Department of Psychiatry, Division of Child and Adolescent Psychiatry
Health Services Administration | Mental and Social Health | Pediatrics | Psychiatry | Psychiatry and Psychology
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.
ADHD, discontinuation, evidence, intentional, psychostimulants, youth
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Copyright © 2021 Lohr, Wanta, Baker, Grudnikoff, Morgan, Chhabra and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
DOI of Published Version
Lohr WD, Wanta JW, Baker M, Grudnikoff E, Morgan W, Chhabra D, Lee T. Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis. Front Psychiatry. 2021 Apr 20;12:642798. doi: 10.3389/fpsyt.2021.642798. PMID: 33959050; PMCID: PMC8093505. Link to article on publisher's site
Frontiers in psychiatry
Lohr WD, Wanta JW, Baker M, Grudnikoff E, Morgan W, Chhabra D, Lee T. (2021). Intentional Discontinuation of Psychostimulants Used to Treat ADHD in Youth: A Review and Analysis. Open Access Publications by UMass Chan Authors. https://doi.org/10.3389/fpsyt.2021.642798. Retrieved from https://escholarship.umassmed.edu/oapubs/4683
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