Rates of attention-deficit/hyperactivity disorder (ADHD) medication use, particularly stimulants, have been rising in the United States, especially since the COVID-19 pandemic. Prescriptions for both stimulant and nonstimulant ADHD medications are surging.

This has prompted a renewed focus on the safety profiles of ADHD medications. Recent research shows that all common treatments result in slight increases in blood pressure and heart rate. However, experts caution that these effects should be considered alongside the significant benefits these medications provide.

Increased Blood Pressure and Heart Rate

A comprehensive analysis published in The Lancet Psychiatry found that ADHD medications could raise or lower blood pressure in patients.

Researchers analyzed data from more than 22,000 patients across 102 clinical trials, finding that stimulants and nonstimulants alike produced small cardiovascular changes.

The medications examined included stimulants such as amphetamines and nonstimulants such as atomoxetine (Axetra, Axepta, Attera, Tomoxetin, and Attentin), methylphenidate (Ritalin, Concerta, Delmosart, Equasym, Medikinet), and viloxazine (Qelbree), which are selective norepinephrine reuptake inhibitors.

They work by hindering the reuptake of norepinephrine in the brain, allowing more of it to remain available to enhance focus. However, the elevated norepinephrine levels may also increase sympathetic nervous system activity, which can raise blood pressure.

Among children and teens, systolic blood pressure rose by an average of 1.07 millimeters of mercury (mmHg) with atomoxetine, and by 1.81 mmHg with methylphenidate. In adults, increases ranged from 1.66 mmHg with methylphenidate to 2.3 mmHg with amphetamines.

Viloxazine and atomoxetine were also associated with higher pulse rates compared with placebo, with viloxazine linked to an increase of about 2.8 beats per minute and atomoxetine to an increase of 5.6 beats per minute.

While these increases aren’t concerning on their own, especially in the context of a normal blood pressure reading, people who already have high blood pressure may experience further risks from taking ADHD medications.

Guanfacine (Tenex, Intuniv) had the opposite effect. Since it can also be prescribed to reduce blood pressure, it lowered blood pressure and pulse rate in both groups, causing a drop of 2.83 mmHg in systolic blood pressure for children and a 10.10 mmHg decrease for adults.

Rather than increasing norepinephrine levels in the brain like other stimulants, guanfacine mimics norepinephrine by binding to the same receptors that norepinephrine would normally activate. This binding activates neurons to improve concentration. At the same time, the receptors that guanfacine binds to cause a relaxing of blood vessels, resulting in downstream blood pressure-reducing effects.

“Practitioners should monitor blood pressure and pulse in patients with ADHD treated with any pharmacological intervention, and not stimulants only,” the study authors advised.

ADHD medications can have side effects.

“The most common are decreased appetite and trouble falling asleep,” Dr. Cathryn A. Galanter, professor of psychiatry and division director of child and adolescent psychiatry at Stony Brook Medicine, told The Epoch Times. “Thus it is important to monitor eating, height, and weight if you take medication for ADHD.”

However, medication isn’t the only way to treat ADHD, experts said.

To best treat ADHD in a child or adolescent, the first step is a comprehensive assessment that involves interviewing the patient and parents and gathering information from teachers, Galanter said.

While medications have strong evidence of effectiveness, Galanter noted that several complementary approaches can also be beneficial.

Galanter said there may be situations in which it is preferable to start with behavioral therapy, for example, “with preschool children, or when a family would prefer to try behavioral therapy before medication.”

Less common adverse effects include mood changes, reduced growth, and in very rare cases, “heart symptoms such as feeling like [the] heart is pounding or passing out,” she said.

Balancing Medication and Behavioral Approaches

The most effective treatment for ADHD requires combining medication with behavioral strategies and support systems alongside lifestyle changes, Sanam Hafeez, neuropsychologist and director of Comprehend the Mind in New York City, told The Epoch Times.

“A multifaceted approach is required to treat ADHD because no single solution fits everyone’s needs,” she said, noting that stimulant medications such as Adderall and Ritalin often help many people improve their focus, impulse control, and executive functioning.

For those who prefer nonmedication approaches or experience intolerable side effects, Hafeez suggested several evidence-based alternatives. People can effectively manage their symptoms with nondrug approaches such as cognitive behavioral therapy (CBT), coaching, structured routines, mindfulness practices, and exercise.

“CBT stands as one of the most scientifically supported nonpharmacological treatments which enables people to learn coping mechanisms while enhancing time management skills and minimizing impulsive behaviors,” Hafeez said.

Kirsten Tretbar, psychotherapist at Tretbar Therapy in Kansas City, Missouri, uses CBT along with narrative therapy, which involves encouraging patients to find alternative narratives that emphasize finding the positives in their experiences.

“With CBT, we focus on changing those tricky thought patterns,” Tretbar said. “And with narrative therapy, we help people reframe their stories.”

She noted that ADHD can also be interpreted as having an extraordinary ability.

“I like to tell folks that ADHD isn’t just a struggle; it’s kind of like having a superpower,” Tretbar said. “Many of my clients with ADHD are also highly gifted or intelligent. They have the kind of brain that can hyperfocus on something, kind of like how a race car driver can tune everything out except for the track.”

For children younger than age 6, behavior therapy is often recommended before medication, and for older children, a combination of medication and behavior therapy is often used.

Waking Up the ADHD Brain

Tretbar noted that people with ADHD often experience difficulties with morning routines and self-regulation, which can be addressed through structured behavioral strategies and understanding.

“One thing I always share with families is how the ADHD brain often wakes up feeling like it’s still in a deep sleep,” Tretbar said.

She explained that it can take longer for an ADHD brain to “wake up” than a typical brain, so mornings can be rough times. This can lead people with ADHD to develop some interesting coping mechanisms, including picking fights to get themselves going.

“It’s not ideal,” Tretbar said. “But it’s their brain trying to get itself going.”

She described her firsthand experience learning this “the hard way” by living with her husband, who has ADHD.

“Now, we just laugh about it,” Tretbar said. “I’ll say, ‘You waking up your brain, honey?’ and he’ll shout, ‘Yep, just waking up my brain!’ It works. We laugh, and we go about our day. I don’t take it personally anymore, and he’s honestly less grumpy.”

She said some people may choose to adopt risky behavior to feel regulated, such as “jumping a ramp on a bike or doing something daring like rock climbing into a dark cave.”

“For ADHD folks, it can actually help wake up their brains,“ she said. ”It’s like an instant brain energizer.”

She pointed out that acknowledging the condition is an important step toward managing it.

“I always say, ‘Name it to tame it,’” Tretbar said, explaining that once you can name the problem, it loses some of its power and becomes much easier to discuss.

“When the whole family gets on board with understanding ADHD, it really is a game changer,” she said. “People start to adapt, and that’s when the real progress happens.”