Articles instigate conversation about ADHD in women

Plus, posts expressed distrust in puberty blockers and shared concerns about a recalled antidepressant.

This past week, two articles initiated a spike in conversation about ADHD in women. Posts also responded to an article about an unpublished study looking at the impact of puberty blockers on the mental health of transgender youth. Other discussions expressed concerns about a recall of the antidepressant duloxetine, which is often sold under the brand name Cymbalta.

In response, public health communicators may outline the symptoms of ADHD in women and treatment options; explain how puberty blockers work, when they are prescribed, and what research tells us about their impact on trans mental health; and share general information about duloxetine, as well information about the recall and what patients should do if a medication they take is recalled.

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What’s trending nationally in conversations about mental health

Two recent articles published in National Geographic and on ABC News discussed the increasing number of women who have been diagnosed with ADHD and barriers to care that women with ADHD may face. The National Geographic article explained that ADHD has previously been underdiagnosed in girls and women, likely because women and girls with ADHD may exhibit different symptoms than boys and men. The ABC News article featured interviews with women who struggled to receive an ADHD diagnosis and faced barriers to accessing treatment. These articles spread across social media platforms—primarily on Facebook and Instagram. In posts and comments, users shared their own struggles with managing ADHD symptoms and accessing medication. Some comments argued about whether the uptick in ADHD diagnoses in women is due to ADHD being “a trend.”

On October 23, the New York Times published an article about a doctor who has not yet published data from a study on the mental health effects of puberty blockers in trans children due to concerns about how the findings could be weaponized by opponents of trans rights. The study followed trans children for two years after they had been prescribed puberty blockers. While the study has not been published and reviewed, the doctor’s early data suggests that gender-affirming care did not improve mental health in the children who participated in the study, contradicting previous studies’ findings. However, the children did not experience worsening mental health, which suggests that puberty blockers may have preventative effects, according to an expert quoted in the article. Other researchers quoted in the article expressed concern about the delay in publishing the study’s findings. The article spread widely across social media platforms. One X post from the New York Post sharing an article that referenced the New York Times story received approximately 57.5 million views, 25,000 likes, 8,800 reposts, and 1,100 comments as of October 30. Most comments expressed distrust in puberty blockers and in doctors who prescribe them. Other comments falsely claimed that puberty blockers are unsafe or that they “don’t exist.”

Many recent articles and social media posts discussed the FDA’s recall of thousands of bottles of duloxetine, an antidepressant, due to the presence of N-nitroso duloxetine, which can be toxic at elevated levels and can potentially cause cancer. The recall only applies to 20 mg capsules sold in 500-count bottles. In response to posts sharing this news on X and Facebook, users expressed concern about the recall, with some asking what they should do if they rely on the recalled medication. Others discussed the side effects they experienced after missing doses of duloxetine or weaning off of the medication. One read, “Coming off of duloxetine almost killed me. I thought I was going to die every day from the physical and mental side effects.”

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Recommendations for public health professionals

Each week, the Infodemiology.com team will provide messaging recommendations in response to some of the trending narratives outlined above. These helpful tips can be used when creating content, updating web and FAQ pages, and developing strategy for messaging about mental health.

In light of conversation about ADHD in women, communicators may outline the symptoms in ADHD in girls and women, as well as information about how people who suspect that they have ADHD can seek a diagnosis. Messaging may emphasize that there are three types of ADHD with distinct symptoms: inattentive, hyperactive/impulsive, and combined. Women are more likely to have inattentive ADHD, which results in trouble focusing, difficulty completing tasks, trouble staying organized, and forgetfulness. These symptoms can be more challenging to recognize than the symptoms of other types of ADHD, thus contributing to ADHD being underdiagnosed in girls and women. Sharing the types of ADHD medication and how they work is recommended. Communicators may also want to share online tools for ADHD management that people can use in combination with medication or on their own.

Conversations about puberty blockers provide an opportunity to explain how they work and how they benefit trans youth. Communicators may explain that puberty blockers temporarily delay the production of hormones that initiate puberty, giving trans youth more time to understand their gender identities before deciding on next steps. Prior to their use in gender-affirming care, puberty blockers were used safely for decades to treat children experiencing early puberty and are still prescribed for the same purpose today. Messaging may emphasize that both the Endocrine Society and the American Academy of Pediatrics recommend that trans children and teens have access to developmentally appropriate gender-affirming care. Communicators may also explain that public research shows that gender-affirming care positively impacts mental health in trans youth and adults. A 2022 study found that access to hormone replacement therapy and puberty blockers lowered the odds of depression in trans people between the ages of 13 and 20 by 60 percent and also reduced the odds of self-harm and suicidal thoughts by 73 percent. 

In response to concerns about the duloxetine recall, communicators may explain that the only duloxetine pills that have been recalled are 20 mg capsules sold in 500-count bottles. The FDA advises that people who are currently taking duloxetine should continue taking their medication as prescribed until they can talk to their health care provider about getting a new prescription, “as the risks of stopping their medicine may outweigh the potential risk of exposure to nitrosamines.” People who have questions about recalled medication can contact the FDA’s Division of Drug Information via email at DrugInfo@fda.hhs.gov or by phone at 855-543-DRUG (3784) and 301-796-3400. Sharing general information about what physical and mental health conditions duloxetine is approved to treat is recommended. Messaging may emphasize that stopping duloxetine suddenly can trigger withdrawal symptoms. Patients who are stopping duloxetine should taper off the medication under the guidance of a health care provider.