26 Jul Risk of Suicide Attempts With Methylphenidate Treatment for ADHD
MedicalResearch.com Interview with:
Professor Ian Chi Kei Wong and
Kenneth KC Man, Senior Research Assistant
Department of Social Work and Social Administration, Faculty of Social Science
Department of Pharmacology and Pharmacy, LKS Faculty of Medicine
The University of Hong Kong
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients with attention-deficit/hyperactivity disorder (ADHD) are at higher risk of various mental health problems. Previous studies suggested that individuals with ADHD are having a higher chance of both attempted and completed suicide. Methylphenidate is a psychostimulant that is recommended for the treatment of ADHD. With the increasing usage of methylphenidate over the past decade, there are concerns about the safety of the medication, in particular, psychiatric adverse effects such as suicide attempt.
The current study looked into over 25,000 patients aged 6 to 25 years in Hong Kong who were receiving methylphenidate in 2001 to 2015. Using the self-controlled case series design, in which the patients act as their own control, we found that the risk of suicide attempt was 6.5 fold higher during a 90-day period before methylphenidate was initiated, remained elevated 4-fold during the first 90 days of treatment, and returned to the normal level during ongoing treatment.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: These findings indicate that the increased risk of suicide attempts preceding the initiation of methylphenidate is unlikely to be causally related to the drug’s effects. The elevated risk of suicide attempts observed before treatment initiation may be linked to emerging mental health symptoms that may also lead to medical consultations that led to the decision to start ADHD treatment.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Further research is needed to understand the dose effect of methylphenidate on suicide attempt and also research on the effect of other ADHD medications is also needed.
MedicalResearch.com: Is there anything else you would like to add?
Response: There are documented benefits to methylphenidate use such as improvements in ADHD symptoms (attention, hyperactivity, impulsivity) but there are also well-documented side effects such as decreased appetite and sleep disturbances. Drug treatment of ADHD remains only part of a comprehensive treatment programme, which incorporates psychosocial interventions as well. Use of these medications should only be initiated after a careful evaluation and weighing the risk and benefits.
Disclosure: The Attention Deficit/Hyperactivity Disorder Drug Use Chronic Effects (ADDUCE) project, European Community’s 7th Framework Programme project number 260576, partially funded this project.
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Man KKC, Coghill D, Chan EW, Lau WCY, Hollis C, Liddle E, Banaschewski T, McCarthy S, Neubert A, Sayal K, Ip P, Schuemie MJ, Sturkenboom MCJM, Sonuga-Barke E, Buitelaar J, Carucci S, Zuddas A, Kovshoff H, Garas P, Nagy P, Inglis SK, Konrad K, Häge A, Rosenthal E, Wong ICK. Association of Risk of Suicide Attempts With Methylphenidate Treatment. JAMA Psychiatry. Published online July 26, 2017. doi:10.1001/jamapsychiatry.2017.2183
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