ADHD Medications Associated With Reduced Risk for Suicidality, Hospitalizations

Keypoint: A third of adults with ADHD experience some form of work disability.

Attention-deficit/hyperactivity disorder (ADHD) medication use is associated with a lower risk for hospitalizations – both psychiatric and nonpsychiatric – and suicidal behavior, according to study results published in JAMA Network Open.

Although pharmacotherapy is the primary treatment recommendation for ADHD, there are ongoing concerns about its long-term effectiveness and safety, particularly regarding its potential effect on cardiovascular health and the risk of inducing psychosis. To this aim, researchers conducted a prospective population-based cohort study to evaluate the relationship between ADHD medication use and both hospitalization outcomes and work disability.

The researchers used data from Swedish national registers to identify individuals 16 to 65 years of age who were residing in Sweden and diagnosed with ADHD between January 2006 and December 2021. The primary exposure was ADHD medication use, confirmed via Anatomical Therapeutic Chemical codes. The primary outcomes of interest included psychiatric hospitalizations, attempts of suicide or suicide-related deaths, hospitalizations for nonpsychiatric reasons, and instances of work disability (defined as instances of sickness absence lasting over 14 days or the issuance of a disability pension of any level). Both ADHD diagnoses and outcomes were verified using International Classification of Diseases (ICD) codes.

A total of 221,714 individuals were included for analysis. On average, individuals were 25 years of age at baseline and 54.6% (n=120,968) were boys/men. Over half of the individuals (56.5%) presented with psychiatric comorbidities, which primarily consisted of anxiety or stress-related disorders (24%) and depression or bipolar disorders (19.5%). The majority of participants (61%) possessed a low level of education, though this was largely attributed to the group’s relatively young age.

The researchers found that methylphenidate was the most commonly used ADHD medication, as it was utilized by 68.5% (n=151,837) of individuals. Lisdexamphetamine was the second most common (35.2%; n=78,106), followed by polytherapy (27.1%; n=60,102) and atomoxetine (15.6%; n=34,631).

Over the 15-year study period, 25.6% (n=56,704) of individuals experienced psychiatric hospitalization. The risk for psychiatric hospitalization was significantly lower among individuals using amphetamine (adjusted hazard ratio [aHR], 0.74; 95% CI, 0.61-0.90; P =.003), lisdexamphetamine (aHR, 0.80; 95% CI, 0.78-0.82; P <.001), ADHD polytherapy (aHR, 0.85; 95% CI, 0.82-0.88; P <.001), dexamphetamine (aHR, 0.88; 95% CI, 0.83-0.94; P <.001), and methylphenidate (aHR, 0.93; 95% CI, 0.92-0.95; P <.001), relative to periods when ADHD medications were not used.

The risk for suicidal behavior was also significantly lower among those using dexamphetamine (aHR, 0.69; 95% CI, 0.53-0.89; P =.004), lisdexamphetamine (aHR, 0.76; 95% CI, 0.68-0.84; P <.001), ADHD polytherapy (aHR, 0.85; 95% CI, 0.74-0.98; P =.02) and methylphenidate (aHR, 0.92; 95% CI, 0.86-0.98; P =.007).

The ADHD medications associated with a lower risk for nonpsychiatric hospitalizations included amphetamine (aHR, 0.62; 95% CI, 0.45-0.84; P =.002), lisdexamphetamine (aHR, 0.64; 95% CI, 0.61-0.67; P <.001), polytherapy (aHR, 0.67; 95% CI, 0.62-0.72; P <.001), dexamphetamine (aHR, 0.72; 95% CI, 0.65-0.80; P <.001), methylphenidate (aHR, 0.80; 95% CI, 0.78-0.82; P <.001), and atomoxetine (aHR, 0.84; 95% CI, 0.78-0.90; P <.001).

Additionally, the researchers evaluated work disability among a subset of 189,380 participants and found that 30% faced work disability over a 6-year follow-up period.

Atomoxetine was associated with a marginally lower risk for work disability (aHR, 0.89; 95% CI, 0.82-0.97), particularly in adolescents and young adults aged 16 to 29 years (aHR, 0.82; 95% CI, 0.73-0.92). Conversely, the use of polytherapy was associated with an increased risk for work disability (aHR, 1.12; 95% CI, 1.05-1.20).

“Considering the high prevalence of psychiatric comorbidity in persons with ADHD, these results suggest that ADHD medication use can reduce morbidity in adolescents and adults with ADHD,” the researchers concluded.

Study limitations include limited adjustment for psychiatric conditions, incomplete clinical data due to the reliance on nationwide registers, and a lack of accurate data regarding nonpharmacological treatments, work disability (beyond the study definition), and suicide attempts that did not lead to hospital admission.

Note: This article originally appeared on Psychiatry Advisor