Do medications for ADHD work and are they safe?

My review of research about the effectiveness and safety of stimulant type medication for ADHD led me to conclude that these medications are very effective and very safe. However, concerns continued to be expressed regarding possible cardiac side-effects, addiction risk and reduced appetite. Recent studies have repeatedly shown that people taking stimulant medication to help concentration difficulties due to ADHD are not going to become addicted. The addiction risk is exclusively associated with use of stimulant medications by people who do not have ADHD.

I have treated a number of people with ADHD who require doses of stimulant medication over 60 mg per day. Some physicians have stated that 60 mg is the maximum daily dose of Adderall. This is likely because studies that are only determining if Adderall is able to improve concentration so that when it statistically separates from placebo the study ends. If the dose was 60 mg when the effectiveness of Adderall was determined this is mistakenly considered a maximum dose . These were not studies determining maximum doses and the FDA has stated that the doses need to be titrated for each person being treated and there is no maximum dose. I have patients with doses from 20 mg a day to over 100 mg per day. Some patients have problems absorbing the medications and thus require higher doses. Other patients need to have support for concentration for longer hours every day requiring higher doses. It is also my experience that it is important to have concentration supported during all waking hours. This is especially important as frequently support for concentration is not maintained into the evening even though concentration is required to support interpersonal relationships such as interactions with family members that require sustained focus and concentration to be successful. Finally, it is clear that some generic manufacturers of stimulant medications are not equivalent and less effective. Unfortunately the FDA is no longer monitoring generic manufacturers of medications to be sure that the doses are actually what they are listed to be.

Regarding risk of cardiac side-effects, an interview of Tim Wilens, M.D. in the May/June 2025 issue of AACAP News has Dr. Wilens stating that even though results from Zhang, et al, 2024 found increased cardiovascular disease and hypertention and then opposite results from the same cohort had lower rates of morbidity compared to nonstimulant treated individuals. Also, data from Copper et al. 2011 and the meta-analysis from the Karolinska group [Zhang et al, 2022] both showed no increased cardiovascular or cerebrovascular adverse outcomes associated with stimulant treatment. So, it seems that the stimulant medications are safe to use. However before prescribing these medications the American Heart Association recommendations are followed including asking about a family history of premature cardiovascular adverse outcomes, a personal history of congenital or acquired cardiovascular disease, and symptoms such as chest / discomfort, shortness of breath, syncopal like episodes, dizzy spells of unknown etiology, or palpitations.

What about how effective the stimulant medications are. Dr. Wilens stated that reduced long term symptoms, reduced sequelae [negative impact of ADHD symptoms] and improved functional outcomes throughout the life span of people with ADHD treated with stimulant medications continues to support the use of these medications over lifespans.

So, ADHD medications are effective and safe and it is ok to titrate doses above 60 mg and are very effective over the lifespan of people with ADHD.