ADHD, anxiety meds may increase risk of heat-related illnesses

On the heels of a handful of heat-related deaths in student-athletes, athletic trainers are searching for answers.

With more and more student-athletes taking prescribed ADHD and anxiety medication, healthcare professionals are looking into a possible negative reaction to those medications when individuals are exerting themselves in the heat.

A recent investigative story from ESPN.com’s Paula Lavigne dove into the data surrounding prescription ADHD and anxiety medication with heat-related illness in student-athletes. Below is an excerpt from Lavigne’s investigative piece.

Federal data show that heat-related illness diagnoses and heat stroke deaths have increased as global temperatures have risen. This summer, the hottest on record globally, five middle and high school football players in the U.S. died of heat stroke — the most since 2011, according to the National Center for Catastrophic Sport Injury Research.

“It’s almost like one of those perfect storm kind of things,” said Michael Szymanski, a research associate at the University of Connecticut. UConn is home to the Korey Stringer Institute, which studies heat-related deaths in sport.

Nearly one in three college students is on some type of psychotropic medication, according to the 2023-24 Healthy Minds Study of college students’ mental health. It is not uncommon for young adults to have multiple mental health conditions and to take more than one medication. About 35% of elite athletes “suffer from disordered eating, burnout, depression and/or anxiety,” according to a 2021 statement from the American College of Sports Medicine.

Nationally, doctors wrote 567 million prescriptions for mental health medications in 2022, according to data research company Statista, second only to prescriptions for drugs treating hypertension. That includes middle schoolers and middle-aged weekend warriors, who are less likely than college and pro athletes to be monitored by medical staff but could also be at higher risk for heat illness.

Studies show medications for treating mental health conditions can increase the risk for heat stroke by constricting blood vessels or inhibiting sweating, which prevents the body from adequately cooling itself. They can also raise blood pressure and core temperature, decrease the body’s perception of fatigue and/or put a general strain on the cardiovascular system.

“Blood vessels expand to let the heat dissipate during exertion,” Szymanski said. But stimulants, for example, can hamper that mechanism because they constrict blood vessels. “You just have a ramped-up system.”

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When asked whether these types of drugs are tested for heat stroke risk or whether they list heat stroke as a possible risk factor, a spokeswoman with the U.S. Food and Drug Administration wrote that each drug’s approval process is unique and she couldn’t answer based on the four classes of drugs.

Last year, the FDA updated the warning information on stimulants used to treat ADHD, listing Adderall, Concerta, Dexedrine and Ritalin as examples. The updated labels tell patients to look out for increased heart rate or blood pressure but do not mention heat stroke, exercise or exertion.

To read the full investigative story from ESPN.com about heat-related illnesses, click here.