Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study

Linden, Stephan; Bussing, Regina; Kubilis, Paul; Gerhard, Tobias; Segal, Richard; Shuster, Jonathan J.; Winterstein, Almut G.

doi:10.1542/peds.2015-3199

Cited by 19 publications

(13 citation statements)

References 31 publications

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“…We identified five studies from Europe and Asia that investigated completed suicide or suicide attempts or self-harm (59)(60)(61)(62)(63). Three studies investigated short-term effects (59,62,63) and two of them adopted within-individual designs (59,63).…”

Section: Suicidalitymentioning

confidence: 99%

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

Chang

Ghirardi

Quinn³

et al. 2019

Biological Psychiatry

108

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ADHD medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry, and its use is increasing rapidly in adult psychiatry. However, major questions and concerns remain regarding the benefits and risks of ADHD medication, especially in real-world settings. We conducted a qualitative systematic review on studies that investigated the effects of ADHD medication on behavioral and neuropsychiatric outcomes using linked prescription databases from the last ten years, and identified 40 studies from Europe, North America, and Asia. Among them, 18 have used within-individual designs to account for confounding by indication. These studies suggested short-term beneficial effects of ADHD medication on several behavioral or neuropsychiatric outcomes (i.e., injuries, motor vehicle accidents, education, substance use disorder), with estimates suggesting relative risk reduction of 9-58% for these outcomes. The within-individuals studies found no evidence of increased risks for suicidality and seizures. Replications studies are needed for several other important outcomes (i.e., criminality, depression, mania, psychosis). The available evidence from pharmacoepidemiology studies on long-term effects of ADHD medication are less clear. We discussed time-varying confounding and other limitations which should be considered when interpreting results from

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Section: Suicidalitymentioning

confidence: 99%

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

Chang

Ghirardi

Quinn³

et al. 2019

Biological Psychiatry

108

View full text Add to dashboard Cite

show abstract

“…A few studies using prescription databases from Europe and Asia have found null or protective effects of stimulant medications on risk of suicidal behavior (18)(19)(20)(21), but evidence from large-scale US studies is lacking. Only one comparative study between atomoxetine and stimulants is available (22), but it provided no direct estimate of the effects of these medications on risk of suicidal behavior. In addition, several clinically relevant questions are yet to be explored.…”

Section: Introductionmentioning

confidence: 99%

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

Chang

Quinn

O’Reilly

et al. 2020

Biological Psychiatry

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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) using data from commercial healthcare claims 2005-2014 in the US. We used population-level and within-individual analyses to compare risk of suicide attempts during months when individuals received prescribed stimulant or non-stimulant 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% CI: 0.66-0.73, and OR=0.61, 95% CI: 0.57-0.66, respectively). Similar reductions were found in children to middleaged adults and in clinically relevant subgroups, including ADHD patients with pre-existing depression or substance use disorder. The reduction was mainly seen for stimulant medication (OR=0.72, 95% CI: 0.66-0.77); non-stimulant 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.

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Section: Discussionmentioning

confidence: 99%

“…48 Finally, a US insurance claims study of 223,303 patients between 5 and 17 years of age, who had used CS as a first-line ADHD treatment, confirmed that suicidal events (attempt or completed suicide) were rare, 26.3 per 100,000 person years during current CS use and 32.6 per 100,000 person years during former CS use. 49 Adjunctive CS treatment in patients with BD In patients with BD, depressive symptoms have been associated with an increased risk of suicidal behaviour. [50][51][52] This makes patients with BD-II disorder particularly vulnerable.…”

Section: Risk Of Suicidal Behaviour With Cs In Patients With Only Adhdmentioning

confidence: 99%

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

Öhlund

Ott

Lundqvist

et al. 2020

Therapeutic Advances in Psychopharmacology

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Background: Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events. Methods: A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers. Results: Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events ( p = 0.013) and numbers of events experienced ( p = 0.004). These effects were preserved 2 years after CS initiation. Conclusions: CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.

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Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study

Cited by 19 publications

References 31 publications

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases

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

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

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