Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis
Objectives: This paper reviews the literature on intentional discontinuation of psychostimulants in ADHD to summarize what is known about clinical course of controlled discontinuation and guide practitioners who are considering stopping these medications for youth with ADHD.Methods: A systematic sea...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-04-01
|
| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2021.642798/full |
| _version_ | 1818724901856477184 |
|---|---|
| author | W. David Lohr Jonathon W. Wanta Megan Baker Eugene Grudnikoff Wynne Morgan Divya Chhabra Terry Lee |
| author_facet | W. David Lohr Jonathon W. Wanta Megan Baker Eugene Grudnikoff Wynne Morgan Divya Chhabra Terry Lee |
| author_sort | W. David Lohr |
| collection | DOAJ |
| description | Objectives: This paper reviews the literature on intentional discontinuation of psychostimulants in ADHD to summarize what is known about clinical course of controlled discontinuation and guide practitioners who are considering stopping these medications for youth with ADHD.Methods: A systematic search was executed in Cochrane CENTRAL, EMBASE, Psychinfo, and MEDLINE databases to identify all articles that addressed the topic of deprescribing of psychotropic medications in children and adolescents. Keywords and search strings were developed using “PICO” framework, involving Population of interest (<18 y.o.), Intervention (“discontinuation,” “deprescribing,” and synonyms), Comparator (continuation of specific medications), and Outcomes. Ten reviewers conducted the initial screen via a single reviewer system. Articles that met a set of three inclusionary criteria were selected for full text review and identification as specific to discontinuation of stimulants in ADHD.Results: The literature review identified 35 articles specifically addressing intentional deprescribing, discontinuation, tapering, or withdrawal of stimulants for children and adolescents with ADHD. In addition to providing broad support for the efficacy of stimulants to treat ADHD and reduce negative outcomes, there is a distinct population of children and adolescents with ADHD who do not relapse or deteriorate when taken off medications for ADHD. The majority of articles addressed either the re-emergence of ADHD symptoms or side effects, both desired and adverse, following discontinuation of stimulants. While confirming the ability of stimulants to treat ADHD in youth, our results support periodic consideration of trials of stopping medications to determine continued need.Conclusions: This systematic review summarizes the literature on deprescribing stimulants for ADHD in children and adolescents. Further research is needed to determine the optimal duration of treatment, identify patients that may benefit from medication discontinuation, and inform evidence-based guidelines for discontinuation when appropriate. More research is needed to understand and define the subgroup of youth who may succeed with stimulant discontinuation. |
| first_indexed | 2024-12-17T21:33:47Z |
| format | Article |
| id | doaj.art-c77445ffe6394f4ebdde19ee42275139 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-17T21:33:47Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-c77445ffe6394f4ebdde19ee422751392022-12-21T21:31:48ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402021-04-011210.3389/fpsyt.2021.642798642798Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and AnalysisW. David Lohr0Jonathon W. Wanta1Megan Baker2Eugene Grudnikoff3Wynne Morgan4Divya Chhabra5Terry Lee6Division of Child and Adolescent Psychiatry, Department of Pediatrics, University of Louisville, Louisville, KY, United StatesDepartment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United StatesMomentum for Mental Health, Palo Alto, CA, United StatesSchool of Medicine, Hofstra University, Hempstead, NY, United StatesDivision of Child and Adolescent Psychiatry, University of Massachusetts Medical School, Worcester, MA, United StatesDepartment of Psychiatry, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, Weill Cornell Medical College, New York, NY, United StatesDepartment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United StatesObjectives: This paper reviews the literature on intentional discontinuation of psychostimulants in ADHD to summarize what is known about clinical course of controlled discontinuation and guide practitioners who are considering stopping these medications for youth with ADHD.Methods: A systematic search was executed in Cochrane CENTRAL, EMBASE, Psychinfo, and MEDLINE databases to identify all articles that addressed the topic of deprescribing of psychotropic medications in children and adolescents. Keywords and search strings were developed using “PICO” framework, involving Population of interest (<18 y.o.), Intervention (“discontinuation,” “deprescribing,” and synonyms), Comparator (continuation of specific medications), and Outcomes. Ten reviewers conducted the initial screen via a single reviewer system. Articles that met a set of three inclusionary criteria were selected for full text review and identification as specific to discontinuation of stimulants in ADHD.Results: The literature review identified 35 articles specifically addressing intentional deprescribing, discontinuation, tapering, or withdrawal of stimulants for children and adolescents with ADHD. In addition to providing broad support for the efficacy of stimulants to treat ADHD and reduce negative outcomes, there is a distinct population of children and adolescents with ADHD who do not relapse or deteriorate when taken off medications for ADHD. The majority of articles addressed either the re-emergence of ADHD symptoms or side effects, both desired and adverse, following discontinuation of stimulants. While confirming the ability of stimulants to treat ADHD in youth, our results support periodic consideration of trials of stopping medications to determine continued need.Conclusions: This systematic review summarizes the literature on deprescribing stimulants for ADHD in children and adolescents. Further research is needed to determine the optimal duration of treatment, identify patients that may benefit from medication discontinuation, and inform evidence-based guidelines for discontinuation when appropriate. More research is needed to understand and define the subgroup of youth who may succeed with stimulant discontinuation.https://www.frontiersin.org/articles/10.3389/fpsyt.2021.642798/fulldiscontinuationpsychostimulantsADHDyouthintentionalevidence |
| spellingShingle | W. David Lohr Jonathon W. Wanta Megan Baker Eugene Grudnikoff Wynne Morgan Divya Chhabra Terry Lee Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis Frontiers in Psychiatry discontinuation psychostimulants ADHD youth intentional evidence |
| title | Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis |
| title_full | Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis |
| title_fullStr | Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis |
| title_full_unstemmed | Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis |
| title_short | Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis |
| title_sort | intentional discontinuation of psychostimulants used to treat adhd in youth a review and analysis |
| topic | discontinuation psychostimulants ADHD youth intentional evidence |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2021.642798/full |
| work_keys_str_mv | AT wdavidlohr intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis AT jonathonwwanta intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis AT meganbaker intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis AT eugenegrudnikoff intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis AT wynnemorgan intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis AT divyachhabra intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis AT terrylee intentionaldiscontinuationofpsychostimulantsusedtotreatadhdinyouthareviewandanalysis |