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

Abstract 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 middle-aged 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. Conclusions Stimulant medication was associated with a reduced risk of suicide attempts in patients with ADHD, and non-stimulant medication is unlikely to increase the risk of suicide attempts.