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

Abstract

Background Attention-deficit/hyperactivity disorder (ADHD) is associated with high rates of psychiatric comorbidity, including depression. However, it is not yet clear whether ADHD medication increases or decreases the risk for depression. Methods We studied all individuals born between 1960 and 1998 and diagnosed with ADHD in Sweden (n=38,752). We obtained data for prescription of ADHD medication, diagnosis of depression and other psychiatric disorders, and socio-demographic factors from population-based registers. The association between ADHD medication and depression was estimated with Cox proportional hazards regression. Results ADHD medication was associated with a reduced long-term risk for depression (i.e., three years later), after adjustment for a number of socio-demographic and clinical confounders (HR=0.58, 95% CI: 0.51–0.67). The risk was lower for longer duration of ADHD medication. ADHD medication was also 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 (HR=0.80, 95% CI: 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.

ADHD Medication and Substance-Related Problems

“…They extend a finding of associations between stimulant medication and lower risk of substance-related problems in Sweden by demonstrating within-individual associations with not only lower concurrent risk but also lower long-term risk of substance-related events (19). Moreover, accumulating findings have also demonstrated within-individual associations with lower risk for injuries, transport accidents, criminality, depression, and suicide (26, 31–36). If these results reflect protective effects, it is possible that differing processes underlie decreased substance-related risk in the short and longer term.…”

Individualization of attention-deficit/hyperactivity disorder treatment: pharmacotherapy considerations by age and co-occurring conditions

“…184 With mild or moderate cases of depression, treatment of ADHD should be pursued, as it can reduce the long-term risk for depressive episodes. 185 A large study in Taiwan found lower rates of antidepressant resistance when individuals with ADHD and depression received combined treatment with antidepressants and psychostimulants vs treatment with antidepressant alone. 186 However, treatment of depression should take precedent over ADHD when it is the most disabling condition such as in major depressive disorder or suicidal cases.…”

What are the benefits of methylphenidate as a treatment for children and adolescents with attention-deficit/hyperactivity disorder?

“…Since long-term randomized trials are impossible and unavailable due to ethical limitations, recent analyses from registries provide the most convincing evidence on the long-term benefits of methylphenidate. These studies indicate, for example, that treatment with methylphenidate has beneficial effects in terms of important distal outcomes that go beyond symptom control such as a reduction in comorbid depression, substance-use and dependency, trauma-related visits to the emergency room and mortality (Chang et al 2014(Chang et al , 2016Dalsgaard et al 2015;Man et al 2015). Furthermore, in the absence of clinically relevant effects of non-pharmacological treatment options on the core symptoms of ADHD (SonugaBarke et al 2013), a dogmatically biased devaluation of the currently most effective treatment is neither helpful for science nor patients.…”