Hundreds of thousands of Britons who take ADHD medication are at risk of debilitating gut symptoms that leave them constantly fearful of an embarrassing accident.
Experts have told the Daily Mail that the stimulant pills, such as methylphenidate, also known as Ritalin, taken by increasing numbers of patients, can drastically affect signals sent between the brain and the bowel, resulting in greater ‘urgency’.
Meanwhile, some have reported having to stop the ‘nightmare’ medication – and suffer troublesome ADHD symptoms – as a result of the unbearable digestive side effects.
One woman wrote on social media that she’d been rushing to the toilet so frequently that she’d developed ‘very sore’ haemorrhoids, which is when a swollen vein pushes through the back passage.
While the problem is most commonly associated with constipation, the frequent straining and wiping involved with diarrhoea can both trigger and worsen it.
‘To put it delicately, my bowels are moving more than they are used to, and this in turn has inflamed my piles,’ the woman said.
‘It’s been manageable until this last week when it has been very sore. Mornings are not fun.’
Another told Reddit: ‘The damage in the toilet was beyond control… now my tummy is bloated like a balloon and I feel nauseous.’
Jacob Wooderson, from London, suffered sudden arrhythmic death syndrome shortly after his dose of Elvanse, also known as lisdexamfetamine, was increased
Others have told The Mail that the medication makes them rush to the toilet ‘immediately’, while some say bouts of diarrhoea became ‘the new normal’ while on the treatment.
‘They were a total nightmare for me…I quit them,’ one young woman said.
The revelations come a week after The Daily Mail published campaigners‘ concerns about the link between ADHD medication and deadly heart rhythm problems in those with underlying cardiovascular conditions.
The charity Cardiac Risk In The Young warned that most of the thousands who are vulnerable to lethal heart side effects will be unaware of their increased risk – as the conditions are typically not diagnosed until a life-threatening event such as a heart attack strikes.
Doctors are not obliged to screen patients for cardiac problems before prescribing the drugs, which speed up heart rate and raise blood pressure.
It’s estimated that around 190,000 people in the UK are currently taking medication for ADHD.
Last year the Mail reported the death of 28-year-old Jacob Wooderson, a finance worker from London who suffered sudden arrhythmic death syndrome after his dose of Elvanse, also known as lisdexamfetamine, was increased.
Elvanse was listed as a cause of his death. He had been diagnosed with ADHD six months earlier.
At the time, coroner Sarah Bourke called on the Government to launch an inquiry into the tablet’s safety, which is ‘increasingly being prescribed in the NHS’. However, no such inquiry was ever commenced.
Elvanse was listed as a cause of Jacob Wooderson’s death. He had been diagnosed with ADHD six months earlier
ADHD is a neurodevelopmental condition in which the connections between different brain regions work differently to that of a neurotypical person’s, leading to issues with attention, impulsivity and hyperactivity.
This can manifest as problems sleeping, an inability to focus and troubles with executive functioning – which is crucial for forward planning and following instructions.
Previously it was considered a rare condition that affected children – primarily boys. However there are now 750,000 children and 1.5 million adults diagnosed with ADHD in the UK.
As awareness of the condition has grown, so too has the number of people seeking medication.
The number of women on ADHD medication has risen 20-fold in the past 15 years, while the number of men has risen 15-fold.
Now, experts have raised the alarm about other side effects that, while not life-threatening, can dramatically impact patients’ quality of life.
Dr James Arkell, consultant psychiatrist at the Central Health London clinic, says most doctors are aware of the dramatic impact on the gut, and must keep an eye on digestive side effects.
‘We need to listen to where patients are at with gut problems. Often we have to find a sweet spot – a point where there’s enough medication for a benefit, but not so much that it’s affecting their bowel.’
Some patients, he adds, suffer extreme constipation and require laxatives to ease their discomfort.
According to Leyla Hannbeck of the Independent Pharmacies Association, the digestive side effects are wide-ranging and, while loose, frequent stools are common, so is reduced appetite, nausea and debilitating stomach pain.
‘The collection of symptoms are very similar to irritable bowel syndrome (IBS),’ she says.
In the UK, stimulant tablets are predominantly prescribed for ADHD, although non-stimulant types are available. Both types can only be prescribed by a specialist – such as a psychiatrist – and not a GP.
Stimulant ADHD medications include methylphenidate – sold under brand names such as Ritalin, Concerta and Delmosart, – dexamfetamine and lisdexamfetamine, known as Elvanse in the UK and Vyvanse in the US.
The drugs increase the activity of dopamine and noradrenaline, chemical messengers involved in attention, motivation and impulse control.
This can improve concentration and reduce symptoms such as hyperactivity and impulsivity.
Dr Arkell explains that these medications have an ‘adrenaline-like effect’ on multiple bodily functions.
‘The gut contains receptors that respond to the brain chemicals that are triggered by the stimulant medication,’ he says.
‘This leads to interference with movement of the muscles in the bowel, including increasing peristalsis – the wave-like contractions that propel food and waste through the digestive tract.’
‘They can also affect the mucus that helps lubricate the bowel and allow for stools to easily leave the body.’
To make matters worse, stimulant medication can also affect the release of the neurotransmitter acetylcholine, which tells the digestive muscles to relax, leading to diarrhoea in many patients.
One user on Reddit forum ADHDUK shared that while the medication she is taking has worked wonders for her brain, it makes her dread going to the bathroom – and she is considering coming off of the tablets altogether.
She posted that she had found the best dose for managing her symptoms, but for the last three months had suffered chronic diarrhoea.
Another user told the Daily Mail that she had ‘really bad gastric problems’ while taking the stimulant tablets but only made the connection once she stopped taking them.
Ms Hannbeck says it’s difficult to identify which drug is worse for gut side effects.
‘People respond to ADHD medication differently,’ she says.
‘A medicine that is unsuitable for one patient may be the most effective and best-tolerated option for another.
‘The dosage makes a big difference too. Often a small tweak to the dose results in a big change in side effects.’
The experts also point to evidence that medicines can influence the balance of bacteria in the gut, triggering bowel symptoms – although they add the details of this link is not yet fully understood.
Many forum users claim that taking their medication with yogurt has reduced some of the more embarrassing toilet problems.
‘Eating fermented foods such as yoghurt may help keep your gut microbiome healthy, which could protect against an upset stomach,’ says Hannbeck.
Dr Arkell adds that often a small change to a patient’s lifestyle can be a surprising fix.
‘I often have to remind patients not to drink coffee – the combination of the drug and caffeine can send the gut into disarray. Sometimes a tweak as simple as this stops the side effects. Other times it takes more work.
‘But most patients will be able to work with their prescriber to come up with a solution.’
