ADHD medications and suicide risk: Is there a connection?

There was no association found between medications commonly prescribed to treat attention deficit hyperactivity disorder and an increased risk of suicide attempts or completed suicides among adolescents and young adults, according to a recent well-designed study in the British Medical Journal.

The investigators of the study were able to follow over 37,000 individuals diagnosed with ADHD when they were and were not taking ADHD medications using data gathered from Sweden's national health registry. Not only was there no association found between taking the ADHD medications and suicidality; remarkably, results even suggested a protective effect for patients taking stimulants. That is, records showed fewer instances of suicidal behaviors when patients were taking these medications than when they were not. However, this was an association, and cannot prove that ADHD medication actually prevented suicidal behaviors.

These results should be considered in light of the FDA's decision in 2005 to add a black box safety warning to all packages of the non-stimulant Atomoxetine (Strattera), which stated that the drug was associated with increased suicidal thinking among children and adolescents.  The FDA's decision was based on a review of 12 studies where the drug was compared to placebo. Of the 1,375 patients taking Atomoxetine in those 12 studies, 0.4 percent (that's 4 in 1000) reported thinking about suicide, one patient actually attempted suicide (that's 0.07 percent), and no one died.

The results of the BMJ study should also provide worried parents some measure of relief when they are considering whether to add medications to the treatment of their child's ADHD.

Parents that I speak to in my clinic typically voice some or all of the following other concerns regarding ADHD medications:

1.

That they don't work.

No drug works for everybody. But, extremely well-designed, randomized, double-blind studies generally have shown ADHD medications to be

» READ MORE: considerably more effective

in treating ADHD symptoms than placebos.

» READ MORE: Reviews of these studies

have shown that 65-75 percent of individuals with ADHD responded to stimulants, compared to 4-30 percent who responded to placebos.

2.

That they aren't "safe."

As with any drug, there can be side effects.  However, the evidence for the effectiveness and safety of FDA-approved ADHD medications is

» READ MORE: so well-established

that the American Academy of Pediatrics “strongly recommends” them as a first line treatment for children 6 and over in their 2011 official

» READ MORE: clinical practice guidelines

.

3.

That they are addictive or a gateway drug.

In fact, good longitudinal studies generally have shown that taking FDA-approved medications for ADHD is associated with

less

» READ MORE: risk of smoking

and

» READ MORE: abuse of other drugs

.

4.

That more "natural" treatment – such as a change in diet or vitamin supplementation – is preferable

. Although some parents may “prefer” these interventions,

» READ MORE: scientific evidence generally does not support this practice

for most children with ADHD and these approaches may not work.

But ADHD medications alone are neither the be-all nor end-all of treatment for the disorder.  The addition of behavioral therapy via an experienced clinician can provide additional, sweet relief of impairments associated with ADHD. Indeed, the AAP advises this multi-modal approach and even recommends behavior therapy alone as a first line of treatment for preschoolers.

So what should parents of a child with ADHD do? Get that child scientifically-based care and maintain the stamina to continue with it as their child ages.

"There are a number of treatment options for parents who are trying to help their children manage ADHD. These options include stimulant and non-stimulant medications and behavioral interventions applied with the family and in school," states Tom Power, Ph.D., director of the ADHD Center at Children's Hospital of Philadelphia.

He further recommends that parents "collaborate with their child's primary care provider and school professionals to develop a comprehensive plan, monitor progress, and adapt the plan over time in response to the developmental needs of the child and changes in the family and school environments."

Have a question for the Healthy Kids panel? Ask it here. Read more from the Healthy Kids blog »