Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.

The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.

The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.

It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.

Why do people want cosmetic surgery?

Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.

The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.

The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.

The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.

People don’t always get the results they expect

Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.

However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.

People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.

What’s changing?

According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.

For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.

It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.

It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.

What about the mental health assessment?

The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.

According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.

While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.

So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.

Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.

Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.

Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.

In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.

If you’re considering cosmetic surgery

The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:

1. have an independent physical and mental health assessment before you commit to cosmetic surgery

2. make an informed decision knowing the risks

3. choose your practitioner, knowing their training and qualifications

4. discuss your care after your operation and where you can go for support.

My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.

Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.