The number of adults in Ontario who started taking stimulants, mainly to treat ADHD, more than doubled in the wake of the COVID-19 pandemic, according to a new study that found women were the most frequent new consumers of medications once taken mostly by hyperactive boys.
The research, published Monday in the Canadian Medical Association Journal, showed that more than 220,000 adults in Ontario filled a new prescription for a stimulant such as Vyvanse or Concerta in the four years after March, 2020, up from about 107,000 in the four years beforehand.
The study found new stimulant prescriptions plummeted immediately after COVID-19 emerged, when health care facilities all but shut down to non-COVID-19 patients, but rose soon thereafter.
The increase was driven primarily by women, who made up 59 per cent of new adult stimulant-takers in the period after the virus struck, compared to 48 per cent in the earlier period.
“We don’t often see this rapid of a growth in a drug class, especially one that has been around for so long,” said study author Mina Tadrous, a pharmacist and drug policy researcher at the University of Toronto. “We’re trying to raise the flag to say, ‘We need to look at this.’”
Stimulant prescriptions for ADHD up sharply since 2015, especially among women
The new CMAJ study is the latest to confirm a recent surge in prescriptions for drugs to treat attention deficit hyperactivity disorder in adults, particularly women. A study published in December in the journal JAMA Network Open drew on the same prescription data and found similar trends in Ontario, while researchers in the United States, Britain and some European countries have noted the same phenomenon.
Doctors and researchers are still trying to figure out what’s behind the rise in adult ADHD, said Daniel Myran, the research chair in family and community medicine at North York General Hospital and one of the authors of the December paper in JAMA Network Open.
Dr. Myran became interested in the subject when he noticed an uptick in young adults asking him for stimulant prescriptions after being diagnosed with ADHD at for-profit virtual care clinics.
The new CMAJ study found a sharp increase in the number of stimulant prescriptions initiated with a virtual visit after March of 2020. Twenty-nine per cent of new patients obtained their prescriptions that way after the arrival of COVID-19, compared to nearly zero beforehand, when telemedicine was rare in Canada.
“This can be done very quickly from the comfort of your home,” Dr. Myran said. “That can make it easier for someone who really has ADHD to get a diagnosis but can also lead to overdiagnosis.”
Overdiagnosis of ADHD is a concern, he added, because stimulants, which are central nervous system agents that improve attention, focus and energy, have side effects. Long-term use raises the risk of cardiovascular disease. In rare cases, stimulants can also provoke manic episodes if prescribed inappropriately to people with other types of mental illness.
ADHD content on TikTok is misinformed, could steer youth to self-diagnose, study finds
Some researchers hypothesize that living life on a screen during the pandemic led to a genuine increase in the incidence of the attention-deficit side of ADHD. Others suspect a flood of videos from influencers with ADHD on TikTok and other social-media sites raised awareness of the disorder.
Still others say clinicians have become better at recognizing ADHD in women who’ve had the disorder all their lives but masked it with good behaviour in school, setting them apart from the disruptive boys who are the stereotypical face of ADHD.
Emma Climie, a registered psychologist and associate professor at the University of Calgary, said some of the highest rates of new ADHD diagnoses are now occurring in women in their 30s and 40s.
She and her colleague Brandy Callahan, a registered psychologist and Canada Research Chair in adult clinical neuropsychology, are in the midst of a long-term study of adult women with ADHD.
Some women wake up to their ADHD symptoms when their children are diagnosed, Dr. Climie said, adding that ADHD has a genetic component.
For others, the coping strategies that worked in their youth break down under the pressures of demanding careers and young kids.
“They’re burned out, they’re exhausted,” Dr. Climie said. “They’re really struggling with, ‘Why does it look like everybody else has everything together? And I’m not able to do this.’”