title: Use of drugs for ADHD among adults-a multinational study among 15.8 million adults in the Nordic countries.
abstract: OBJECTIVE
  The use of ADHD drugs among adults is controversial and has until recently not been approved for use in adults in most countries. The aim was to investigate use of ADHD drugs (stimulants and atomoxetine) among the entire adult population in the Nordic countries.
  
  
  METHODS
  We conducted a multinational population-based prescription register study based on the entire adult population in the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). All users of ADHD drugs aged 18-64 years during 2008-2012 were included, which for 2012 comprised 76,896 drug users among 15.8 million adult inhabitants.
  
  
  RESULTS
  Annual prevalence of drug use increased during the study period for both genders and all age groups. The overall prevalence increased from 2.4 to 5.3 per 1000 men and 1.8 to 4.4 per 1000 women. Incidence also increased, but to a lesser extent in the last part of the study period. Methylphenidate was used by 88 % of drug users. Treatment was discontinued within the first year by 21 % of new drug users. Among all users of ADHD drugs, 53 % of men and 64 % of women concurrently used other psychotropic drugs, most frequently antidepressants and hypnotics. Psychotropic co-medication increased with age and was more pronounced among women than men.
  
  
  CONCLUSIONS
  Use of ADHD drug among adults more than doubled over a 5-year period, and a majority were concurrently treated with other psychotropics. Adults constitute a substantial proportion of persons treated with ADHD drugs. Thus, evidence for long-term efficacy and safety in adults is urgently needed.
authors: Department of Pharmacoepidemiology, Norwegian Institute of Public Health, P.O.box 4404 Nydalen, 0403, Oslo, Norway. oystein.karlstad@fhi.no.
authors: Øystein
authors: http://orcid.org/0000-0003-1204-787X
authors: Ø
authors: Karlstad
authors: Centre of Public Health Sciences, Faculty of Medicine, University of Iceland Reykjavik, Reykjavik, Iceland.
authors: Helga
authors: H
authors: Zoëga
authors: Department of Pharmacoepidemiology, Norwegian Institute of Public Health, P.O.box 4404 Nydalen, 0403, Oslo, Norway.
authors: Kari
authors: K
authors: Furu
authors: Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
authors: Shahram
authors: S
authors: Bahmanyar
authors: Research Department, The Social Insurance Institution, Helsinki, Finland.
authors: Jaana E
authors: JE
authors: Martikainen
authors: Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
authors: Helle
authors: H
authors: Kieler
authors: Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors: Anton
authors: A
authors: Pottegård
mesh_terms: D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000661:Amphetamine / Q000627:therapeutic use; D000069445:Atomoxetine Hydrochloride / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D016208:Databases, Factual; D003913:Dextroamphetamine / Q000627:therapeutic use; D004363:Drug Utilization / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012537:Scandinavian and Nordic Countries; D055815:Young Adult
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride; D000661:Amphetamine; D003913:Dextroamphetamine
keywords: ADHD; Adults; Nordic countries; Pharmacoepidemiology; Psychostimulants