Association of Risk of Suicide Attempts With Methylphenidate Treatment,JAMA Psychiatry

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Association of Risk of Suicide Attempts With Methylphenidate Treatment
JAMA Psychiatry ( IF 22.5 ) Pub Date : 2017-10-01 , DOI: 10.1001/jamapsychiatry.2017.2183
Kenneth K. C. Man ₁ , David Coghill ₂ , Esther W. Chan ₃ , Wallis C. Y. Lau ₃ , Chris Hollis ₄ , Elizabeth Liddle ₄ , Tobias Banaschewski ₅ , Suzanne McCarthy ₆ , Antje Neubert ₇ , Kapil Sayal ₄ , Patrick Ip ₈ , Martijn J. Schuemie ₉ , Miriam C. J. M. Sturkenboom ₁₀ , Edmund Sonuga-Barke ₁₁ , Jan Buitelaar ₁₂ , Sara Carucci ₁₃ , Alessandro Zuddas ₁₃ , Hanna Kovshoff ₁₁ , Peter Garas ₁₄ , Peter Nagy ₁₄ , Sarah K. Inglis ₁₅ , Kerstin Konrad ₁₆ , Alexander Häge ₅ , Eric Rosenthal ₁₇ , Ian C. K. Wong ₁₈

Affiliation

Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong2Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong3Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands4The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium5Division of Neuroscience, School of Medicine, University of Dundee, Dundee, Scotland6Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium7Centre for ADHD and Neuro-developmental Disorders Across the Lifespan, Institute of Mental Health, Nottingham, England8Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, England
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium9Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium10School of Pharmacy, University College Cork, Cork, Ireland
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium11Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
Janssen Research & Development, LLC, Titusville, New Jersey
Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium13Department of Psychology, University of Southampton, Southampton, England
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium14Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, and Karakter Child and Adolescent Psychiatry, Nijmegen, the Netherlands
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium15Department of Biomedical Sciences, Section Of Neuroscience and Clinical Pharmacology, University of Cagliari, and Child and Adolescent Neuropsychiatry Unit, G. Brotzu Hospital Trust, Cagliari, Italy
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium16Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium5Division of Neuroscience, School of Medicine, University of Dundee, Dundee, Scotland17Tayside Clinical Trials Unit, University of Dundee, Dundee, Scotland
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium18Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinics Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium19Evelina London Children’s Hospital, London, England
Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong2Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong4The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium20Research Department of Practice and Policy, University College London School of Pharmacy, London, England

Importance Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear.

Objective To investigate the association between methylphenidate and the risk of suicide attempts.

Design, Setting, and Participants A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients.

Main Outcomes and Measures Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods.

Results Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts during methylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was 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 (IRR, 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 attempts was not elevated (IRR, 0.78; 95% CI, 0.26-2.35).

Conclusions and Relevance The incidence of suicide attempts was higher in the period immediately before the start of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study’s results do not support a causal association between methylphenidate treatment and suicide attempts.

更新日期：2017-10-06

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