Discontinuing medication for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, but not adults is associated with a small yet statistically significant decrease in quality of life, according to the results of a meta-analysis and systematic review published in the Journal of Clinical Psychiatry.
Functional impairments concerning interpersonal relationships, education, and occupational achievements, as well as quality of life, are common in patients with ADHD. However, there is limited evidence for the efficacy and safety of long term medication use in this population.
To determine the risk-benefit ratio of the long term use of ADHD medication, Noa Tsujii, MD, PhD, of the department of neuropsychiatry, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan, and colleagues used the PubMed, Cochrane Library, and Embase databases to identify studies that compared the outcomes of discontinuing versus continuing medication in patients with ADHD.
Overall, 9 studies were included in the analysis, with 5 studies focusing on children and adolescents (n=1126 children aged 6 to 17 years) and 4 on adults (n=708 adults aged 18 to 65 years). Whereas 5 studies evaluated quality of life, all 9 studies measured relapse. In 5 studies included in the meta-analysis, patients received stimulants, whereas in the other 4 studies patients received nonstimulants such as atomoxetine and guanfacine.
The investigators found greater quality of life decreases among those who discontinued ADHD medication compared with those who continued medication (standardized mean difference [SMD], 0.19; 95% CI, 0.08-0.30). Subgroup analysis showed that the SMD for children and adolescents with ADHD, who discontinued medication, compared with those who did not was 0.21 (95% CI, 0.06-0.36). In the adult subgroup analysis, the investigators found no significant difference between those discontinuing and those continuing medication (SMD, 0.02; 95% CI, -0.46 to 0.50).
In the subgroup analysis evaluating nonstimulants, decreases in quality of life were higher among those discontinuing medication compared with those who did not discontinue medication (SMD, 0.21; 95% CI, 0.10-0.32). However, a subgroup analysis restricted to stimulants could not be conducted because only 1 study investigated changes in quality of life with stimulants. The investigators observed a statistically significant relapse rate (2.85; 95% CI, 1.78-4.56) among those discontinuing medication for ADHD, which remained significant in subgroup analyses of both age groups.
Among the study limitations, the investigators noted the inability to do a meta-analysis on the stimulant subgroup regarding quality of life, the inability to explore potential publication bias as 10 studies are the minimum required to use a funnel plot, and the variability in the tools used to assess quality of life and symptom severity.
“After discontinuing medications, regularly assessing quality of life may support decisions regarding whether treatment should be resumed for patients with ADHD,” the researchers noted.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Tsujii N, Okada T, Usami M, et al. Effect of continuing and discontinuing medications on quality of life after symptomatic remission in attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. J Clin Psychiatry. 2020;81:3.