ADHD drug prescriptions have increased during the pandemic, CDC report finds

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According to a report released Thursday by the Centers for Disease Control and Prevention, prescriptions for attention-deficit/hyperactivity disorder drugs increased in the first year of the pandemic.

The jump in prescriptions came after several years of increases, dating back to 2016, according to the report. The trend coincides with rising rates of ADHD diagnoses among teens, adults, and women.

“This report shows that there is this growing population of adults who have been diagnosed with ADHD, and that there is a need for support for this population,” said the study’s lead author, Melissa Danielson, CDC statistician.

Pandemic pressure

In the report, researchers used insurance claims data to determine the number of stimulant prescriptions filled from 2016 to 2021 for people aged 5 to 64.

Three types of stimulants are approved for ADHD: amphetamine (Dexedrine, Adderall), methamphetamine (Desoxyn), and methylphenidate (Ritalin).

Overall, the percentage of people enrolled in employer-sponsored insurance plans who had a stimulant prescription filled fell from 3.6% in 2016 to 4.1% in 2021, but zooming in on some years and some age groups revealed much larger increases, particularly in prescriptions filled by adults in the first year of the pandemic. Patients who paid for their drugs out of pocket were not included in the data.

From 2020 to 2021, the number of stimulant prescriptions filled increased by more than 10% among women aged 15-44 and men aged 25-44. Among women aged 20 to 24, there was an increase of almost 20%.

Diagnoses for all mental health disorders have increased during the pandemic.

Joshua Langberg, an ADHD specialist and director of Rutgers University’s Center for Youth Social Emotional Wellness, said this may explain the further rise in teens and adults filling ADHD medication prescriptions during this time.

“People tend to seek diagnoses during times of stress and crisis, and we have anecdotal evidence that there has been a significant increase in the number of people seeking diagnoses during the pandemic,” Langberg said.

Increased access

Overall, stimulant prescriptions fell slightly among children, but increased among most adults, particularly among women, according to the report.

The exact reasons for the decline in children are unknown, said Danielson of the CDC.

One reason for the rise in stimulant prescriptions among teens and adults could be changes in the way ADHD is diagnosed. The Diagnostic and Statistical Manual of Mental Disorders, the set of guidelines used by professionals to diagnose mental health disorders, was updated in 2013 in response to a growing understanding of how ADHD can manifest differently according to the people.

One of the changes raised the eligibility age at which a person’s symptoms must have started, from 7 to 12 years old. In other words, people whose symptoms began at a later age would now be considered eligible for an ADHD diagnosis, Langberg said.

Symptoms fall into two categories, inattentive and hyperactive-impulsive, and include failure to follow instructions, failure to pay close attention to detail, frequent loss of things, and excessive talking.

Although the symptoms used to diagnose ADHD in children and adults are the same, adults need fewer symptoms to qualify, said J. Russell Ramsay, director of the ADHD Treatment and Research Program at adults at the Perelman School of Medicine at the University of Pennsylvania.

Pandemic-era changes that have allowed mental health care providers to see patients via telehealth have opened up the possibility for more people to access care. This included a change that allowed qualified practitioners to prescribe Schedule II stimulants – which includes stimulants approved for ADHD – via telehealth without first seeing a patient in person, which was previously prohibited.

“This increased access allowed some people who had flown under the radar, or who said they were doing quite well, to get help,” Ramsay said.

Increased awareness

In recent years, social media has fueled increased awareness of how signs of ADHD can occur differently in women and adults, which has likely prompted more people whose symptoms had been overlooked to seek a diagnosis. later in life, Ramsay said.

But increased awareness can be a double-edged sword. Viral memes or online videos can also lead to misdiagnoses.

“The benefit of awareness is that more women are being diagnosed. The downside is that people can see ADHD in themselves when it’s not there,” Ramsay said.

Many ADHD symptoms, such as trouble concentrating, are not unique to the disorder, which can further complicate an accurate diagnosis.

“Things like being distracted can be a symptom of anxiety, depression, schizophrenia, or even Lyme disease. You need more information,” Ramsay said.

The complexity of the disease has led to both overdiagnosis and underdiagnosis, Langberg said.

“A comprehensive ADHD assessment is time-consuming, can be expensive, and involves not only assessing ADHD, but also other things that can lead to concentration issues such as anxiety, depression, and lack of sleep,” he said, noting that providers don’t have the time, expertise or resources to perform comprehensive ADHD assessments for everyone who needs them.

Questionnaires can replace a full assessment in some cases, and some telehealth companies and pharmacies are being investigated for potential overprescription of stimulant medications for ADHD.

“Because ADHD occurs half the time with other mental health disorders, you need to make sure one of them isn’t causing ADHD symptoms,” said program director Dr. Lenard Adler. of ADHD for adults at NYU Langone. “You need to take a careful history.”

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