Stimulant prescription for ADHD in people with a past history of anorexia nervosa

BackgroundADHD is a common neurodevelopmental disorder. Stimulants are the gold standard treatment resulting in measurable improvements in associated functional impairment. However, people with a history of comorbid anorexia nervosa (AN), an illness characterised by restricted intake and malnutrition, find it challenging to access stimulant treatment. In our clinical experience, amidst a scarce safety-profile for this population, stimulants are ceased or withheld due to concerns about appetite suppression, weight loss, and cardiac risks. We responded to the paucity of literature by reviewing the cases of people with ADHD and a history of AN who have received stimulant-treatment.MethodWe reviewed the medical records and personal experiences of six community patients with ADHD and a history of AN, to assess the safety and acceptability of stimulants.ResultsSide-effects included appetite suppression and stimulant induced weight loss. This did not appear to exacerbate AN-pathology. Patients experienced subjective improvement in ADHD pathology, attenuation of the negative impacts of ADHD on AN, and subjective improvements in anxiety, depression, and suicidality.ConclusionThese preliminary findings indicate safety and acceptability for the careful use of stimulants in people with ADHD and a history of AN and paves the way for larger studies to demonstrate clinical benefit.