Could ADHD drugs reduce the risk of early death? Unpacking the findings from a new Swedish study

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Attention-deficit hyperactivity disorder (ADHD) can have a considerable impact on the day-to-day functioning and overall wellbeing of people affected. It causes a variety of symptoms including difficulty focusing, impulsivity and hyperactivity.

For many, a diagnosis of ADHD, whether in childhood or adulthood, is life changing. It means finally having an explanation for these challenges, and opens up the opportunity for treatment, including medication.

Although ADHD medications can cause side effects, they generally improve symptoms for people with the disorder, and thereby can significantly boost quality of life.

Now a new study has found being treated for ADHD with medication reduces the risk of early death for people with the disorder. But what can we make of these findings?

A large study from Sweden

The study, published this week in JAMA (the prestigious journal of the American Medical Association), was a large cohort study of 148,578 people diagnosed with ADHD in Sweden. It included both adults and children.

In a cohort study, a group of people who share a common characteristic (in this case a diagnosis of ADHD) are followed over time to see how many develop a particular health outcome of interest (in this case the outcome was death).

For this study the researchers calculated the mortality rate over a two-year follow up period for those whose ADHD was treated with medication (a group of around 84,000 people) alongside those whose ADHD was not treated with medication (around 64,000 people). The team then determined if there were any differences between the two groups.

What did the results show?

The study found people who were diagnosed and treated for ADHD had a 19% reduced risk of death from any cause over the two years they were tracked, compared with those who were diagnosed but not treated.

In understanding this result, it’s important – and interesting – to look at the causes of death. The authors separately analysed deaths due to natural causes (physical medical conditions) and deaths due to unnatural causes (for example, unintentional injuries, suicide, or accidental poisonings).

The key result is that while no significant difference was seen between the two groups when examining natural causes of death, the authors found a significant difference for deaths due to unnatural causes.

So what’s going on?

Previous studies have suggested ADHD is associated with an increased risk of premature death from unnatural causes, such as injury and poisoning.

On a related note, earlier studies have also suggested taking ADHD medicines may reduce premature deaths. So while this is not the first study to suggest this association, the authors note previous studies addressing this link have generated mixed results and have had significant limitations.

In this new study, the authors suggest the reduction in deaths from unnatural causes could be because taking medication alleviates some of the ADHD symptoms responsible for poor outcomes – for example, improving impulse control and decision-making. They note this could reduce fatal accidents.

The authors cite a number of studies that support this hypothesis, including research showing ADHD medications may prevent the onset of mood, anxiety and substance use disorders, and lower the risk of accidents and criminality. All this could reasonably be expected to lower the rate of unnatural deaths.

Strengths and limitations

Scandinavian countries have well-maintained national registries that collect information on various aspects of citizens’ lives, including their health. This allows researchers to conduct excellent population-based studies.

Along with its robust study design and high-quality data, another strength of this study is its size. The large number of participants – almost 150,000 – gives us confidence the findings were not due to chance.

The fact this study examined both children and adults is another strength. Previous research relating to ADHD has often focused primarily on children.

One of the important limitations of this study acknowledged by the authors is that it was observational. Observational studies are where the researchers observe and analyse naturally occurring phenomena without intervening in the lives of the study participants (unlike randomised controlled trials).

The limitation in all observational research is the issue of confounding. This means we cannot be completely sure the differences between the two groups observed were not either partially or entirely due to some other factor apart from taking medication.

Specifically, it’s possible lifestyle factors or other ADHD treatments such as psychological counselling or social support may have influenced the mortality rates in the groups studied.

Another possible limitation is the relatively short follow-up period. What the results would show if participants were followed up for longer is an interesting question, and could be addressed in future research.

What are the implications?

Despite some limitations, this study adds to the evidence that diagnosis and treatment for ADHD can make a profound difference to people’s lives. As well as alleviating symptoms of the disorder, this study supports the idea ADHD medication reduces the risk of premature death.

Ultimately, this highlights the importance of diagnosing ADHD early so the appropriate treatment can be given. It also contributes to the body of evidence indicating the need to improve access to mental health care and support more broadly.The Conversation

Hassan Vally, Associate Professor, Epidemiology, Deakin University

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

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  • Older Americans Say They Feel Trapped in Medicare Advantage Plans

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    In 2016, Richard Timmins went to a free informational seminar to learn more about Medicare coverage.

    “I listened to the insurance agent and, basically, he really promoted Medicare Advantage,” Timmins said. The agent described less expensive and broader coverage offered by the plans, which are funded largely by the government but administered by private insurance companies.

    For Timmins, who is now 76, it made economic sense then to sign up. And his decision was great, for a while.

    Then, three years ago, he noticed a lesion on his right earlobe.

    “I have a family history of melanoma. And so, I was kind of tuned in to that and thinking about that,” Timmins said of the growth, which doctors later diagnosed as malignant melanoma. “It started to grow and started to become rather painful.”

    Timmins, though, discovered that his enrollment in a Premera Blue Cross Medicare Advantage plan would mean a limited network of doctors and the potential need for preapproval, or prior authorization, from the insurer before getting care. The experience, he said, made getting care more difficult, and now he wants to switch back to traditional, government-administered Medicare.

    But he can’t. And he’s not alone.

    “I have very little control over my actual medical care,” he said, adding that he now advises friends not to sign up for the private plans. “I think that people are not understanding what Medicare Advantage is all about.”

    Enrollment in Medicare Advantage plans has grown substantially in the past few decades, enticing more than half of all eligible people, primarily those 65 or older, with low premium costs and perks like dental and vision insurance. And as the private plans’ share of the Medicare patient pie has ballooned to 30.8 million people, so too have concerns about the insurers’ aggressive sales tactics and misleading coverage claims.

    Enrollees, like Timmins, who sign on when they are healthy can find themselves trapped as they grow older and sicker.

    “It’s one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing,” said Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.

    “But it’s when they actually need to use it for these bigger issues,” Huberty said, “that’s when people realize, ‘Oh no, this isn’t going to help me at all.’”

    Medicare pays private insurers a fixed amount per Medicare Advantage enrollee and in many cases also pays out bonuses, which the insurers can use to provide supplemental benefits. Huberty said those extra benefits work as an incentive to “get people to join the plan” but that the plans then “restrict the access to so many services and coverage for the bigger stuff.”

    David Meyers, assistant professor of health services, policy, and practice at the Brown University School of Public Health, analyzed a decade of Medicare Advantage enrollment and found that about 50% of beneficiaries — rural and urban — left their contract by the end of five years. Most of those enrollees switched to another Medicare Advantage plan rather than traditional Medicare.

    In the study, Meyers and his co-authors muse that switching plans could be a positive sign of a free marketplace but that it could also signal “unmeasured discontent” with Medicare Advantage.

    “The problem is that once you get into Medicare Advantage, if you have a couple of chronic conditions and you want to leave Medicare Advantage, even if Medicare Advantage isn’t meeting your needs, you might not have any ability to switch back to traditional Medicare,” Meyers said.

    Traditional Medicare can be too expensive for beneficiaries switching back from Medicare Advantage, he said. In traditional Medicare, enrollees pay a monthly premium and, after reaching a deductible, in most cases are expected to pay 20% of the cost of each nonhospital service or item they use. And there is no limit on how much an enrollee may have to pay as part of that 20% coinsurance if they end up using a lot of care, Meyers said.

    To limit what they spend out-of-pocket, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or a private Medigap policy. If they are low-income, Medicaid may provide that supplemental coverage.

    But, Meyers said, there’s a catch: While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or base their prices on medical underwriting.

    Only four states — Connecticut, Maine, Massachusetts, and New York — prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease.

    Paul Ginsburg is a former commissioner on the Medicare Payment Advisory Commission, also known as MedPAC. It’s a legislative branch agency that advises Congress on the Medicare program. He said the inability of enrollees to easily switch between Medicare Advantage and traditional Medicare during open enrollment periods is “a real concern in our system; it shouldn’t be that way.”

    The federal government offers specific enrollment periods every year for switching plans. During Medicare’s open enrollment period, from Oct. 15 to Dec. 7, enrollees can switch out of their private plans to traditional, government-administered Medicare.

    Medicare Advantage enrollees can also switch plans or transfer to traditional Medicare during another open enrollment period, from Jan. 1 to March 31.

    “There are a lot of people that say, ‘Hey, I’d love to come back, but I can’t get Medigap anymore, or I’ll have to just pay a lot more,’” said Ginsburg, who is now a professor of health policy at the University of Southern California.

    Timmins is one of those people. The retired veterinarian lives in a rural community on Whidbey Island just north of Seattle. It’s a rugged, idyllic landscape and a popular place for second homes, hiking, and the arts. But it’s also a bit remote.

    While it’s typically harder to find doctors in rural areas, Timmins said he believes his Premera Blue Cross plan made it more challenging to get care for a variety of reasons, including the difficulty of finding and getting in to see specialists.

    Nearly half of Medicare Advantage plan directories contained inaccurate information on what providers were available, according to the most recent federal review. Beginning in 2024, new or expanding Medicare Advantage plans must demonstrate compliance with federal network expectations or their applications could be denied.

    Amanda Lansford, a Premera Blue Cross spokesperson, declined to comment on Timmins’ case. She said the plan meets federal network adequacy requirements as well as travel time and distance standards “to ensure members are not experiencing undue burdens when seeking care.”

    Traditional Medicare allows beneficiaries to go to nearly any doctor or hospital in the U.S., and in most cases enrollees do not need approval to get services.

    Timmins, who recently finished immunotherapy, said he doesn’t think he would be approved for a Medigap policy, “because of my health issue.” And if he were to get into one, Timmins said, it would likely be too expensive.

    For now, Timmins said, he is staying with his Medicare Advantage plan.

    “I’m getting older. More stuff is going to happen.”

    There is also a chance, Timmins said, that his cancer could resurface: “I’m very aware of my mortality.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • Top Foods Against Neuroinflammation

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    Chronic inflammation is something you might feel in your joints, but it will usually be in the brain too. There, neuroinflammation can disrupt brain function, affecting stress responses, mood, cognition, and even alter brain structure. It’s also heavily implicated in the pathogenesis of various forms of dementia.

    What to do about it

    Dr. Tracey Marks, psychiatrist, bids us eat:

    1. Fatty fish: omega-3-rich fish like salmon reduce neuroinflammation.
    2. Leafy greens: spinach, kale, and collards protect brain cells and support neurotransmitter production.
    3. Berries: blueberries and strawberries improve memory and protect neurons.
    4. Nuts and seeds: walnuts, almonds, and flaxseeds support brain health and reduce inflammation.
    5. Turmeric: curcumin combats inflammation and supports neuron growth (best with supplements).
    6. Fermented foods: yogurt and sauerkraut improve gut health, benefiting the brain via the gut-brain axis; not just the vagus nerve, but also, remember that various neurotransmitters (including serotonin) are made in the gut.

    Of course, you should also avoid alcohol, nicotine, red meat, processed meat, and ideally also white flour products, and sugary foods (unless they are also rich in fiber, like whole fruit).

    For more on each of these, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    How to Prevent (or Reduce) Inflammation

    Take care!

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  • Metabolic Health Roadmap – by Brenda Wollenberg

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    The term “roadmap” is often used in informative books, but in this case, Wollenberg (a nutritionist with decades of experience) really does deliver what can very reasonably be described as a roadmap:

    She provides chapters in the form of legs of a journey [to better metabolic health], and those legs are broadly divided into an “information center” to deliver new information, a “rest stop” for reflection, “roadwork” to guide the reader through implementing the information we just learned, in a practical fashion, and finally “traveller assistance” to give additional support / resources, as well as any potential troubleshooting, etc.

    The information and guidance within are all based on very good science; a lot is what you will have read already about blood sugar management (generally the lynchpin of metabolic health in general), but there’s also a lot about leveraging epigenetics for our benefit, rather than being sabotaged by such.

    There’s a little guidance that falls outside of nutrition (sleep, exercise, etc), but for the most part, Wollenberg stays within her own field of expertise, nutrition.

    The style is idiosyncratic; it’s very clear that her goal is providing the promised roadmap, and not living up to any editor’s wish or publisher’s hope of living up to industry standard norms of book formatting. However, this pays off, because her delivery is clear and helpful while remaining personable and yet still bringing just as much actual science, and this makes for a very pleasant and informative read.

    Bottom line: if you’d like to improve your metabolic health, as well as get held-by-the-hand through your health-improvement journey by a charming guide, this is very much the book for you!

    Click here to check out the Metabolic Health Roadmap, and start taking steps!

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  • In Plain English…

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    It’s Q&A Time!

    This is the bit whereby each week, we respond to subscriber questions/requests/etc

    Have something you’d like to ask us, or ask us to look into? Hit reply to any of our emails, or use the feedback widget at the bottom, and a Real Human™ will be glad to read it!

    Q: Love to have someone research all the additives in our medicines, (risk of birth control and breast cancer) and what goes in all of our food and beverages. So much info out there, but there are so many variations, you never know who to believe.

    That’s a great idea! There are a lot of medicines and food and beverages out there, so that’s quite a broad brief, but! We could well do a breakdown of very common additives, and demystify them, sorting them into good/bad/neutral, e.g:

    • Ascorbic acid—Good! This is Vitamin C
    • Acetic acid—Neutral! This is vinegar
    • Acetylsalicylic acid—Good or Bad! This is aspirin (a painkiller and blood-thinning agent, can be good for you or can cause more problems than it solves, depending on your personal medical situation. If in doubt, check with your doctor)
    • Acesulfame K—Generally Neutral! This is a sweetener that the body can’t metabolize, so it’s also not a source of potassium (despite containing potassium) and will generally do nothing. Unless you have an allergy to it, which is rare but is a thing.
    • Sucralose—Neutral! This is technically a sugar (as is anything ending in -ose), but the body can’t metabolize it and processes it as a dietary fiber instead. We’d list it as good for that reason, but honestly, we doubt you’re eating enough sucralose to make a noticeable difference to your daily fiber intake.
    • Sucrose—Bad! This is just plain sugar

    Sometimes words that sound the same can ring alarm bells when they need not, for example there’s a big difference between:

    • Potassium iodide (a good source of potassium and iodine)
    • Potassium cyanide (the famous poison; 300mg will kill you; half that dose will probably kill you)
    • Cyanocobalamine (Vitamin B12)

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    While for legal reasons we cannot give medical advice, talking about common contraindications (e.g., it’s generally advised to not take this with that, as one will stop the other from working, etc) is definitely something we could do.

    For example! St. John’s Wort, very popular as a herbal mood-brightener, is on the list of contraindications for so many medications, including:

    • Antidepressants
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    Q: As I am a retired nurse, I am always interested in new medical technology and new ways of diagnosing. I have recently heard of using the eyes to diagnose Alzheimer’s. When I did some research I didn’t find too much. I am thinking the information may be too new or I wasn’t on the right sites.

    (this is in response to last week’s piece on lutein, eyes, and brain health)

    We’d readily bet that the diagnostic criteria has to do with recording low levels of lutein in the eye (discernible by a visual examination of macular pigment optical density), and relying on the correlation between this and incidence of Alzheimer’s, but we’ve not seen it as a hard diagnostic tool as yet either—we’ll do some digging and let you know what we find! In the meantime, we note that the Journal of Alzheimer’s Disease (which may be of interest to you, if you’re not already subscribed) is onto this:

    Read: Cognitive Function and Its Relationship with Macular Pigment Optical Density and Serum Concentrations of its Constituent Carotenoids

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    Q: As to specific health topics, I would love to see someone address all these Instagram ads targeted to women that claim “You only need to ‘balance your hormones’ to lose weight, get ripped, etc.” What does this mean? Which hormones are they all talking about? They all seem to be selling a workout program and/or supplements or something similar, as they are ads, after all. Is there any science behind this stuff or is it mostly hot air, as I suspect?

    Thank you for asking this, as your question prompted yesterday’s main feature, What Does “Balancing Your Hormones” Even Mean?

    That’s a great suggestion also about addressing ads (and goes for health-related things in general, not just hormonal stuff) and examining their claims, what they mean, how they work (if they work!), and what’s “technically true but may be misleading* cause confusion”

    *We don’t want companies to sue us, of course.

    Only, we’re going to need your help for this one, subscribers!

    See, here at 10almonds we practice what we preach. We limit screen time, we focus on our work when working, and simply put, we don’t see as many ads as our thousands of subscribers do. Also, ads tend to be targeted to the individual, and often vary from country to country, so chances are good that we’re not seeing the same ads that you’re seeing.

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    • Step 1: add our email address to your contacts list, if you haven’t already
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    • Step 3: Send the ad to us by email

    We’ll do the rest! Whenever we have enough ads to review, we’ll do a special on the topic.

    We will categorically not be able to do this without you, so please do join in—Many thanks in advance!

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  • Four Thousand Weeks – by Oliver Burkeman

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    This is not, strictly speaking, a time management book. It’s more a “contemplating mortality and making things count while still doing the necessaries”.

    Burkeman’s premise is that we get around 4,000 weeks of life, on average. If we live to 120, it’s more like 6,200. Unlucky souls may have to do the best they can with 1,000 or so.

    The book is thought-provoking; consider:

    1. how was your last week?
    2. how will your next week be?
    3. what if it were your last?

    Of course, we cannot necessarily liquidate all our assets and spend next week burning out in style, because then the following week comes. So, what’s the solution?

    That’s something Burkeman lays out over the course of the book, with key ideas including passion projects and figuring out what can be safely neglected, but there’s far more there than we could sum up here.

    Bottom line: if you ever find yourself struggling to balance what is expected of you with what is of value to you, this book can help you get the most out of your choices.

    Click here to check out Four Thousand Weeks, and make yours count!

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  • Life Is in the Transitions – by Bruce Feiler

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    Change happens. Sometimes, because we choose it. More often, we don’t get a choice.

    Our bodies change; with time, with illness, with accident or incident, or even, sometimes, with effort. People in our lives change; they come, they go, they get sick, they die. Our working lives change; we get a job, we lose a job, we change jobs, our jobs change, we retire.

    Whether we’re undergoing cancer treatment or a religious conversion, whether our families are growing or down to the last few standing, change is inescapable.

    Our author makes the case that on average, we each undergo at least 5 major “lifequakes”; changes that shake our lives to the core. Sometimes one will come along when we’ve barely got back on our feet from the previous—if we have at all.

    What, then, to do about this? We can’t stop change from occurring, and some changes aren’t easy to “roll with”. Feiler isn’t prescriptive about this, but rather, descriptive:

    By looking at the stories of hundreds of people he interviewed for this book, he looks at how people pivoted on the spot (or picked up the pieces!) and made the best of their situation—or didn’t.

    Bottom line: zooming out like this, looking at many people’s lives, can remind us that while we don’t get to choose what winds we get swept by, we at least get to choose how we set the sails. The examples of others, as this book gives, can help us make better decisions.

    Click here to check out Life Is In The Transitions, and get conscious about how you handle yours!

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