Recommendation for Long-term Management of Adult Attention-Deficit/Hyperactivity Disorder in Military Populations, Veterans, and Dependents: A Narrative Review.

This article focuses on evaluating the long-term safety and efficacy of stimulant medications for treating adult attention-deficit/hyperactivity disorder (ADHD), with particular attention to military populations who have a higher burden of mental health comorbidities. The review found insufficient high-quality evidence supporting the long-term (>6–12 months) safety of stimulants, which carry risks including cardiovascular events (e.g., hypertension, arrhythmias, myocardial infarction, stroke), psychosis, and potential for addiction and abuse. Nonstimulant FDA-approved alternatives, such as atomoxetine, clonidine, and guanfacine, may offer safer long-term management options by reducing sympathetic nervous system load and addressing comorbid anxiety, especially in older adults or those with cardiovascular vulnerabilities. The article emphasizes the importance of thoroughly assessing and managing coexisting behavioral health conditions before initiating ADHD treatment to avoid misdiagnosis and unnecessary exposure to stimulant side effects, and calls for further research on the causal effects of long-term stimulant use on cardiovascular health.