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Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Depression: A Nationwide Longitudinal Cohort Study

Published:February 23, 2016DOI:https://doi.org/10.1016/j.biopsych.2016.02.018

      Abstract

      Background

      Attention-deficit/hyperactivity disorder (ADHD) is associated with high rates of psychiatric comorbidity, including depression. However, it is unclear whether ADHD medication increases or decreases the risk for depression.

      Methods

      We studied all individuals with a diagnosis of ADHD born between 1960 and 1998 in Sweden (N = 38,752). We obtained data for prescription of ADHD medication, diagnosis of depression and other psychiatric disorders, and sociodemographic factors from population-based registers. The association between ADHD medication and depression was estimated with Cox proportional hazards regression.

      Results

      After adjustment for sociodemographic and clinical confounders, ADHD medication was associated with a reduced long-term risk (i.e., 3 years later) for depression (hazard ratio = 0.58; 95% confidence interval, 0.51–0.67). The risk was lower for longer duration of ADHD medication. Also, ADHD medication was associated with reduced rates of concurrent depression; within-individual analysis suggested that occurrence of depression was 20% less common during periods when patients received ADHD medication compared with periods when they did not (hazard ratio = 0.80; 95% confidence interval, 0.70–0.92).

      Conclusions

      Our study suggests that ADHD medication does not increase the risk of later depression; rather, medication was associated with a reduced risk for subsequent and concurrent depression.

      Keywords

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      Linked Article

      • Can Medication Effects Be Determined Using National Registry Data? A Cautionary Reflection on Risk of Bias in “Big Data” Analytics
        Biological PsychiatryVol. 80Issue 12
        • Preview
          Stimulant and nonstimulant medications are recommended as part of attention-deficit/hyperactivity disorder (ADHD) treatment, based on the best available evidence of their costs and benefits (1). At the same time, some important clinical questions remain to be definitively resolved. This is because of both limitations in the scope of previous trials and, in some cases, their methodological and design weaknesses. Added to this, a degree of skepticism exists, in some quarters, concerning the veracity of the ADHD medication evidence base as a whole, because of the potentially distorting effect of pharmaceutical industry involvement in trials.
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