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In 2004 the FDA approved the first stimulant for adult ADHD: Adderall XR. Now it’s nearly 20 years later, and some of those patients are elderly. Yet there are only a few studies of stimulants in people over age 50 ─ yes that’s the medical definition of elderly these days ─ and they are limited to case reports and patient surveys. [Link]

Published On: 7/15/2020

Duration: 2 minutes, 7 seconds

Transcript:

In 2004 the FDA approved the first stimulant for adult ADHD: Adderall XR. Now it’s nearly 20 years later, and some of those patients are elderly. Yet there are only a few studies of stimulants in people over age 50 ─ yes that’s the medical definition of elderly these days ─ and they are limited to case reports and patient surveys.

So today’s study adds significantly to our knowledge even though its methodology  ─  a retrospective chart review of 113 patients with ADHD 55 to 79 ─ isn’t level-1 evidence. Here’s what they found:

1. The doses were low. Most took methyphenidate (mean dose of 30mg a day), 10% on dextroamphetamine (mean 10mg/day)
2. The responses were good. 65% had better concentration, mood stability, sleep, and energy, and only 5% quite because the med didn’t work.
3. The side effects were fairly high: 1 in 3 quit the med due to problems with anxiety, depression, sleep.
4. Although 7% had cardiovascular symptoms that caused them to stop the med, on average there the stimulants did not raise blood pressure, even in the 30% with preexisting cardiac risk factors.

Bottom line: Stimulants can work in older adults, but they may have more side effects and need lower doses. Although we’re reassured about the cardiovascular risks with these patients, we’d need to see more than 113 patients to understand that.

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