The consumption of drugs for Attention Deficit Hyperactivity Disorder (ADHD) has skyrocketed in Europe since 2010. In Spain, for example, its use has almost doubled – reaching 0.42% of the population, more than 204,000 people – and it is one of the countries in which it has grown the least of the five studied in
The figures, however, remain low in the opinion of some of the leading specialists in the field. They are used by between 0.26% of citizens (in Germany) and 1.56% (in the Netherlands), when the prevalence of ADHD according to the criteria of the main clinical guidelines is between 2.5% and 8% of children and between 1% and 3% of adults. Meanwhile, other public health experts critical of these parameters warn of overmedicalization.
ADHD is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and/or impulsivity that significantly interferes with daily functioning or development. It begins in childhood, but
It is mainly treated with five drugs – methylphenidate, dexamphetamine, lisdexamfetamine, atomoxetine and guanfacine – which act by modulating the dopaminergic and noradrenergic systems of the brain, which improves sustained attention, self-regulation and impulse control, and reduces maladaptive behaviors.
Although the growth of this medication has been widespread in the countries studied, the patterns have varied greatly in each one. In the United Kingdom, where it has increased the most, its use has tripled since 2010 (but only reaches 0.39% of the population). The Netherlands has more than doubled consumption, which in Belgium is more moderate and has increased more slightly. Germany follows a more irregular pattern, with a rebound starting in 2017. Spain had rapid growth until the middle of the last decade and subsequent stabilization; in children aged 3 to 11 years has even decreased since 2015, which is also the case in the Netherlands.
From these data, Javier Quintero, professor of Psychiatry at the Complutense University of Madrid, concludes that ADHD is insufficiently treated. “It is clearly observed that there is still an important gap between the prevalence of the disorder and that of treated patients, which despite growing in striking numbers, does not even reach a fifth of real patients,” he emphasizes.
One of the findings of the research is the shift in consumption towards older ages. At the end of the study period, the use of ADHD medication in the 18-24 age group already exceeds that of younger children in the United Kingdom, the Netherlands and Spain. Among adults, growth is marked in all countries and particularly intense among women, with increases reaching more than 1,000%, although starting from very low figures at the beginning of the decade.
Although males continue to be the majority among minors who begin treatment, the gap between the sexes has been closing and, among adults, a change in pattern is already observed: in some countries there are more women than men who start medication in recent years, a change that points to a late recognition of female ADHD rather than a phenomenon exclusive to childhood.
The interpretation that Josep Antoni Ramos-Quiroga, head of the Psychiatry Service at the Vall d’Hebron University Hospital in Barcelona, makes of this is that for many years there have been people (especially women) who have not accessed the necessary treatment.
“Before, on many occasions they have received a lot of antidepressants, benzodiazepines. What does that mean? That they have not been diagnosed correctly, that they have been treated with other medications that they did not need, until reaching the appropriate diagnosis,” explains Ramos-Quiroga.
As with many psychiatric diseases, such as depression, there are no biological markers to detect ADHD. which includes standardized interviews and questionnaires to assess the impact of symptoms on the patient’s life, and can present with different intensity.
It is, for Ramos-Quiroga, a loss of opportunities for the patient: “ADHD is a very high risk factor for addictive behaviors: cocaine, cannabis, pathological gambling. If we treat it correctly, the risk is reduced, as several studies have shown. It shows how, if you correctly treat people who are in prison and who have committed criminal acts with these medications, the risk of relapse is between 30% and 40% lower.”
Both Quintero and Ramos-Quiroga, who have studied the syndrome in depth, are committed to greater visibility of the disorder, which improves its recognition to reach an “early diagnosis” and have complementary alternatives to pharmacological treatment for its effective approach, since medicalization is not necessary in all cases. But both, in line with the majority consensus in psychiatry, believe the drugs are not widespread enough.
Criticism of medicalization
At the other extreme, there is a current of psychiatrists and public health experts who believe that the standards used to diagnose ADHD classify this disorder as people who have it and who should not be treated with drugs.
Juan José Criado, doctor of medicine and specialist in public health, and Carme Romo, doctor of medical sciences and clinical psychologist, have analyzed the data from the study for EL PAÍS. The Lancet in which they conclude that overdiagnosis and overtreatment of the population are occurring.
“Many school failures and poor educational achievements are attempted to be resolved through medication.” […]. There is a tendency to label any behavior in everyday life: everything must have a diagnosis or a label. This favors the emergence, among influencers, opinion leaders and the media, of a category that encompasses multiple diagnoses, many of them difficult to define precisely. Underlying all of this is a medicalization of life,” they say.
Critics of these treatments believe that the clinical trials behind the drugs have a lot of weight from the pharmaceutical industry. There are many studies that show the improvement in the quality of life of the treated people, but some reviews, ―an independent international organization that prepares systematic reviews of scientific evidence to evaluate the effectiveness and safety of health interventions― relativize the positive effects of these pharmacological interventions and call for more research and caution with their use.
For Criado and Romo, the central challenge is not to stop the increase in consumption, but to guarantee that the treatment is “adequate, well evaluated, sustained over time and accompanied by psychosocial interventions, avoiding both undertreatment and excessive medicalization.”
