain injury, suicide risk and employment success -- still needs to be investigated." (is your team planning any such studies?)
https://www.sciencedaily.com/releases/2019/07/190723085959.htm
Lack of sleep could cause mood disorders in teens
December 6, 2017
Science Daily/American College of Neuropsychopharmacology
Chronic sleep deprivation -- which can involve staying up late, and waking up early for work or school -- has become a way of life for both kids and adults, especially with the increasing use of phones and tablets late into the night. But this social jet lag poses some serious health and mental health risks: new research finds that for teenagers, even a short period of sleep restriction could, over the long-term, raise their risk for depression and addiction.
University of Pittsburgh's Peter Franzen and Erika Forbes invited 35 participants, aged 11.5-15 years, into a sleep lab for two nights. Half the participants slept for 10 hours, while the other half slept only four hours. A week later, they came back to the lab for another two nights and adopted the opposite sleep schedule from their initial visit.
Each time they visited the lab, the participants underwent brain scans while playing a game that involved receiving monetary rewards of $10 and $1. At the end of each visit, the teens answered questions that measured their emotional functioning, as well as depression symptoms.
The researchers found that sleep deprivation affected the putamen, an area of the brain that plays a role in goal-based movements and learning from rewards. When participants were sleep-deprived and the reward in the game they played was larger, the putamen was less responsive. In the rested condition, the brain region didn't show any difference between high- and low-reward conditions.
Franzen and Forbes also found connections between sleep restriction and mood: after a night of restricted sleep, the participants who experienced less activation in the putamen also reported more symptoms of depression. This is consistent with findings, from a large literature of studies on depression and reward circuitry, that depression is characterized by less activity in the brain's reward system.
The results suggest that sleep deprivation in the tween and teen years may interfere with how the brain processes rewards, which could disrupt mood and put a person at risk of depression, as well as risk-taking behavior and addiction.
https://www.sciencedaily.com/releases/2017/12/171206090624.htm