What considerations do you take in starting stimulant medications for the management of adult ADHD?

Adult stimulant prescriptions for ADHD and The Journal of the American College of Cardiology in particular have published several articles in the last few years investigating the cardiovascular risk of long-term use of these medications. There have been three already in 2024 and data remains mixed.

I have found this JACC topic of the week to be an incredibly helpful reference; Torres-Acosta et al., PMID 32792083.

In general, I try and discuss the risks and benefits of stimulant medications for adu...

In over 45 years of general psychiatric practice, I had many adults present thinking that they "had" ADHD. I agree with the idea that if ADHD symptoms, or reports of such symptoms, arise in an adult for the first time, it is not residual childhood ADHD. Nevertheless, some adults have a better quality of life if they can take CNS stimulants responsibly. (As we often find out, to our chagrin, many can't take them responsibly, just like with benzodiazepines). My practice, assuming the patient gave ...

Defer until PCP is clear.

First, be sure of the diagnosis for this adult, as others have commented. By definition, symptoms of ADHD must be present before 12 years of age. The most useful clinical information is the adult patient's elementary school report cards. Elementary school teachers see the child throughout the day rather than just 45 minutes as is the case with middle school and high school. The teacher has usually seen thousands of students of that age and sex, so they usually have a good idea of what is normal ...