Early ADHD Drug Treatment Linked With Reduced Risk of Suicide, Substance Misuse, and Other Adverse Outcomes
Patients with attention-deficit/hyperactivity disorder (ADHD) who began drug treatment within 3 months of diagnosis had significantly reduced rates of suicidal behaviors, substance misuse, traffic accidents, and criminality over 2 years compared with patients who did not initiate ADHD medication, according to a study published in The BMJ.
“This study provides evidence on the effects of starting and sustaining drug treatment for ADHD on important clinically relevant outcomes. These findings are applicable to people with ADHD in routine clinical settings, who face challenges across different domains and throughout different phases of their lives,” wrote corresponding author Le Zhang, PhD, a postdoctoral researcher at Karolinska Institutet, Stockholm, Sweden, and study coauthors.
The study, based on national registry data for 148,581 pediatric and adult patients with newly diagnosed ADHD in Sweden, used a target trial emulation framework. Target trial emulation employs the design principles of randomized trials and is one of the most rigorous ways to analyze observational data.
>>FACULTY INSIGHTS: Breaking Down Treatment Barriers for Girls and Women With ADHD
Among patients in the study, 41.3% were female and the median age was 17.4 years. Some 56.7% began drug treatment for ADHD within 3 months of diagnosis. The most common medication prescribed was methylphenidate (88.4%).
After controlling for age, sex, education, psychiatric diagnoses, and medical history, researchers found ADHD medication was associated with reduced rates of a first occurrence of 4 of 5 outcomes over 2 years of follow-up. Compared with no drug treatment, ADHD medication was linked with a 17% decrease in suicidal behavior, a 15% decrease in substance misuse, a 12% decrease in traffic accidents, and a 13% decrease in criminality.
The decrease associated with ADHD medication was not statistically significant for a first occurrence of an accidental injury, which had an incident rate of 88.5 vs 90 per 1000 person years for patients with no drug treatment.
“For recurrent events,” researchers reported, “ADHD drug treatment was statistically associated with reduced rates of all these outcomes, including accidental injuries.”
Specifically, people with recurrent events who began early ADHD medication had decreases of 15% for suicidal behaviors , 25% for substance misuse, 4% for accidental injuries, 16% for traffic accidents, and 25% for criminality.
“Additionally, ADHD drug treatment was associated with greater risk reduction in people with a history of the outcome event and for repeated suicidal behaviour events in children and youths,” researchers wrote. “Stimulant drugs were associated with lower rates of all 5 outcomes compared with nonstimulant drugs.”
The findings, researchers advised, should be used to guide clinical practice and inform debate on medication for patients with ADHD.
References
