Seasonality and changes in ADHD medication sales to pharmacies in Poland from 2018 to 2023
DOI:
https://doi.org/10.56782/pps.905Keywords:
methylphenidate, atomoxetine, trend, utilisation, psychopharmacoepidemiologyAbstract
To investigate the seasonality and the impact of the COVID-19 pandemic on ADHD medication, including immediate-release (IR), long-acting (LA), and osmotic-controlled release oral delivery system (OROS) methylphenidate and atomoxetine consumption in Poland between February 2018 and April 2024. Data on ADHD medication consumption were analyzed using defined daily doses (DDD) per 1,000 inhabitants per day. Seasonal variation was assessed with the Holt-Winters method, and changes post-March 2020 were evaluated by comparing pre- and post-pandemic monthly values. The test statistic, denoted as Q, measured pairs of months where post-pandemic values exceeded pre-pandemic ones, with a p-value < 0.05 indicating a significant increase. There was a clear seasonal pattern in ADHD medication consumption, with a decrease observed in June, July, and August for all the drugs and formulations studied. A statistically significant increase in consumption (p < 0.05) was observed for ADHD medications overall, as well as for atomoxetine and the IR and LA formulations of methylphenidate. However, no significant increase was noted for the OROS formulation of methylphenidate after the onset of the pandemic in March 2020. The consumption of ADHD medications in Poland has shown a notable increase in recent years. The identified seasonality patterns and the observed rise in consumption may provide valuable insights for improving healthcare system planning and optimization, as well as for preparing to address emerging challenges.
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References
1. WHO. International Classification of Diseases, Eleventh Revision (ICD-11); 2019/2021.
2. Lee, Y.C.; Yang, H.J.; Chen, V.C.; Lee, W.T.; Teng, M.J.; Lin, C.H.; Gossop, M. Meta-analysis of quality of life in children and adolescents with ADHD: By both parent proxy-report and child self-report using PedsQL. Res. Dev. Disabil. 2016, 51-52, 160-172. DOI: 10.1016/j.ridd.2015.11.009 DOI: https://doi.org/10.1016/j.ridd.2015.11.009
3. Strine, T.W.; Lesesne, C.A.; Okoro, C.A.; McGuire, L.C.; Chapman, D.P.; Balluz, L.S.; Mokdad, A.H. Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Prev. Chronic Dis. 2006, 3, Art. No: A52.
4. Beheshti, A.; Chavanon, M.L.; Christiansen, H. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry 2020, 20, Art. No: 120. DOI: 10.1186/s12888-020-2442-7 DOI: https://doi.org/10.1186/s12888-020-2442-7
5. Polanczyk, G.V.; Salum, G.A.; Sugaya, L.S.; Caye, A.; Rohde, L.A. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J. Child Psychol. Psychiatry 2015, 56, 345-365. DOI: 10.1111/jcpp.12381 DOI: https://doi.org/10.1111/jcpp.12381
6. Song, P.; Zha, M.; Yang, Q.; Zhang, Y.; Li, X.; Rudan, I. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. J. Glob. Health 2021, 11, Art. No: 04009. DOI: 10.7189/jogh.11.04009 DOI: https://doi.org/10.7189/jogh.11.04009
7. Polish National Health Fund. dane.gov.pl. Available online: https://dane.gov.pl/en
8. Willcutt, E.G. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012, 9, 490-499. DOI: 10.1007/s13311-012-0135-8 DOI: https://doi.org/10.1007/s13311-012-0135-8
9. Polanczyk, G.V.; Willcutt, E.G.; Salum, G.A.; Kieling, C.; Rohde, L.A. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014, 43, 434-442. DOI: 10.1093/ije/dyt261 DOI: https://doi.org/10.1093/ije/dyt261
10. Polanczyk, G.; de Lima, M.S.; Horta, B.L.; Biederman, J.; Rohde, L.A. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007, 164, 942-948. DOI: 10.1176/ajp.2007.164.6.942 DOI: https://doi.org/10.1176/ajp.2007.164.6.942
11. Warsaw School of Economics; Association of Financial Companies in Poland. Consumer Finance Market Barometer, First Quarter of 2025. Available online: https://www.sgh.waw.pl/kae/sites/kae/files/2025-03/adanel%20sygnalna_zpfirg_202501_20250208.pdf
12. National Health Fund. Terminy leczenia. Available online: https://terminyleczenia.nfz.gov.pl/ (accessed on 31.03.2026).
13. Faraone, S.V.; Banaschewski, T.; Coghill, D.; Zheng, Y.; Biederman, J.; Bellgrove, M.A.; Newcorn, J.H.; Gignac, M.; Al Saud, N.M.; Manor, I.; et al. The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci. Biobehav. Rev. 2021, 128, 789-818. DOI: 10.1016/j.neubiorev.2021.01.022 DOI: https://doi.org/10.1016/j.neubiorev.2021.01.022
14. Cortese, S.; Adamo, N.; Del Giovane, C.; Mohr-Jensen, C.; Hayes, A.J.; Carucci, S.; Atkinson, L.Z.; Tessari, L.; Banaschewski, T.; Coghill, D.; et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 2018, 5, 727-738. DOI: 10.1016/S2215-0366(18)30269-4 DOI: https://doi.org/10.1016/S2215-0366(18)30269-4
15. Vasiliadis, H.M.; Lunghi, C.; Rahme, E.; Rochette, L.; Gignac, M.; Massamba, V.; Diallo, F.B.; Fansi, A.; Cortese, S.; Lesage, A. ADHD medications use and risk of mortality and unintentional injuries: a population-based cohort study. Transl. Psychiatry 2024, 14, Art. No: 128. DOI: 10.1038/s41398-024-02825-y DOI: https://doi.org/10.1038/s41398-024-02825-y
16. Kidwell, K.M.; Van Dyk, T.R.; Lundahl, A.; Nelson, T.D. Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis. Pediatrics 2015, 136, 1144-1153. DOI: 10.1542/peds.2015-1708 DOI: https://doi.org/10.1542/peds.2015-1708
17. Holmskov, M.; Storebo, O.J.; Moreira-Maia, C.R.; Ramstad, E.; Magnusson, F.L.; Krogh, H.B.; Groth, C.; Gillies, D.; Zwi, M.; Skoog, M.; et al. Gastrointestinal adverse events during methylphenidate treatment of children and adolescents with attention deficit hyperactivity disorder: A systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. PLoS One 2017, 12, Art. No: e0178187. DOI: 10.1371/journal.pone.0178187 DOI: https://doi.org/10.1371/journal.pone.0178187
18. Liang, E.F.; Lim, S.Z.; Tam, W.W.; Ho, C.S.; Zhang, M.W.; McIntyre, R.S.; Ho, R.C. The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression. Int. J. Environ. Res. Public Health 2018, 15(8), Art. No: 1789. DOI: 10.3390/ijerph15081789 DOI: https://doi.org/10.3390/ijerph15081789
19. Faraone, S.V.; Biederman, J.; Morley, C.P.; Spencer, T.J. Effect of stimulants on height and weight: a review of the literature. J. Am. Acad. Child Adolesc. Psychiatry 2008, 47, 994-1009. DOI: 10.1097/CHI.ObO13e31817eOea7 DOI: https://doi.org/10.1097/CHI.ObO13e31817eOea7
20. Cheng, J.Y.; Chen, R.Y.; Ko, J.S.; Ng, E.M. Efficacy and safety of atomoxetine for attention-deficit/hyperactivity disorder in children and adolescents-meta-analysis and meta-regression analysis. Psychopharmacology (Berl) 2007, 194, 197-209. DOI: 10.1007/s00213-007-0840-x DOI: https://doi.org/10.1007/s00213-007-0840-x
21. Wernicke, J.F.; Faries, D.; Girod, D.; Brown, J.; Gao, H.; Kelsey, D.; Quintana, H.; Lipetz, R.; Michelson, D.; Heiligenstein, J. Cardiovascular effects of atomoxetine in children, adolescents, and adults. Drug Saf. 2003, 26, 729-740. DOI: 10.2165/00002018-200326100-00006 DOI: https://doi.org/10.2165/00002018-200326100-00006
22. Kratochvil, C.J.; Wilens, T.E.; Greenhill, L.L.; Gao, H.; Baker, K.D.; Feldman, P.D.; Gelowitz, D.L. Effects of long-term atomoxetine treatment for young children with attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry 2006, 45, 919-927. DOI: 10.1097/01.chi.0000222788.34229.68 DOI: https://doi.org/10.1097/01.chi.0000222788.34229.68
23. National Institute for Health and Care Excellence. Attention Deficit Hyperactivity Disorder: Diagnosis and Management; NICE Guideline NG87; NICE: London, UK, 2018.
24. Pliszka, S. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Psychiatry 2007, 46, 894-921. DOI: 10.1097/chi.0b013e318054e724 DOI: https://doi.org/10.1097/chi.0b013e318054e724
25. Ibrahim, K.; Donyai, P. Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades. J. Atten. Disord. 2015, 19, 551-568. DOI: 10.1177/1087054714548035 DOI: https://doi.org/10.1177/1087054714548035
26. Gimbach, S.; Vogel, D.; Fried, R.; Faraone, S.V.; Banaschewski, T.; Buitelaar, J.; Dopfner, M.; Ammer, R. The impact of the COVID-19 pandemic on ADHD medicine consumption in 47 countries and regions. Eur. Neuropsychopharmacol. 2023, 73, 24-35. DOI: 10.1016/j.euroneuro.2023.04.008 DOI: https://doi.org/10.1016/j.euroneuro.2023.04.008
27. Raman, S.R.; Man, K.K.C.; Bahmanyar, S.; Berard, A.; Bilder, S.; Boukhris, T.; Bushnell, G.; Crystal, S.; Furu, K.; KaoYang, Y.H.; et al. Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases. Lancet Psychiatry 2018, 5, 824-835. DOI: 10.1016/S2215-0366(18)30293-1 DOI: https://doi.org/10.1016/S2215-0366(18)30293-1
28. Supreme Audit Office. Opieka Psychiatryczna nad Dziećmi i Młodzieżą; Supreme Audit Office: Warsaw, Poland, 2024.
29. Kazda, L.; Bell, K.; Thomas, R.; McGeechan, K.; Sims, R.; Barratt, A. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw. Open 2021, 4, Art. No: e215335. DOI: 10.1001/jamanetworkopen.2021.5335 DOI: https://doi.org/10.1001/jamanetworkopen.2021.5335
30. Gascon, A.; Gamache, D.; St-Laurent, D.; Stipanicic, A. Do we over-diagnose ADHD in North America? A critical review and clinical recommendations. J. Clin. Psychol 2022, 78, 2363-2380. DOI: 10.1002/jclp.23348 DOI: https://doi.org/10.1002/jclp.23348
31. Oner, O.; Yilmaz, E.S.; Karadag, H.; Vural, M.; Vural, E.H.; Akbulat, A.; Gursoz, H.; Turkcapar, H.; Kerman, S. ADHD Medication Trends in Turkey: 2009-2013. J. Atten. Disord. 2017, 21, 1192-1197. DOI: 10.1177/1087054714523129 DOI: https://doi.org/10.1177/1087054714523129
32. Shyu, Y.C.; Lee, S.Y.; Yuan, S.S.; Yang, C.J.; Yang, K.C.; Lee, T.L.; Wang, L.J. Seasonal Patterns of Medications for Treating Attention-Deficit/Hyperactivity Disorder: Comparison of Methylphenidate and Atomoxetine. Clin. Ther. 2016, 38, 595-602. DOI: 10.1016/j.clinthera.2016.01.015 DOI: https://doi.org/10.1016/j.clinthera.2016.01.015
33. Cascade, E.; Kalali, A.H.; Weisler, R.H.; Lenderts, S. Seasonality and the changing adult/child prescription ratios in ADHD therapy. Psychiatry (Edgmont) 2008, 5, 23-25.
34. Martins, S.; Tramontina, S.; Polanczyk, G.; Eizirik, M.; Swanson, J.M.; Rohde, L.A. Weekend holidays during methylphenidate use in ADHD children: a randomized clinical trial. J. Child Adolesc. Psychopharmacol. 2004, 14, 195-206. DOI: 10.1089/1044546041649066 DOI: https://doi.org/10.1089/1044546041649066
35. Safer, D.; Allen, R.; Barr, E. Depression of growth in hyperactive children on stimulant drugs. N. Engl. J. Med. 1972, 287, 217-220. DOI: 10.1056/NEJM197208032870503 DOI: https://doi.org/10.1056/NEJM197208032870503
36. Klein, R.G.; Landa, B.; Mattes, J.A.; Klein, D.F. Methylphenidate and growth in hyperactive children. A controlled withdrawal study. Arch. Gen. Psychiatry 1988, 45, 1127-1130. DOI: 10.1001/archpsyc.1988.01800360075011 DOI: https://doi.org/10.1001/archpsyc.1988.01800360075011
37. Pliszka, S.R.; Matthews, T.L.; Braslow, K.J.; Watson, M.A. Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry 2006, 45, 520-526. DOI: 10.1097/01.chi.0000205702.48324.fd DOI: https://doi.org/10.1097/01.chi.0000205702.48324.fd
38. Satterfield, J.H.; Cantwell, D.P.; Schell, A.; Blaschke, T. Growth of hyperactive children treated with methylphenidate. Arch. Gen. Psychiatry 1979, 36, 212-217. DOI: 10.1001/archpsyc.1979.01780020102011 DOI: https://doi.org/10.1001/archpsyc.1979.01780020102011
39. Waxmonsky, J.G.; Pelham, W.E., 3rd; Campa, A.; Waschbusch, D.A.; Li, T.; Marshall, R.; Babocsai, L.; Humphery, H.; Gnagy, E.; Swanson, J.; et al. A Randomized Controlled Trial of Interventions for Growth Suppression in Children With Attention-Deficit/Hyperactivity Disorder Treated With Central Nervous System Stimulants. J. Am. Acad. Child Adolesc. Psychiatry 2020, 59, 1330-1341. DOI: 10.1016/j.jaac.2019.08.472 DOI: https://doi.org/10.1016/j.jaac.2019.08.472
40. Matthijssen, A.M.; Dietrich, A.; Bierens, M.; Kleine Deters, R.; van de Loo-Neus, G.H.H.; van den Hoofdakker, B.J.; Buitelaar, J.K.; Hoekstra, P.J. Continued Benefits of Methylphenidate in ADHD After 2 Years in Clinical Practice: A Randomized Placebo-Controlled Discontinuation Study. Am. J. Psychiatry 2019, 176, 754-762. DOI: 10.1176/appi.ajp.2019.18111296 DOI: https://doi.org/10.1176/appi.ajp.2019.18111296
41. Wernicke, J.F.; Adler, L.; Spencer, T.; West, S.A.; Allen, A.J.; Heiligenstein, J.; Milton, D.; Ruff, D.; Brown, W.J.; Kelsey, D.; et al. Changes in symptoms and adverse events after discontinuation of atomoxetine in children and adults with attention deficit/hyperactivity disorder: a prospective, placebo-controlled assessment. J. Clin. Psychopharmacol. 2004, 24, 30-35. DOI: 10.1097/01.jcp.0000104907.75206.c2 DOI: https://doi.org/10.1097/01.jcp.0000104907.75206.c2
42. Hammerness, P.; McCarthy, K.; Mancuso, E.; Gendron, C.; Geller, D. Atomoxetine for the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a review. Neuropsychiatr. Dis. Treat. 2009, 5, 215-226. DOI: 10.2147/ndt.s3896 DOI: https://doi.org/10.2147/NDT.S3896
43. Schonwald, A. Update: attention deficit/hyperactivity disorder in the primary care office. Curr. Opin. Pediatr. 2005, 17, 265-274. DOI: 10.1097/01.mop.0000156983.71532.eb DOI: https://doi.org/10.1097/01.mop.0000156983.71532.eb
44. Behrmann, J.T.; Blaabjerg, J.; Jordansen, J.; Jensen de Lopez, K.M. Systematic Review: Investigating the Impact of COVID-19 on Mental Health Outcomes of Individuals With ADHD. J. Atten. Disord. 2022, 26, 959-975. DOI: 10.1177/10870547211050945 DOI: https://doi.org/10.1177/10870547211050945
45. Chief Pharmaceutical Inspectorate. Dostępność Produktów Leczniczych w Polsce. Available online: https://www.gov.pl/web/gif/dostepnosc-produktow-leczniczych-w-polsce-16082024 (accessed on 31.03.2026).
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