“We found a rapid drop in misuse of these medications, largely driven by a decline in Adderall misuse among young adults. More recent data suggest that those lower rates have remained stable since 2023,” said Margaret Maglione, MPP, a project leader at the Southern California Evidence Review Center at the Keck School of Medicine of USC and the study’s first author.

That decline may be tied, in part, to a nationwide ADHD medication shortage that began in 2022. During the peak of the shortage, an estimated 71.5% of patients said they had difficulty filling their prescriptions, according to the U.S. Centers for Disease Control and Prevention.

The rapid review, which included 64 studies conducted between 2004 and 2024, summarizes data on prevalence and frequency of misuse, reasons and consequences of misuse, demographic patterns, and how medications were obtained and taken.

Two patterns of misuse

ADHD stimulant medications, including Adderall, Ritalin, and Vyvanse, are commonly misused because they can produce immediate cognitive effects, even in people who use them only occasionally. The most common reasons for misuse are to help concentrate (about 35% of users), to be alert or stay awake (about 31%), and to get high or counter the effects of other drugs (about 16%). Most people who misuse these medications get them from friends or relatives with a prescription, who may share them thinking they can help someone study or focus.

Misuse tends to follow one of two patterns, according to the evidence review. One group of users primarily includes young adults, approximately 18 to 30 years old, who occasionally take ADHD medications without a prescription, often to study or focus on detailed work. This group tends to take pills by mouth, is most likely to use Adderall, and is more likely than other users to get pills for free from friends or relatives.

Another group of people misuse ADHD medications more frequently, with “high-frequency use” typically defined as seven or more days per month. People in this group are more likely to be over age 30, to not have a college degree, and to be separated or divorced or on work disability. They are also more likely to obtain medications by doctor-shopping or from a drug dealer and are more likely to snort, smoke or inject the substance.

“The data shows us that most patients do use the medications safely and as prescribed, but these medications are most likely to be misused by those who have a legitimate prescription or those who have access to someone else’s medication,” said Jaskanwar S. Batra, MD, MHA, a clinical professor and vice chair for clinical affairs in psychiatry and behavioral sciences at the Keck School of Medicine. “Physicians are advised to caution and educate their patients about proper use and safekeeping of these medications.”

Consequences of misuse

Misusing ADHD medications can have life-threatening consequences. Between 2012 and 2016, 33,239 incidents involving these drugs were reported to U.S. poison control centers. These incidents included accidental exposures, intentional misuse and suicide attempts.

Many people who misuse ADHD medications report using other substances at or around the same time, making drug interactions a concern. The review found that of adults who misused these medications, 52.8% of adults also simultaneously used alcohol, 26.2% used cannabis, 19.8% used cocaine and 19.5% used other prescription medications.

The researchers cited a study on 1.5 million admissions for substance use treatment, including both inpatient and outpatient programs. They found that only a tiny fraction (0.2%) of admissions were primarily for prescription stimulant misuse.

Importantly, the review found no evidence that taking prescribed ADHD medication during adolescence increases the risk of a substance use disorder later in life.

Filling gaps in research

The researchers found no long-term U.S. studies on the health effects of misusing ADHD stimulant medications.

“The misuse of stimulants is nothing new—this has been in the public eye for many decades,” said Susanne Hempel, PhD, a professor of clinical population and public health sciences at the Keck School of Medicine and director of the Southern California Evidence Review Center, who oversaw the work. “But we didn’t find any long-term studies on the physical health consequences of long-term misuse of these drugs, which was surprising.”

Another research gap involves people who misuse ADHD medications frequently over a long period of time. More research is needed to understand whether some occasional users go on to become long-term, heavy users, or whether other factors drive these patterns of misuse.

The review was commissioned by the U.S. Food and Drug Administration and is part of a broader analysis of ADHD that covers diagnosis, treatment, monitoring and medication misuse. A 2024 study from the same research team summarized the evidence on diagnosing and treating ADHD, finding that both medication and psychosocial treatments are effective.

Researchers at the Keck School’s Department of Psychiatry and Behavioral Sciences and Southern California Evidence Review Center performed the analysis. The latter conducts large-scale reviews of scientific evidence to help distill findings into takeaways that can inform government policy, medical practice, and public health efforts.

About this research

In addition to Maglione, Hempel and Batra, the study’s other authors are Joey Trampush, Sheila Pakdaman, Kimny Sysawang, Sachi Yagyu, Erin Foster, Diana Zhang, Aneesa Motala and Danica Tolentino from the Southern California Evidence Review Center, Keck School of Medicine of USC, University of Southern California; and Bradley Peterson from the Division of Psychiatry, Children’s Hospital Los Angeles.

This work was supported by the U.S. Agency for Healthcare Research and Quality [Contract No. 75Q80120D0000]

The key is a gradual approach to tapering opioid doses that puts the patient in the driver’s seat.

“So much of the fear of opioid tapering is about losing control,” said Beth Darnall, PhD, a professor of anesthesiology, perioperative and pain medicine and lead author of the study published July 7 in the Annals of Internal Medicine. “We tested a patient-centered methodology where we really focused on the individual patient and developed methods to ensure that they had maximal control in the process.”

The study enrolled more than 500 adult patients who had pain for at least six months and taken prescription opioids for at least three months. (On average, the participants had taken opioids for 12.4 years.) Patients worked with their clinicians to create a personalized opioid tapering plan with the goal of achieving their lowest comfortable opioid dose over 12 months. Doses were reduced no more than 10% per month, and patients could control the pace of their taper and pause the taper in collaboration with their clinician.

After 12 months, about half of patients achieved a successful response, defined as cutting their opioid dose by at least 50% without increased pain or staying at the same dose with significantly less pain.

“For patients, I think the data are reassuring that if opioids are tapered the right way, meaning a patient-centered approach, people can significantly reduce their opioid doses without having increased pain long term,” Darnall said.

The tapering program is not designed for people who have an addiction to opioids, she added, and patients with moderate or severe opioid use disorder were excluded from the study. Many people who take opioids long-term develop physiological dependence to the medications — and experience withdrawal symptoms when the medication is reduced — but do not meet other criteria for addiction, which include taking more than prescribed, drug-seeking behavior, and negative impacts on work and social life.

The study also compared the impact of two behavioral supportive therapies for pain management offered on top of the patient-centered tapering plan. One-third of participants were randomly assigned to receive eight weekly sessions of cognitive behavioral therapy for chronic pain, which focused on psychological skills to understand and ease pain. Another third were randomly assigned to receive six weekly sessions of a peer-led chronic pain self-management program, which included education on pain management, nutrition and communication with clinicians. Another third received only the patient-centered tapering plan.

The researchers found that the addition of supportive therapies did not boost the success rate of opioid tapering, but cognitive behavioral therapy for chronic pain seemed to lessen opioid withdrawal symptoms.

Tapering too fast

The patient-centered approach to opioid tapering is in line with current recommendations from the Centers for Disease Control and Prevention, but that was not always the case.

Through the late 1990s and 2000s, a surge in opioid prescribing for chronic pain contributed to a rise in addiction, overdose and other health complications. In response, in 2016, the CDC released opioid prescribing guidelines that emphasized the need to reduce opioid doses but without clear guidance on how to taper.

“What ended up happening was that after the publication of the 2016 guidelines, there was rapid deprescribing, meaning there were people who had been taking opioids for a long time who were tapered too fast,” Darnall said.

Some patients were cut off abruptly and without their consent. For some, the ensuing mental distress and severe opioid withdrawal symptoms led to suicidal behavior or overdose from illicit drugs.

“Ironically, in the name of reducing their risk, we were creating new risks by reducing opioids in the wrong way,” Darnall said. “The data told us that there are risks when you go up on doses, but there are risks when you go on down on doses, too.”

Patient-centered approach

At the time, most studies on opioid tapering focused on inpatient settings, but as a pain psychologist, Darnall had long heard from her chronic pain patients that many wanted to reduce their opioid dose but didn’t know how. In 2018, she and her collaborators published a small, four-month study showing that a slow, individually designed taper could help many patients at a community pain clinic lower their opioid dose.

The new study expands on that work, recruiting patients from 11 primary care and pain clinic sites in five states. Patients met with their clinician every three to four weeks, either in person or online. Integral to the patient-centered approach was an electronic platform, called CHOIR, developed by Sean Mackey, MD, PhD, the Redlich Professor, chief of the Division of Pain Medicine and member of the study’s executive research team. It automated weekly and monthly check-ins with the patients and responded with recommendations and compassionate messages.

“If they reported having major distress or major symptoms, that would get escalated to the clinic so the doctor would know and be communicating with the patient quickly,” Darnall said.

The platform also included an opioid tapering calculator that recalibrated the personalized plan based on tapering decisions made throughout the year.

The researchers hope that these electronic tools can help more clinicians implement patient-centered opioid tapering.

“We’re making available to the public our opioid tapering calculator, which we developed as part of this study, and the entire CHOIR informatics platform, which can monitor patients and provide automated support,” Darnall said. “We’re making it available for free, but it still requires that health care systems dedicate resources to integrate it into their system.”

Easing withdrawal symptoms

The CDC updated its opioid prescribing guidelines in 2022 to encourage more individualized care and shared decision-making with the patient, and to warn against rapid tapering. It also suggests that integrating behavioral support therapies into the tapering process could improve outcomes.

The new study is the first to compare tapering programs with and without behavioral support therapies, though the results were not what the researchers expected.

“When we originally conceptualized this study, we thought that if we apply these two behavioral interventions, maybe patients will reduce their doses more and have less pain, and we didn’t find that,” Darnall said. In fact, the groups assigned the supportive therapies had slightly lower rates of tapering success — 48.6% for the cognitive behavioral therapy for pain group and 44.5% for the chronic pain self-management program, compared with 50.9% for the taper-only group.

Participation in the supportive therapies was relatively low, with only about 60% of participants attending any of their assigned sessions, perhaps because the tapering program was already time intensive.

But when the team analyzed the results, they found that patients in supportive therapy groups experienced fewer opioid withdrawal symptoms. In particular, those assigned to cognitive behavioral therapy for chronic pain reported about half as many withdrawal symptoms as those in the taper-only group.

The researchers also noted that a patient’s self-rated “readiness” to taper at the start of the study was a good predictor of taper success, underscoring the importance of allaying patients’ fears and giving them a sense of control.

Before embarking on the study, Darnall’s team surveyed hundreds of patients and found that 68% of patients on prescription opioids had tried tapering without success. Most had attempted on their own, sometimes cold turkey.

“If they stop abruptly, it’s probably going to be a horrible experience,” Darnall said. “So that’s the experience they have and they think, ‘I need to stay on my dose; I can’t taper opioids.’ But often that’s not true — it was a flawed experiment.”

Researchers from the University of Arizona College of Medicine, Vi Palo Alto, Jonathan M. Wainwright Memorial Veterans Affairs Medical Center, University of the Pacific, University of Maryland School of Nursing, Kaiser Permanente, MedNOW Clinics, Lehigh Valley Physician Group, Intermountain Health and Stieg Clinics also contributed to the work.

The study was supported by funding from the Patient-Centered Outcomes Research Institute (PCORI).

The strongest increase in consultations for anxiety and depression was observed for symptoms, such as feeling depressed or anxious, rather than anxiety or depressive disorders, the findings indicate.

Mental health problems have reportedly increased in many high-income countries, particularly among teens and young adults, raising concerns about deteriorating population mental health, note the researchers.

But it’s not clear if rising service use might reflect greater underlying mental ill health or changes in help seeking behaviour and diagnostic practice, they add.

In a bid to find out, the researchers studied all 10–46 year olds in Norway between 2010 and 2024—a total of 3,728,002 people.

They analysed administrative registers of general practitioner (GP) data to estimate the annual sex- and age-specific prevalence of any mental health consultation.

In the Norwegian primary care reimbursement system doctors code the reasons for contact as either symptoms or disorders.

Analysis of the data showed that the proportion of 10–46 year olds with any mental health consultation recorded by a GP rose from just under 10% in 2010 to 16% in 2024.

Among girls and women, it rose from nearly 12% to just over 19.5%, and from just over 8% to just over 12.5% among boys and men.

The steepest increases occurred among 21–30 year olds, with relative increases of 69% for women—from 13% to 22%—and 52% for men—from just under 9% to nearly 14%.

Among the youngest age group (10–15 year olds), the proportion of those with any mental health consultation rose from 3.5% of girls and just over 5% of boys in 2010 to around 9% for both sexes in 2024.

When consultations for anxiety and depression—two of the most common reasons for mental health consultations—were disaggregated, symptom codes showed notably steeper increases than disorder codes across all age groups.

The proportion of primary care consultations for anxiety or depressive symptoms increased substantially over the study period: 286% relative rise in those coded as anxiety symptoms (from 0.44% to 1.7%); 147% relative rise in those coded as depressive symptoms (from 0.73% to 1.8%).

By comparison, the proportion of consultations coded as anxiety or depressive disorders rose only slightly or remained stable: 46% relative increase for those coded as anxiety disorder (from 0.95% to 1.4%); 4% decrease for those coded as depressive disorder (from 2.8% to 2.7%).

The steepest increase in recorded anxiety symptoms was among 16–20 year old women, rising from 0.4% to 2.3%—a 475% relative increase—while the proportion recorded as anxiety disorder rose by a relative increase of 64%–from just under 1.5% to just over 2%.

The steepest increases in depressive symptom consultations were among 21–46 year old women, particularly after 2020, and particularly among 21-30 year olds.

By comparison, there was no comparable increase in the proportion of depressive disorder consultations in either sex at any age.

The researchers caution that their study relied only on primary care data, which didn’t include symptom severity, so can’t be used to provide conclusive evidence on the mechanisms underlying the changes in primary healthcare service use for mental health problems.

“The observed increases could reflect changes in underlying distress, but also changes in recognition, willingness to disclose symptoms, help-seeking and clinical recording practices,” they note.

“While the observed over-proportional increase in symptoms is consistent with changes in norms for help-seeking, it cannot exclude alternative explanations, such as an actual increase in lighter mental health problems among young people, for example, due to increased social media use, the pandemic experience, or other factors,” they add.

Nevertheless they conclude: “The findings suggest that changes in help-seeking behaviour and/or diagnostic recording, rather than worsening underlying morbidity, are key drivers of rising primary care mental health contacts.”

The findings also have implications for primary care, they point out.

“The growing volume of symptom-level presentations poses an organisational challenge for GPs, who face increasing demand that may be more appropriately managed through psychoeducation or brief digital interventions rather than traditional clinical pathways,” they suggest.

The research found that self-directed CBT-CP was associated with modest improvements in pain interference at four months, with those gains sustained through to twelve months. Participants in the self-directed group also showed small to moderate improvements across a range of secondary outcomes at four months. Notably, session-completion rates were higher among those using the self-directed format compared with those receiving clinician-delivered therapy.

Chronic pain affects a significant proportion of the population and places a substantial burden on healthcare systems. CBT is an established psychological treatment for chronic pain, but access to clinician-delivered therapy can be limited by availability, cost, and logistical barriers. The findings suggest that scalable, self-directed formats could help address this gap, potentially increasing the overall uptake of an evidence-based intervention.

The authors conclude that self-directed CBT-CP may represent an effective and more accessible alternative to traditional clinician-delivered care, with implications for how psychological pain management services are designed and delivered.

The study was led by corresponding author Alicia Heapy, PhD, and is published in JAMA (doi:10.1001/jama.2026.7861). The full text is freely accessible here.

The population-based retrospective cohort study, which analysed data from more than 1.8 million Canadian adults, examined how initial prescribing patterns influence whether patients go on to use benzodiazepines over the long term. The findings highlight a critical window of opportunity at the point of first prescription, suggesting that the decisions clinicians make early on can have a significant bearing on a patient’s longer-term trajectory.

Benzodiazepines are widely prescribed for conditions including anxiety, insomnia, and seizure disorders, but long-term use carries well-documented risks including dependence, cognitive impairment, and difficulties with withdrawal. Concerns about overprescribing and the potential for harm have made identifying modifiable risk factors a priority for researchers and health systems alike.

The study – funded by a Womenmind Grant to co-principal investigators at the Centre for Addiction and Mental Health (CAMH) – found that three initial prescribing characteristics were associated with earlier discontinuation: keeping the initial course short, prescribing a single benzodiazepine rather than multiple agents, and opting for short-acting formulations over longer-acting ones.

The research team say the results could directly inform prescribing guidelines, offering clinicians practical, evidence-based levers for reducing the risk of patients transitioning from short-term to long-term use.

The full paper, Association between initial benzodiazepine prescribing patterns and time to benzodiazepine discontinuation: A population-based retrospective cohort study, is freely available at https://plos.io/4uxybkF.

Image: Researchers assess long-term benzodiazepine use in Canada.

Credit: Haley Lawrence, Unsplash (CC0, https://creativecommons.org/publicdomain/zero/1.0/)

Social anxiety disorder, sometimes referred to as social phobia, is a mental health condition characterized by an intense fear of being judged or embarrassed in social situations, often leading to significant distress, impaired relationships and work performance, reduced quality of life, and substantial economic costs to society. “Social anxiety is becoming more common in Canada, and understanding why this increase is happening is essential for improving mental health support,” said Tak-Lai Nellie Chau, recent MSW graduate of the Factor-Inwentash Faculty of Social Work (FIFSW), University of Toronto.

The research revealed that nearly 14% of Canadian adults have experienced social anxiety at some point in their lives, up from just over 8% in 2002.

While the study did not examine why social anxiety may have increased, the authors hypothesize that recent social changes, such as increased use of social media and the effects of the COVID-19 pandemic, may be contributing to this rise.

Young People Are Most at Risk

The research shows a strong pattern: younger Canadians are far more likely to experience social anxiety than older adults. About 1 in 4 or 24% of people aged 20 to 24 had a social anxiety disorder at some point in their life, compared to only 6.2% of those aged 65 and older.

Digital communication and reduced face-to-face interaction could be to blame.

“Young adulthood is a key life stage where social pressures are high, which may increase vulnerability to social anxiety,” said Stephen A. Oliver, recent MSW graduate of the FIFSW, University of Toronto. “Add to this the experience of increased isolation during the pandemic, growing pressures to achieve certain ideals on social media, and increased polarization and those pressures are bound to  intensify.”

Early Life Experiences and Childhood Trauma Play a Role

The study also found that early life experiences are strongly associated with social anxiety disorders.  Individuals who experienced childhood sexual abuse or witnessed domestic violence had significantly higher rates of social anxiety disorder.

The prevalence of lifetime social anxiety was also linked to chronic pain, multiple health conditions, and substance use disorders, showing that social anxiety often overlaps with other challenges.

“These findings highlight the importance of a life course approach to understanding mental health,” said Esme Fuller-Thomson, Director of the Institute for Life Course and Aging, and Professor at the FIFSW, University of Toronto. “Childhood experiences can cast a long shadow on adult mental health”.

Social Support Makes a Difference

The research showed that people with low social support — those who felt they didn’t have someone to rely on — were much more likely to have a social anxiety disorder.

At the same time, people who reported that spirituality was important in their lives were less likely to struggle with social anxiety.

“While our study did not test treatments directly, there is strong evidence from other research that cognitive behavioural therapy can be highly effective for social anxiety. Given that one in four young Canadians are affected, improving access to these evidence-based supports is essential,” said Fuller-Thomson.

The study, led by researchers at the Institute for Health Metrics and Evaluation (IHME) in collaboration with partners at the University of Queensland and published in The Lancet, identified that mental disorders disproportionately impact people aged 15–19 and women. It examined the prevalence and burden of mental disorders across both sexes, 25 age groups, 21 regions, and 204 countries and territories from 1990 to 2023, making it the most comprehensive analysis of mental disorder burden to date.

The study assessed 12 mental disorders, with anxiety disorders and major depressive disorder (MDD) ranking 11th and 15th, respectively, in burden among 304 diseases and injuries worldwide.

Mental disorders are now the leading driver of disability worldwide. 

In 2023, mental disorders accounted for 171 million disability-adjusted life years (DALYs) globally, placing these conditions as the fifth-leading cause of total disease burden. DALYs are a measure of overall health loss, combining years lived with disability and years of life lost due to premature death. Mental disorders accounted for more than 17% of all years lived with disability worldwide. This reflects the substantial and growing impact of mental disorders across populations.

Recent increases have been driven largely by anxiety disorders and major depressive disorder. Since 2019, the age-standardized prevalence of major depressive disorder has risen by about 24%, while anxiety disorders have increased by more than 47%, with both conditions peaking in the years following the COVID-19 pandemic.

“These rising trends may reflect both the lingering effects of pandemic-related stress and longer-term structural drivers such as poverty, insecurity, abuse, violence, and declining social connectedness. Addressing this growing challenge will require sustained investment in mental health systems, expanded access to care, and coordinated global action to better support populations most at risk,” said first author Dr. Damian Santomauro, Associate Professor at the Queensland Centre for Mental Health Research in partnership with the University of Queensland. Dr. Santomauro is also an Affiliate Assistant Professor at IHME.

The burden peaks in adolescence and disproportionately affects women. 

Mental disorders affect individuals across all stages of life, but the types of conditions and their impact vary by age. In early childhood, conditions such as autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and idiopathic developmental intellectual disability are most prevalent, with boys affected at higher rates than girls. As children grow into adolescence, anxiety and MDD are the leading contributors to mental disorder burden.

“Our findings show that mental disorder burden peaks among 15–19-year-olds, which is a critical developmental period that can shape trajectories for education, employment, and relationships,” said co-author Dr. Alize Ferrari, Honorary Associate Professor at the Queensland Centre for Mental Health Research in partnership with the University of Queensland. Dr. Ferrari is also an Affiliate Assistant Professor at IHME.

In 2023, 620 million women of all ages were living with a mental disorder compared to 552 million men of all ages globally. Women accounted for 92.6 million DALYs, compared to 78.6 million among men, indicating a higher overall burden. These differences are likely shaped by a complex mix of factors, including greater exposure to domestic violence and sexual abuse, increased caregiving responsibilities, and structural inequalities such as gender discrimination.

Mental disorders impact populations worldwide, highlighting gaps in care. 

Mental disorders burden increased in every region of the world between 1990 and 2023, though the scale and pattern of that burden differ substantially across regions and levels of development. High-income regions such as Australasia and Western Europe recorded some of the highest burden rates globally, particularly in countries like the Netherlands, Portugal, and Australia. Large increases in mental disorder burden rates were also observed in Western sub-Saharan Africa and parts of South Asia.

These patterns translate into substantial impacts for communities worldwide. Mental disorders impact families and caregivers, reduce workforce participation and productivity, and place growing demands on health systems and government resources. GBD analyses estimate that only about 9% of individuals with major depressive disorder globally receive minimally adequate treatment, with less than 5% receiving adequate care in 90 countries. Across 204 countries and territories, only a small number of high-income settings, including Australia, Canada, and the Netherlands, have treatment coverage exceeding 30%, highlighting major global gaps in care.

Expanding access to services, particularly in low- and middle-income countries, will be critical to improving coverage. Achieving this will require coordinated global action and sustained investment in mental health systems to improve outcomes worldwide.

For interviews with the authors, please contact IHME’s Media Team at ihmemedia@uw.edu.

A new study published today [14 May] in The Lancet Psychiatry provides the most comprehensive view of dosage effects for five commonly used medications for ADHD.

To help patients and clinicians choose the right dosage, the international research team led by Professor Samuele Cortese from the University of Southampton has also developed a free online tool based on the findings.

The research was funded by the National Institute for Health and Care Research (NIHR).

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions, affecting about five per cent of school-age children and two to three per cent of adults.

Medication is a key part of treatment, and prescriptions have increased substantially in recent years. However, most clinical guidelines provide limited guidance on the most effective dosages.

Finding the right dose is important to avoid dosages that are too low to be effective or too high, causing unwanted side effects. To identify this dosage ‘sweet spot’, the research team analysed data from 113 clinical trials, including more than 25,000 participants.

They used an advanced method called dose–effects network meta-analysis, which allowed them to estimate how different doses of each medication affect both effectiveness and side effects.

The results show that patterns differ between medications and age groups.

Dr Mikail Nourredine from the University of Lyon, first author of the study, said: “Overall, our findings suggest that clinicians should avoid using doses that are too low to be effective. If symptoms are not well controlled, the dosage may need to be increased.

“We also found no evidence that going beyond the licensed maximum doses improves average effectiveness, and higher doses are usually linked to more side effects. However, our results derive from group averages. Specific individuals with ADHD may benefit from and tolerate well unlicensed doses.”

Evidence from other studies shows that a substantial proportion of children and adolescents are prescribed low dosages without appropriate increases. That’s despite timely and adequate dose adjustments being associated with better adherence to treatment.

Professor Cortese, an NIHR Research Professor at the University of Southampton, commented: “Our study and the tool have the potential to support shared decision-making between clinicians, patients, and families when choosing the best dose. It is not only a clinician’s decision – patients and caregivers should be involved.

“The tool helps show what can be expected from each dose so that the patient knows why that particular dose has been chosen. We are continuing research to further personalise these recommendations based on individual patient characteristics.”

The study Pharmacological interventions for ADHD: a systematic review and dose-effect network meta-analysis is published in The Lancet Psychiatry and is available online.

Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

1. The study Pharmacological interventions for ADHD: a systematic review and dose-effect network meta-analysis will be published in The Lancet Psychiatry. An advanced copy is available upon request.
2. The online tool is available here: https://mikailnourredine.github.io/ADORMA/
3. For interviews, please contact Steve Williams, Media Manager, University of Southampton, press@soton.ac.uk or 023 8059 3212.

Previous meta-analyses looking at the use of antidepressants during pregnancy and risk of neurodevelopmental disorders in children were conducted nearly a decade ago and limited by small study numbers and a lack of controlling for additional factors. This new meta-analysis provides the best evidence to date that the small increase in risk of autism or ADHD in the children of women who used antidepressants when pregnant identified in many studies is not caused by the medication.

“We know many parents-to-be worry about the potential impact of taking medication during pregnancy; our study provides reassuring evidence that commonly used antidepressants do not increase the risk of neurodevelopmental disorders such as autism and ADHD in children. While all medications carry risks, so too does stopping antidepressants during pregnancy due to an increased risk of relapse. Therefore, for women with moderate-severe depression, doctors and patients must carefully weigh the potential risks and benefits of continuing antidepressant treatment during pregnancy against the potential harms of untreated depression,” says author Dr Wing-Chung Chang, University of Hong Kong.

He continues, “Although our study found a small increase in the risk of autism and ADHD in the children of women who had used antidepressants during pregnancy, it also found that this risk disappeared when we accounted for other factors. The increased risk was also seen in the children of fathers who took antidepressants and of mothers with antidepressant use before, but not during, pregnancy. Together, this suggests that it is not the antidepressants themselves causing an increased risk in autism and ADHD but it is more likely to be due to other factors, including genetic predisposition to conditions such as ADHD, autism, and mental health conditions.”

Authors pooled data from 37 studies which included more than 600,000 pregnant women taking antidepressants and almost 25 million pregnancies with no antidepressant use.

Before controlling for key factors such as mental health conditions, the analysis found that antidepressant use by the mother during pregnancy was associated with a 35% increased risk of ADHD and a 69% increased risk of autism. However, this became greatly reduced or non-significant in analyses that better controlled for confounding factors. Use of antidepressants during pregnancy by the father was associated with a 46% increase in the risk of ADHD and a 28% increase in the risk of autism.

Among studies with analyses restricted to mothers with mental health disorders, all selective serotonin reuptake inhibitors (SSRIs) were found to not be associated, only amitriptyline/nortriptyline remained associated with increased ADHD and autism risk. Amitriptyline/nortriptyline are currently considered second or third options as treatments for depression and are often prescribed for treatment-resistant depression. Therefore, women treated with these may have more severe, chronic, or complex underlying mental health conditions than those receiving more common antidepressants, which could be influencing the association between amitriptyline/nortriptyline and increased ADHD and autism risk.

The study found no difference in risk between high and low doses of antidepressants.

“The evidence suggests a link between either parent having a mental health condition and a slightly higher risk of ADHD or autism. In addition to genetic factors, this link could be explained by the home and social environment as ongoing family stress, changes in how the family functions, and differences in how parents behave and care for their children may influence neurodevelopment. There is a need to ensure both parents have access to support and treatment for mental health conditions; for their own sake and to support neurodevelopment of their child,” says Dr. Joe Kwun-Nam Chan, University of Hong Kong.

The researchers note some limitations of their study, including that data on important factors such as socioeconomic status, lifestyle risk factors and low birth weight was lacking in the studies. Additionally, there was only a small number of studies looking at antidepressant use in specific trimesters or exact doses and dose changes, which makes it harder to draw conclusions about these. Finally, women who are prescribed antidepressants tend to have more severe depression than those who are not, so some bias may remain even after controlling for mental health status.

Writing in a linked Comment, Lisa Vitte, Emmanuel Devouche and Gisele Apter from University Rouen Normandy (France), who were not involved in the study, say, “Chang and colleagues’ study adds knowledge and confirms some of the pre-existing knowledge on the use of antidepressants during pregnancy: that they should continue to be taken as they protect maternal mental health and do not harm fetal development. This result is of considerable impact after many contradictory and controversial studies.”

There was no funding source for this study. The study was conducted by researchers from the University of Hong Kong.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf. If you have any questions or feedback, please contact The Lancet press office at pressoffice@lancet.com

Quotes from Authors cannot be found in the text of the Article but have been supplied for the press release. The Comment quote is taken directly from the linked Comment.

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(26)00089-1/fulltext

Pain and fever are common in early pregnancy and the options to manage them have been limited. Studies have raised safety concerns regarding acetaminophen while data on the safety of NSAIDs—which include widely used medications such as ibuprofen, diclofenac, and naproxen—has remained inconclusive.

The new study used data from the Southern Israeli Pregnancy Registry (SiPREG) to analyze 264,858 singleton pregnancies between 1998 and 2018, of which 20,202 (7.6%) were exposed to NSAIDs during the first trimester—most commonly ibuprofen (5.1%), diclofenac (1.6%), and naproxen (1.2%). Major congenital malformations were identified from linked clinical, hospitalization, and termination records. The researchers adjusted risks for maternal and pregnancy characteristics including maternal age, ethnicity, diabetes, obesity, folic acid use, and the reason for NSAID use.

NSAID exposure was not associated with major congenital malformations overall (8.2% vs. 7.0% in unexposed pregnancies; matched adjusted relative risk = 0.99), nor with malformations in specific organ systems including the cardiovascular, musculoskeletal, central nervous system, gastrointestinal, and genitourinary systems. No association was observed for any individual drug, and dose-response analyses found no significant link between cumulative NSAID exposure and birth defect risk.

“Our results provide reassuring evidence that NSAID use in early pregnancy is not associated with major birth defects,” the authors say. “These findings can help both pregnant women and physicians make informed decisions about managing pain and fever in early pregnancy.”

Dr. Daniel adds, “We used data from SiPREG, a large pregnancy registry in southern Israel that tracks medication use and pregnancy outcomes, including birth defects identified not only at birth, but also in pregnancy terminations and during the first year of life.”

“We examined whether common pain relievers from the NSAID group, such as ibuprofen, are linked to birth defects. We found no increased risk overall or for specific types of birth defects.”

Dr. Ariel Hasidim notes, “One of the most interesting parts of this research was finding a careful way to deal with gaps in real-world data. One key issue was that some people may have used common medicines like ibuprofen without it being recorded, which could affect the results. We tackled this head-on by using a special analysis to see whether and how this missing information might have influenced our findings.”

Paper available in PLOS Medicine: https://plos.io/4mGgtZ9

Citation: Hasidim AA, Ben Shitrit I, Idan D, Michael T, Levy A, Pariente G, et al. (2026) First-trimester nonsteroidal anti-inflammatory drugs exposure and risk of major congenital malformations: A retrospective register-based cohort study. PLoS Med 23(5): e1005063. https://doi.org/10.1371/journal.pmed.1005063

Author countries: Israel

Funding: The author(s) received no specific funding for this work.

Obesity has a wide range of potential underlying causes, including mental and psychosocial factors. These factors include financial difficulties, mental stress and loneliness. This study aimed to examine whether these factors occur differently between people with normal weight, overweight or obesity.

The authors used data from the Dutch version of the online screening tool CheckCausesObesity.com This screening tool identifies possible underlying causes of obesity based on international guideline- and evidence-based algorithms. This is an online screening tool that helps identify the underlying causes of obesity in an individual. It systematically maps lifestyle factors, biological, psychological, social, and medication-related factors, as well as more rare medical (eg genetic) causes and also comorbidities, using guideline-based algorithms. All factors are explored in depth through detailed patient input. As part of a comprehensive assessment of multiple lifestyle factors, hormonal, genetic and medical factors which can contribute to overweight, this tool also includes questions about financial problems, loneliness and stress, as well as sex, weight, height and birthyear, enabling the researchers to calculate BMI and age. Patients complete the questions in this screening tool at home, and the results support a more personalized and medically informed treatment approach.

Statistical modelling was performed to explore the associations between financial problems, loneliness, stress and BMI classes (normal weight (BMI 20-24.9 kg/m²), overweight (BMI 25-29.9 kg/m²), obesity class 1 (BMI 30-34.9 kg/m²), obesity class 2 (BMI 35-39.9 kg/m²), and obesity class 3 (BMI ≥40 kg/m2)). Thereafter, statistical analyses were performed, adjusting for age and sex. Finally, potential sex differences in the results were assessed.

The screening tool was completed by 44.407 adults, between June 2024 and November 2025. Mean age was 52 years and the majority were female (76.7%). All the results reported below were statistically significant. The authors looked first at financial difficulties, which were present in 5.4% of the respondents with no difference between men and women. A higher proportion of respondents indicated having financial problems with increasing BMI (normal weight: 4.3%, overweight: 4.7%, obesity class 1: 5.0%, obesity class 2: 6.0% and obesity class 3: 7.2%). Respondents without financial problems had a lower BMI than those indicating they had financial problems (mean BMI: 33.2 kg/m² and 34.5 kg/m²). The association between financial issues and BMI was comparable between men and women.

Secondly, they examined stress, which was reported more frequently by women (34.5%) than by men (22.5%). Respondents experienced more stress with increasing BMI (normal weight: 27.5%, overweight: 28.6%, obesity class 1: 31.2%, obesity class 2: 34.3% and obesity class 3: 37.3%). Accordingly, respondents indicating experiencing stress had a higher mean BMI compared to those without stress (mean BMI: 34.0 kg/m² and BMI: 33.1 kg/m² respectively). This association did not differ between men and women. To explore the reasons underlying respondents’ stress, participants could elaborate on their stress experiences. These qualitative responses were analysed and organised into clusters representing the most frequently reported stress domains. According to these clusters, the three most experienced stress domains were work-related, focused on general well-being or concerns about family-members.

Thirdly, loneliness was more often reported in women (8.7%) than in men (6.3%), and more prevalent among respondents with increasing class of obesity (normal weight: 7.7%, overweight: 7.0%, obesity class 1: 7.6%, obesity class 2: 8.5%, obesity class 3: 11.7%). In addition, individuals who reported loneliness had a higher BMI (mean BMI 34.5 kg/m²) than those without loneliness (mean BMI 33.3 kg/m²). Interestingly, the results suggest that loneliness is more strongly associated with a higher BMI in men than in women.

The authors conclude: “This study shows that higher BMI is associated with more financial problems, loneliness, and stress. These relationships may be bidirectional. On the one hand, higher BMI may contribute to stigma and social isolation, reduced work capacity, and increased healthcare costs. On the other hand, financial strain, chronic stress and social isolation may influence lifestyle coping behaviours, and even biological processes that promote weight gain. Broader environmental factors may further reinforce these patterns. Further research is needed to better understand these mechanisms and to inform prevention and support strategies for individuals facing financial difficulties, mental stress, and loneliness in the context of obesity.

Rates of depression and anxiety have increased worldwide since the COVID-19 pandemic, and more people are pursuing mental health treatment as a result. However, there is limited up-to-date data describing how these individuals seek out and receive care. Detailed, population-level information can help healthcare systems meet this growing population’s needs.

To make a start on gathering this data, Kruk and her colleagues surveyed 32,419 adults in 18 high-, low-, and medium-income countries. More than 1,000 people from each country responded. Participants self-reported data via the People’s Voice Survey in 2022 and 2023.

First, survey respondents self-assessed their physical and mental health (the latter including “poor,” “fair,” “good,” “very good,” and “excellent”). Then, they quantified their overall confidence in the healthcare system, their own use of healthcare services, the typical quality of care received, and their ability to manage their own mental health (a metric called patient activation).

Across all countries, respondents reporting poor mental health were more likely to report chronic illness, poorer overall health, lower patient activation, worse care quality and lower confidence in the healthcare system. Between 0.9% (Lao PDR) and 52.4% (UK) of these respondents reported receiving mental health care in the last year. Respondents in Nigeria reported the best overall mental health (4.7% people reported the lowest proportion of “poor” or “fair” mental health (4.7%), while respondents in China had the highest proportion (39.6%).

The researchers hope these results can help the countries in question — and individual healthcare systems — better serve the needs of those with poor mental health. While this is a descriptive study, the researchers posit patient activation as a potential target for elevating overall health and wellness.

The authors acknowledge that big-picture data doesn’t describe individuals’ specific experiences within the healthcare system. They suggest comparison across similar health systems and tracking system performance over time to continuously improve health services.

The authors add, “What stands out from this study is that poor mental health doesn’t exist in isolation. People reporting poor mental health were nearly twice as likely to have a chronic illness and far less likely to feel empowered to manage their own health. Health systems need to stop treating mental health in a silo and recognize that these patients are showing up across all areas of care — and often with more complex needs.”

Kruk adds, “As a research consortium working across very different health systems, we expected to find variation, and we did, in treatment access. But the experience gap was remarkably consistent: people with poor mental health had worse care, more unmet needs, and less trust in the system, regardless of where they lived. Health systems globally need to rethink how they serve this growing group, not just whether they can reach them.”

Freely available paper in PLOS Medicine: https://plos.io/3O045Xd

Citation: Kruk ME, Kapoor NR, Arsenault C, Carai S, Daray FM, Doubova SV, et al. (2026) Health system use and experience among people with poor mental health: A cross-sectional analysis of the People’s Voice Survey in 18 countries. PLoS Med 23(5): e1004745. https://doi.org/10.1371/journal.pmed.1004745

Author countries: United States of America, Greece, Argentina, Mexico, Peru, Ethiopia, India, South Africa, Republic of Korea, United Kingdom, Nigeria, Italy, China

Funding: This work was supported by the Bill & Melinda Gates Foundation (https://www.gatesfoundation.org/ INV-005254) to MEK; the Swiss Agency for Development and Cooperation (https://www.eda.admin.ch/deza/en/home.html; 81067262) to MEK; Merck Sharp & Dohme LLC (https://www.merck.com) to MEK; the Inter-American Development Bank (https://www.iadb.org/en; Project No. RG-T3768) to EGE; and the Taejae Research Foundation (https://taejaefoundation.or.kr/en) to JO. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.