Last year a patient of mine suffered a cardiac arrest while on holiday in Spain. He was in his forties and perfectly fit. He had no history of heart problems and neither did anyone in his family. In other words, it came totally out of the blue. He was very lucky to survive.Returning home he saw a cardiologist, who scoured his medical history looking for clues. Then he picked up on something that would never have occurred to me.My patient had been on medication for ADHD for many years and the cardiologist wondered whether it might have played some part. I have a very good relationship with this patient, and so when he mentioned it to me I had to confess I wasn’t able to shed any light on the issue.I went home that evening feeling faintly ashamed of myself. I have done courses and training in ADHD assessment and treatment. I’m a consultant psychiatrist and prescribe this medication, and yet I couldn’t have told him what 30 years of taking it does to your heart.So I looked into it. What I found shocked me and changed the way I practise. The average clinical trial of ADHD medication lasts just 75 days. That is the evidence-base on which we hand these drugs to schoolchildren and keep them on them for decades. I wasn’t taught about the long-term effects on the heart at medical school or during my specialist training because, until recently, there was next to nothing to teach. That changed in 2024, when Swedish researchers followed 278,000 people with ADHD for up to 14 years.They found that the longer someone was on the medication, the greater their risk of heart disease. After five years, the risk had climbed by almost a quarter. The risk of high blood pressure was up by 80 per cent.And the higher the dose, the worse it got. Yet despite all this, we’ve somehow convinced ourselves that these are harmless little pills. I hear it constantly, from patients and from colleagues. ‘No harm in giving them a go, they might help.’ I have even heard it said about people who don’t come close to meeting the criteria for ADHD.They are not vitamins. Methylphenidate and lisdexamfetamine, two of the most commonly prescribed medications for ADHD, are Schedule 2 controlled drugs. Methylphenidate and lisdexamfetamine, two of the most commonly prescribed medications for ADHD, are Schedule 2 controlled drugs, which puts them in the same category as morphine and fentanylThat places them in the same category as morphine and fentanyl, drugs the law accepts have a medical use but treats as seriously open to abuse and which are therefore subject to tight controls. But, at the same time, we’re continuing to dish them out to ever-growing numbers.Prescribing to British women over 25 has risen more than 20-fold since 2010. Why? Because of something in medicine known as ‘diagnosis creep’.In 2013 the diagnostic manual for ADHD was rewritten. The number of symptoms an adult needed to be diagnosed dropped from six to five. This change might not seem like much, yet when researchers tested this on university students, 12.7 per cent met the old threshold and 21 per cent met the new one. Taking away a single symptom produced 65 per cent more people with ADHD. The age by which symptoms had to have appeared shifted from seven to 12, while the requirement that those symptoms had actually caused the child any problems was quietly dropped altogether. We didn’t get better at diagnosing ADHD, we simply lowered the bar.And here’s another deeply troubling fact: of British adults over 25 starting on ADHD medication, more than 70 per cent had already been taking antidepressants. That figure stopped me in my tracks.These aren’t people whose lifelong condition has finally been recognised, they’re people who have been round the houses in their search for answers.One label didn’t fit, so here’s another. That pill didn’t work, try this one. I’d wager nobody asked about other factors: stress at work, trouble in their relationships, poor sleep – and how many hours a day they spend staring at a screen.Increasingly, we are viewing life’s challenges as a problem to be medicated. What makes me so angry is that NICE, the body responsible for clinical guidelines, already states plainly how to proceed.For adults, and for children over five years old, medication should only be offered if symptoms are still causing significant impairment after environmental modifications have been tried and reviewed.And what are these environmental modifications? Move a desk, reduce noise, try headphones, take proper breaks – all common-sense stuff.But moving a desk for a child would mean liaising with the school. For an adult it could involve HR at work. Both might take a while to resolve. Filling in the prescription pad, takes minutes.Of course, for people who truly have profound ADHD that makes their lives a misery and stops them functioning, these drugs can be transformative. I have seen it in my own patients. But people are entitled to know what they’re swallowing.Last August the Royal College of Psychiatrists said it found no increase in heart problems in adults on ADHD medication.Since that incident in Spain, I’ve taken to gently asking every patient on ADHD medication whether anyone has ever explained the possible long-term effects on their heart. Not one has said yes.Instead, they stare at me, wide-eyed, and ask why on earth nobody told them. Nobody told my patients because, officially, there isn’t very much to tell.I don’t accept that and neither should you.Claudia is brave to walk away Claudia Winkleman, pictured at the 2024 Baftas, has quit her BBC chat show after a single series, saying she was ‘just too nervous to enjoy it’Claudia Winkleman has walked away from her BBC chat show after a single series, saying she was ‘just too nervous to enjoy it’.Already people are questioning this and wondering what the real story is. Was it a flop? Was she embarrassed?She told us before the first episode even aired that she wasn’t sure she’d be any good at it and it might all be ‘a disaster’ and that she was lacking ‘curiosity and vim.’It turned out that the ratings were healthy, the reviews were mostly warm and the BBC were eager to sign her up for a second series. Despite all this Claudia said ‘no thanks’ and walked away.I love that she did this because it’s something us Brits are usually terrible at. We treat quitting as failure and staying put as strength of character. There’s even a name for it in psychology: the sunk cost fallacy.We carry on with things because of what we’ve already ploughed into them, not because of what we’ll ever get out.Claudia has spent decades in television, 12 years on Strictly Come Dancing and now she fronts The Traitors franchise, BBC’s biggest show in recent years. She can clearly handle the stress and demands of television.It’s why I think she’s telling the truth about nerves and how they prevented her from enjoying the experience of hosting a chat show. A bit of anxiety before something new is perfectly normal, and it usually settles as you get better at the thing. When it doesn’t settle, that’s worth listening to. It’s telling you something about the fit between you and the job. Most of us push on through regardless and call it resilience.Claudia says she already has the best jobs in the world and loves them. Good for her. There’s no shame in trying something and finding it isn’t for you. The only shame is in pretending otherwise.Children born during the first lockdown are struggling to concentrate, follow instructions and manage their emotions according to researchers at City St George’s who tracked 205 of them. A third were rated as having difficulties with ‘executive function’, the ability to plan, resist distraction, stick to a task and regulate emotions. Their language was fine, hardly surprising since their parents were home talking to them all day. What they were starved of was everybody else. We undertook a dreadful, reckless social experiment when we shut a generation of little ones away from other people at the very age when learning to read other people is a baby’s whole job. I said at the time that lockdown would have serious impact on society, and that it would be children who paid the highest price.A drug that slows Alzheimer’s by ‘up to 8 years’ was approved in the US last week and could soon reach the NHS. However, the data comes from a computer model built by the drug’s manufacturers, comparing patients who all received the drug against a historical database of people who didn’t. The actual randomised trial ran for 18 months and the benefit was modest, which means ‘up to’ is doing an awful lot of work in that sentence.Dr Max Prescribes: Time offA few years ago I didn’t take a single day’s leave, not one, in an entire year. The waiting list at the service was so long that going away felt indefensible, so I kept turning up. When someone finally noticed I got a proper telling off, quite rightly. I’ve never let it happen since, though booking time off turns out to be the easy part. So many of my patients spend their fortnight answering work emails from a sunlounger and come home more stressed than when they left. Book the time off. Go. Then switch off... completely.