Nationwide trends in ADHD medication use during 2006-2022: a study from a Norwegian database – BMC Psychiatry

The prevalence and rate of ADHD medication use among Norwegians aged 6 to 64 increased fourfold from 2006 to 2022, mainly due to increases in women and older adults. . As a result, the prevalence rate for men and women decreased during that period and was close to 1 in 2022. This trend must be taken into account for the use of events among young people and older women , which was even higher for men at the end of the study period.

Patterns of ADHD medication use in children

Among 6- to 17-year-olds, there was a two-fold increase in prevalence and incidence of use during the study period. As shown earlier, the consumption level is stable in the middle of the study period (approx. 2010-2020). [9, 19]. However, since then, there has been a sharp increase in use among both boys and girls, especially from 2020 onwards, coinciding with the COVID-19 pandemic. In parallel, a report from the Norwegian Institute of Public Health shows an increase in the diagnosis of ADHD among children and adolescents, especially in the period from 2020 to 2022. [25]. The increase is most noticeable among teenage girls. Our findings are consistent with other Scandinavian studies reporting increased use of psychotropic drugs in children during this epidemic, particularly in 12- to 17-year-olds in Denmark. [26, 27].

The prevalence of use remained higher for boys compared to girls in 2022. However, the male-female prevalence ratio decreased from 3.2 to 2.0 during that period, defined by the incidence of girls aged 13 to 17 years. of boys at the end of the academic term. A similar trend has recently been observed in Finland [28]. A noticeable change in the male to female ratio indicates increased recognition and/or medication treatment of ADHD in girls.

Patterns of ADHD medication use in adults

Among adults aged 18 to 64, there was an eightfold increase in prevalence and a twofold increase in event use during that period, with the most pronounced increase in women and from 2020 onwards. While boys still show higher levels of ADHD medication use than girls, female adults aged 18-34 outnumbered males in terms of use and use at the end of the period. education.

As a result, older women make up an increasing proportion of all ADHD medication users in Norway, contributing to an overall prevalence rate for men and women aged 6-64 that was as close to 1 in 2022. Parallel, a report from the Norwegian Institute of Public Health on the mental health of adults shows an increase in the diagnosis of ADHD among Norwegian adults. [29]. The increase is most pronounced among young adults ages 18 to 27.

The observed pattern of increased use of ADHD medication in Norwegian adults is consistent with findings from the US, Germany and Australia [15, 30, 31]. In the United States, as in Norway, there has been a significant increase in the use of adult ADHD medications during the COVID-19 pandemic beginning in 2020.

The increase in incidence and widespread use may be due to increased awareness of ADHD and the subsequent need for ADHD medication in adulthood, particularly among women. A meta-analysis of longitudinal studies has shown that up to a third of childhood ADHD cases continue to meet full diagnostic criteria into their 20s, and that is about 65% continue to have symptoms of weakness. [32]. Other studies also show an increasing number of adults (and children) being diagnosed with ADHD. [18, 33]suggesting an increased need for patients to continue and/or initiate ADHD medication.

Another explanation could be that guidelines and diagnostic criteria have been changed in a way that encourages the diagnosis of ADHD in adults. The revised Norwegian guidelines for diagnosing and treating ADHD specifically recommend the use of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) in the diagnostic process, compared to earlier versions was a more flexible use of DSM-IV/V. and the International Classification of Diseases, 10th Revision (ICD-10) was adopted [2]. As summarized and argued by Epstein and Loren [34]changes to the DSM-V diagnostic criteria have made the ADHD criteria more applicable to adolescents and adults. For example, in DSM-V the age of onset of symptoms is required to be before the age of 12, compared to before the age of seven in the ICD-10 and DSM-IV. [35,36,37]making adult self-reporting of symptoms more appropriate. Thus, the observed increase in the use of ADHD medications in adults may reflect adaptation to new guidelines and diagnostic criteria for clinical trials.

The increasing use of ADHD medications – more new users or increased use time?

The prevalence of use can be explained by the increasing number of new users, and the longer duration of treatment once ADHD medication is started. The prevalence rate for the population aged 6-64 was relatively stable around 0.2 for most of the study period but increased to 0.25 at the end of the study period. Thus, by 2022 approximately 25% of the increase in ADHD drug use can be attributed to the addition of new users to widespread use, and this addition appears to remain constant over time. . On the other hand, the remaining 75% of the increase in the prevalence of use is due to the longer duration of treatment in patients who have already started using ADHD drugs. During the study period, other types of drugs were approved for use. In general, long-acting drugs are associated with longer treatment times than short-acting drugs [38]. A study by Karlstad et al. showed that the use of long-acting methylphenidate increased among adults during the period 2008 to 2011 compared to short-acting methods. [16]. It is possible that multiple treatments and medication use associated with continued improvement in substance use over time may also explain the increase in prevalence of overall ADHD medication use.

The prevalence-to-incidence ratio was higher in children aged 6-17 than in adults aged 18-64. Thus, young users accounted for a greater proportion of the prevalence of use in children than in adults, which may be a logical consequence of continuing treatment over time from childhood to adulthood. groups of adults.

Strengths and weaknesses

The study is based on data from a nationwide prescription register that covers the entire population of Norway, eliminating selection and recall bias. However, our results may slightly underestimate the use of ADHD drugs, as the NorPD does not include information on drugs prescribed to individuals in hospitals or institutions. This study examines ADHD medication use as a group and does not reveal information about specific ADHD drug use patterns. Additionally, the analyzes were based on prescriptions filled as proxies for ADHD medication use, and it is not known whether patients actually took the medication. No information was available on the indication of use. Furthermore, we do not know to what extent some of the increase in medication use was for other symptoms, such as sleepiness and/or excessive daytime sleepiness, since some stimulants Intermediates other than modafinil may be used for this purpose. [39]. However, due to the lack of this condition [40]we consider the impact of the results to be minimal.