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Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts

Published:December 13, 2019DOI:https://doi.org/10.1016/j.biopsych.2019.12.003

      Abstract

      Background

      Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for suicidal behavior, but the effect of ADHD medication on suicidal behavior remains unclear. This study aimed to examine the associations between medication treatment for ADHD and risk of suicide attempts.

      Methods

      We identified a large cohort of patients with ADHD (N = 3,874,728, 47.8% female patients) using data from commercial health care claims from 2005 to 2014 in the United States. We used population-level and within-individual analyses to compare risk of suicide attempts during months when individuals received prescribed stimulant or nonstimulant medication relative to months when they did not receive medication.

      Results

      In both population-level and within-individual analyses, ADHD medication was associated with lower odds of suicide attempts (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.66–0.73; and OR, 0.61; 95% CI, 0.57–0.66, respectively). Similar reductions were found in children to middle-aged adults and in clinically relevant subgroups, including patients with ADHD with preexisting depression or substance use disorder. The reduction was mainly seen for stimulant medication (OR, 0.72; 95% CI, 0.66–0.77); nonstimulant medication was not associated with statistically significant changes in risk of suicide attempts (OR, 0.94; 95% CI, 0.74–1.19). Sensitivity analyses assessing the influence of different exposure definitions, different outcome definitions, subsets of the cohort, and different analytic approaches provided comparable results.

      Conclusions

      Stimulant medication was associated with a reduced risk of suicide attempts in patients with ADHD, and nonstimulant medication is unlikely to increase the risk of suicide attempts.

      Keywords

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      Linked Article

      • The Impact of Attention-Deficit/Hyperactivity Disorder Medications on Suicidality: Implications and Mechanisms
        Biological PsychiatryVol. 88Issue 6
        • Preview
          Although stimulant medications for attention-deficit/hyperactivity disorder (ADHD) have been used for many decades and are recommended in clinical guidelines, they have been the target of many media campaigns that decry their effectiveness and raise alarms about adverse effects, despite substantial evidence to the contrary from double-blind randomized controlled trials (RCTs) (1). The dissemination of misinformation about medications for ADHD is far from benign. It creates stigma and diverts parents and patients from evidence-based treatments to less effective or ineffective alternatives (2).
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