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ADHD drugs not linked to suicidal behavior

New data published in The BMJ suggest that attention-deficit/hyperactivity disorder therapy does not increase the risk of suicide or attempts.

“We found no evidence for the link between drug treatment for ADHD and suicidal behavior,” Qi Chen, a PhD students at Karolinska Institute in Sweden, told Healio.com. “Although no evidence is not that same as evidence for no adverse effect, out research, in several ways, indicate that drug treatment is unlikely to systematically increase the risk of suicidal behavior because the research was based on large representative sample, long-term follow-up, and analyses from different perspectives.”

Qi Chen

Larsson and colleagues evaluated 37,936 people diagnosed with ADHD between 1960 and 1996 who were followed up between 2006 and 2009 to determine whether drug therapy, suicide attempts and suicides are linked.

Overall, there were 7,019 suicide-related events. Suicidal behaviors were more common among females (P<.001), older patients (P<.001), those receiving ADHD treatment (P<.001), those taking antidepressants (P<.001) and those with more comorbid conditions (P<.001) vs. patients without suicidal behaviors.

When the rate of suicide related events during treatment periods was compared with the rate for the same patients during non-treatment periods, no relationship was found between treatment and suicide-related events (HR=0.89; 95% CI, 0.79-1).

No increased rate for suicidal events was found among stimulant users (HR=0.81; 95% CI, 0.7-0.94). The results seemed to point to a protective effect of stimulants on suicidal behavior. No increased rate was found among non-stimulant/mixed users (HR=0.96; 95% CI, 0.77-1.2).When drug treatment periods were further divided into stimulant periods and non-stimulant treatment periods, no significant association was observed between non-stimulant treatment and suicide related events (HR=0.96; CI, 0.72-1.3).

“When it comes to individual patients, it is always important to balance the pros and cons,” Chen said. “Some patients with moderate to severe levels of ADHD might previously be discouraged to get effective drug treatment, and other might have bad adherence to drug treatment due to special concerns about suicide risk. These untreated or undertreated patients might therefore be at increased risk of ending up with other adverse consequences.” — by Amber Cox

Qi Chen, can be reached at qi.chen@ki.se.

Disclosure: The study was funded in part by the Ake Wibergs Foundation, the Strategic Research Program in Epidemiology at Karolinska Institute, the Swedish Council for Working Life and Social Research, a Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) framework grant, and the Swedish Research Council.