Increase in prescription of drugs to treat ADHD, between real benefits and fears of abuse

Known as Ritalin , methylphenidate, a psychostimulant used to regulate ADHD , saw its prescriptions jump by 154% in France between 2020 and 2024, according to health insurance databases analyzed by AFP.

Classified as narcotics , these drugs stimulate the central nervous system, controlling the main symptoms of this disorder: attention deficit, hyperactivity and impulsiveness.

For child psychiatry professor Olivier Bonnot, who chaired a dedicated working group at the French National Authority for Health (HAS), "they are among the most effective drugs available."

Increasingly better detected thanks to better recognition of neurodevelopmental disorders, ADHD affects around 6% of people under 18 and 2.5% of adults worldwide, with symptoms that can vary throughout life.

"It's not like a virus that you either catch or you don't, but rather like high blood pressure: when the symptoms reach a certain level, they need to be treated," the president of the World ADHD Federation, American professor Stephen Faraone, told AFP.

"I live very well with it"

In the United States, where ADHD diagnoses and treatments are more common, voices have been raised to criticize an overly medicalized approach.

About half of diagnosed American children (3-17 years old) received drug treatment in 2022, according to a national survey on children's health, compared to 10% in France , according to the Haute Autorité de Santé.

"There has been an amalgamation with the American situation which has contributed to demonizing Ritalin. Parents have been accused of drugging their children and some are still subjected to comments from pharmacists," regrets Claudine Casavecchia, president of the HyperSupers - TDAH France association.

But in recent years, the progress of screening, the reimbursement of methylphenidate extended to adults in 2022, and the need to improve care have removed obstacles.

Patients testify to the benefits of psychostimulants . Vanessa, a 51-year-old teacher diagnosed in 2021, found it "extraordinary to be able to watch a series without getting up every five minutes." But she adds: "It's not a miracle molecule."

Alexandre (name changed), 26, has been taking Concerta (another methylphenidate-based medication) since childhood. "I wasn't Bart Simpson running around, but just distracted, constantly losing my things," he recalls. "The treatment helps me in my daily life. I'm seeing a psychiatrist, and I'm coping very well with my ADHD," says the young engineer.

Conversely, Thibault, 33, has bad memories of Ritalin, which he took around the age of eight: "I felt like I was under a bell jar, as if sedated ." "It was wartime, I would hold the pill against my cheek to avoid swallowing it. My mother would watch me until I swallowed," he says.

New molecule

Loss of appetite , sleep disturbances , mood swings , slight growth retardation , headaches : "generally benign" , the side effects "can be resolved by changing the dose or the medication" , according to the World ADHD Federation, which is based on a consensus of international experts.

"The data is reassuring. In the long term, we observe a slight increase in blood pressure and heart rate, which is something to monitor," says Sébastien Weibel, a psychiatrist at Strasbourg University Hospital.

Today, ADHD specialists are welcoming the recent marketing in France of a new molecule, lisdexamphetamine - under the name Xurta - an amphetamine already sold elsewhere in Europe.

Like Ritalin, it acts on dopamine and norepinephrine, which are involved in motivation and learning, but via a different mechanism of action .

"His arrival required a lot of educational work," emphasizes Hugo Prunier, a psychiatrist at CH Le Vinatier, because "the word amphetamine is frightening in France, with prejudices shared by both caregivers and patients."

Especially since in the United States, other amphetamine-based drugs such as Adderall - banned in France - to treat ADHD, have been diverted from their therapeutic indication .

In this country, students may take Ritalin or Adderall to "stay awake and study" or in a festive setting, explains Professor Faraone, president of the World ADHD Federation.

Lack of data

These products also raise concerns about potential addiction, as people with ADHD are at greater risk of developing addictive behavior .

"Being well treated upstream can limit this risk later, in particular by better managing the symptoms of impulsivity," reassures Louise Carton, pharmacologist and psychiatrist-addiction specialist at the Lille University Hospital.

There is little data in France on the misuse or duration of ADHD medications, which were long marginal and most adolescents take for less than a year, according to an international study. "Two years on average for adults," explains Sébastien Weibel, who analyzed data from the Strasbourg University Hospital.

Most of the time, patients develop compensation strategies to live with this disorder, for example by avoiding setting up their desk in front of a window, a source of distraction, or by having instructions repeated to them during an examination.

"The range of care is expanding and enriching" in France, says Eric Acquaviva, child and adolescent psychiatrist at the Robert-Debré Hospital (AP-HP), with alternatives to drug treatments, such as psychoeducation .