Adult ADHD prescriptions still on the rise, especially among women over 35

Prescriptions for ADHD medications have been spiking in recent years, with the sharpest increase among middle-aged and older women. They’re also the least likely to misuse the prescription stimulants, a new study finds.

The rise among women ages 35 to 64 has been substantial. At the end of 2022, 1.7 million women in this age group were prescribed stimulants such as Adderall and Ritalin for ADHD, compared to 1.2 million prescriptions in 2019. 

There’s been an overall jump in ADHD prescriptions since the pandemic and the rise of telehealth. The new analysis, published in JAMA Psychiatry by researchers at the National Institute on Drug Abuse, also looked into how the medications are being misused — that is, taking more of the drugs than prescribed, taking them at times that differed from what the doctor ordered or using medication from someone else’s prescription

The researchers used data from more than 83,000 adults, ages 18 to 64 who participated in the 2021-2022 National Surveys on Drug Use and Health. Information on prescriptions came from the 2019-2022 IQVIA Total Patient Tracker and National Prescription Audit New to Brand databases. 

They found that the prevalence of misuse of prescription stimulants among women aged 35 to 64 was significantly lower than it was among men of the same age (13.7% versus 22.0%). Middle-aged women also misused their medications less than younger women (13.7% versus 36.8%).

Three types of stimulants are approved for ADHD: amphetamine (Dexedrine, Adderall); methamphetamine (Desoxyn); and methylphenidate (Ritalin).

Overall, just over a quarter of people with prescriptions for ADHD medications reported misusing them. About 9% had what is called prescription stimulant use disorder, or addiction. 

People taking an amphetamine or methamphetamine were more likely to misuse than those taking a methylphenidate.

The researchers aren’t sure why there was such a big increase in older adult women being prescribed stimulants for ADHD. 

“It is a very large increase that I can’t fully explain,” said a study co-author, Dr. Wilson Compton, deputy director at the National Institute on Drug Abuse

The size of the increase in middle-aged women is surprising, said Aaron Brinen, an assistant professor of psychiatry and behavioral sciences at the Vanderbilt University Medical Center in Nashville, who was not involved in the study.

Girls with the neurodevelopmental disorder may not be diagnosed because their symptoms are often more subtle than those exhibited by boys, who are more likely to show symptoms of hyperactivity or impulsiveness, research indicates. 

“I wonder if it speaks to women feeling more empowered to talk about what they are needing and about their struggles in life,” Brinen said.

They may realize that they had ADHD as children but were never diagnosed.  

“Girls are more likely to be overlooked because the way they express ADHD isn’t likely to be captured by teachers,” he added.

Brinen has female friends who weren’t diagnosed and treated until they were in their 50s. 

“It was the first time in their lives that they felt functional,” he said. “It’s a tragedy that it took so long.”

Untreated ADHD can lead to feelings of failure and depression, Brinen said. “People think of them as not trying, but they are constantly trying and meeting disappointment,” he added.

Brinen suspects women with ADHD are less likely to misuse the stimulants because their prescriptions make life easier. They don’t get high from the stimulants, they just feel more normal.

Women with ADHD sometimes manage to get by until they hit a stage where life becomes more difficult and challenging, said Mariely Hernandez, a clinical psychologist who specializes in addiction and ADHD and is a postdoctoral research fellow in the department of psychiatry at the Columbia University Vagelos College of Physicians and Surgeons in New York.

The symptoms of ADHD might become a much bigger problem when women have children, Hernandez said. “The executive function needed to manage a family may exceed their cognitive resources, especially when the children are young,” she added. “Then their symptoms become too impairing.”

Hormonal status can also affect the severity of symptoms, Hernandez said. “We see a lot of women diagnosed at menopause,” she said, adding that low estrogen levels in a woman with ADHD can lead to a dopamine deficit.

“Dopamine underlies our reward system,” she explained. “If you don’t make enough or aren’t able to properly utilize it, you won’t be able to focus as well. Women will say, ‘I can’t live like this. I want to be evaluated.’”