best adhd medication for adults with anxiety

His past medical history was unremarkable except for ADHD. After about 1-2 hours, he developed significant palpitations that were different in nature and lasted longer along with shortness of breath and lightheadedness without any chest pain, nausea, or diaphoresis.

However, that evening he also consumed four 16-ounce beers but denied any smoking or use of illicit drugs. On the day of presentation, he had taken mixed amphetamine salts 20 mg in the morning and later took 10 mg in the afternoon. He did not seek medical attention for these symptoms. He had been prescribed 20 mg of mixed amphetamine salts twice daily but three months back had cut back on his dose to 20 mg once a day, on account of intermittent self-limiting episodes of palpitations lasting 5–10 minutes. He restarted taking it 6 months prior to presentation as his symptoms were interfering with his daily activities. His starting dose of mixed amphetamine salts was 7.5 mg and he took it for 5 years after the diagnosis. He was diagnosed with ADHD at 15 years of age and was prescribed mixed amphetamine salts. Here, we discuss a rare case of AMI and atrial fibrillation in an adult who was on mixed amphetamine salts and briefly review pertinent literature.Ī 31-year-old Caucasian man presented to the emergency room with palpitations associated with shortness of breath and lightheadedness. AMI as well as atrial fibrillation has been previously reported in cases of recreational amphetamine abuse and also in adolescent ADHD patients on stimulant therapy. Scrutiny has recently increased, primarily due to marked increase in the use of CNS stimulants among adults. It is possible that, in adults on CNS stimulant therapy, chances of having other cardiovascular risk factors may increase with each passing decade of life. These individuals can be on a number of medications along with stimulant drugs effect of combination drug therapy on cardiovascular system has not been well studied. ADHD patients also have cooccurring psychiatric disorders, like anxiety (47%), mood disorder (38%), poor impulse control (20%), and substance use disorders (15%). Studies suggest that adult ADHD patients are more likely to experiment with licit and illicit substances, especially at earlier ages, and exhibit risky substance use patterns and subsequently develop substance use disorders. Īdults with ADHD are possibly at higher risk for developing unhealthy lifestyle and cardiovascular risk factors, such as smoking and obesity, and have a greater probability of chronic substance misuse. The knowledge of preexisting cardiovascular conditions did not significantly reduce the likelihood of stimulant treatment. Even in patients with preexisting cardiovascular conditions, close to 80% of all ADHD medications initiated were stimulants. In the study by Gerhard et al., 10.5% of adult ADHD patients had evidence of ≥1 preexisting cardiovascular condition. Approximately, 2% of American adults in 20–44 age groups were using stimulant medications for ADHD in 2010 which was a significant increase in use among both males and females (+188% and +265%, resp.) when compared to the prior decade. CNS stimulants act by inhibiting reuptake of norepinephrine and dopamine as well as increasing their release into the extracellular space. CNS stimulants, namely, amphetamine based stimulants, methylphenidate, dextromethamphetamine, dextromethylphenidate, and modafinil, are the first line of treatment for ADHD. It is seen in 4.4% (62% male, 38% female) of the US adult population. We present a unique case of AMI in an adult taking Adderall (mixed amphetamine salts) and briefly discuss the literature relevant to the cardiovascular safety of CNS stimulants for adult ADHD.Īdult ADHD affects an estimated 3% to 5% of adults worldwide. Cardiovascular response attributed to ADHD medication has mainly been observed in heart rate and blood pressure elevations, while less is known about the etiology of rare cardiovascular events like acute myocardial infarction (AMI), arrhythmia, and cardiomyopathy and its long-term sequelae. There has been increasing concern that adults with ADHD are at greater risk for developing adverse cardiovascular events such as sudden death, myocardial infarction, and stroke as compared to pediatric population. With the increase in number of adults on CNS stimulants, the question that arises is how well do we understand the long-term cardiovascular effects of these drugs. Central nervous system (CNS) stimulants are the first line of treatment for ADHD. Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobiological disorder exhibited by difficulty maintaining attention, as well as hyperactivity and impulsive behavior.

Best adhd medication for adults with anxiety