{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T20:48:32Z","timestamp":1740170912515,"version":"3.37.3"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,18]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>In addition to the higher burden of mental health disease in the military, there is a compounding antecedent association between behavioral health comorbidities and the treatment of attention-deficit\/hyperactivity disorder (ADHD) in this population. Despite the low prevalence of new-onset ADHD in adults globally, the rate of stimulant (i.e., amphetamines) prescription is increasing. Stimulants can exacerbate mental health disease (often masquerading as ADHD symptomatology), precluding optimal treatment of the underlying etiology and imposing unnecessary dangerous side effects. This study aimed to evaluate the long-term safety and efficacy of stimulants for managing adult ADHD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A nine-member multidisciplinary team reviewed a PubMed search with the terms \u201cadult,\u201d \u201cADHD,\u201d and \u201cstimulant.\u201d Targeted PubMed and Google Scholar searches for \u201cadult ADHD\u201d paired with Food and Drug Administration -approved ADHD medications and Google Scholar literature using forward and reverse snowballing methods were performed for high-quality studies focusing on long-term treatment in ADHD. An evidence table and clinical algorithm were developed from the review.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 1,039 results, 50 articles were fully reviewed, consisting of 21 descriptive and experimental studies, 18 observational, and 11 systematic reviews and meta-analyses. Illustrative cases within the structured discussion of the results highlighted ADHD and psychiatric comorbidities, risks, harms, and benefits of stimulant use, medication mechanisms of action, and limitations of the current evidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The dearth of high-quality studies on long-term ADHD management in adults fails to establish a causal relationship between stimulant use and physiological harm. Despite mixed evidence supporting the benefit of stimulants, there is clear evidence regarding the risk of harm. The serious risks of stimulants include arrhythmias, myocardial infarction, stroke\/transient ischemic attack, sudden death, psychosis, and worsening of behavioral health disease. Additionally, there is a possible long-term risk of harm due to chronic sympathetic load (i.e., cardiovascular system remodeling). Stimulants pose a greater risk for addiction and abuse compared to other evidence-based nonstimulant medications that have similar effectiveness. Both stimulants and nonstimulants might promote favorable neuroanatomical changes for long-term improvement of ADHD symptoms, but nonstimulants (atomoxetine) have the pharmacological advantage of also mitigating the effects of sympathetic load (sympatholysis) and anxiety (anxiolysis). Given the physiological uncertainty of extended stimulant use for adults, especially older adults with vulnerable cardiovascular systems, clinicians should proceed cautiously when considering initiating or sustaining stimulant therapy. For long-term treatment of ADHD in adults, clinicians should consider nonstimulant alternatives (including behavioral therapy) due to the comparatively lower side effect risk and the possible additional benefit in patients with behavioral health comorbidities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Long-term safety of stimulant use for adults with ADHD is uncertain, as existing studies are limited in quality and duration. This is particularly important for military populations with higher rates of mental health conditions. Managing ADHD and related conditions requires prioritizing cardiovascular safety, especially for older adults. Nonstimulant options can be helpful, especially in comorbid psychiatric disease. Before treating ADHD, ruling out and controlling other behavioral health conditions is essential to avoid masking or worsening underlying issues and reducing unnecessary medication side effects.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad403","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T18:59:15Z","timestamp":1698260355000},"page":"e1343-e1352","source":"Crossref","is-referenced-by-count":0,"title":["Recommendation for\u00a0Long-term Management of\u00a0Adult Attention-Deficit\/Hyperactivity Disorder in\u00a0Military Populations, Veterans, and\u00a0Dependents: A Narrative Review"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5549-6697","authenticated-orcid":false,"given":"Derek J","family":"Baughman","sequence":"first","affiliation":[{"name":"Medical Director\u2014Primary Care, Barksdale AFB, 2nd Medical Group , Barksdale AFB, LA 71110,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Crista M","family":"Watson","sequence":"additional","affiliation":[{"name":"Physician Assistant\u2014Family Health, Barksdale AFB, 2nd Medical Group , Barksdale AFB, LA 71110,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan W","family":"Beich","sequence":"additional","affiliation":[{"name":"Psychiatrist\/MH Element Chief\u2014Behavioral Health, Barksdale AFB, 2nd Medical Group , Barksdale AFB, LA 71110,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"May N Joresa","family":"Herboso","sequence":"additional","affiliation":[{"name":"Aerospace Medical Technician\u2014Primary Care, Barksdale AFB, 2nd Medical Group , Barksdale AFB, LA 71110,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liana K","family":"Cuttie","sequence":"additional","affiliation":[{"name":"Nurse Practitioner, Family Health\u2014Primary Care, Barksdale AFB, 2nd Medical Group , Barksdale AFB, LA 71110,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari-Beth C","family":"Marlyne","sequence":"additional","affiliation":[{"name":"Chief of Medical Staff & Family Medicine Physician, Barksdale AFB, 2nd Medical Group , Barksdale AFB, LA 71110,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"issue":"1","key":"2025012315133976700_R1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-89700-8","article-title":"Global prevalence of\u00a0mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and\u00a0meta-analysis","volume":"11","author":"Nochaiwong","year":"2021","journal-title":"Sci Rep"},{"key":"2025012315133976700_R2","article-title":"Department of\u00a0Veterans Affairs Mental Health Services: Need, Usage, and\u00a0Access and\u00a0Barriers to Care","volume-title":"Evaluation of the Department of Veterans Affairs Mental Health Services","author":"National Academies of Sciences E, Division H and M, Services B on HC, Services C to E the D of VAMH","year":"2018"},{"issue":"2","key":"2025012315133976700_R3","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1176\/appi.ps.004792011","article-title":"Are Iraq and\u00a0Afghanistan veterans using mental health services? 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