Man, Kenneth K.C., Coghill, David, Chan, Esther, Lau, Wallis C.Y., Hollis, Chris, Liddle, Elizabeth, Banaschewski, Tobias, McCarthy, Suzanne, Neubert, Antje, Sayal, Kapil, Ip, Patrick, Scheumie, Martijn, Sturkenboom, Miriam, Sonuga-Barke, Edmund J., Buitelaar, Jan, Carucci, Sara, Zuddas, Alessandro, Kovshoff, Hanna, Garas, Peter, Nagy, Peter, Inglis, Sarah K., Konrad, Kerstin, Hage, Aexander, Rosenthal, Eric and Wong, Ian C.K. (2017) Association of risk of suicide attempts with methylphenidate treatment. JAMA Psychiatry, 74 (10), 1048-1055. (doi:10.1001/jamapsychiatry.2017.2183).
Abstract
IMPORTANCE: Patients with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of attempting suicide. Stimulants such as methylphenidate (MPH) are the most common treatment for ADHD but the relationship between their therapeutic use and suicide is unclear.
OBJECTIVE: To investigate the association between MPH and the risk of suicide attempt.
DESIGN, SETTING, AND PARTICIPANTS: We used a population-based electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System to identify individuals aged 6-25 years who were treated with MPH between 2001 and 2015. Individuals who had attempted suicide were included in the analysis. We applied a self-controlled case series design to control for time-invariant characteristics of the patients.
MAIN OUTCOME MEASURE: Relative incidence of suicide attempt during periods when patients were exposed to MPH compared with non-exposed periods.
RESULTS: Among 25 629 patients with MPH prescriptions, 154 had their first recorded suicide attempt within the study period. The overall incidence of suicide attempt during MPH treatment was 9.27 per 10000 patient-years. An increased risk of suicide attempt was detected during the 90-day period before MPH was first initiated, with an incidence rate ratio (IRR) of 6.55 (95%CI 3.37-12.72). The IRR remained elevated during the first 90-days of treatment with IRR of 3.91 (95%CI 1.62-9.42), before returning to baseline levels during ongoing treatment (IRR=1.35; 95%CI 0.77-2.38). When the risk during the first 90-days of treatment was compared with the 90-days preceding first treatment, the incidence of suicide attempt was not elevated (IRR=0.78; 95%CI 0.26-2.35).
CONCLUSION: The incidence of suicide attempt was higher in the period immediately before the start of MPH treatment. The risk remains elevated immediately after the start of MPH treatment and returns to baseline levels during continuation of MPH treatment. The observed higher risk of suicide attempt prior to the start of treat 86 ment may reflect emerging psychiatric symptoms that trigger medical consultationswhich result in a decision to begin ADHD treatment. Our results, therefore, do not support a causal association between MPH treatment and suicide attempts.
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