Association between psychostimulant agents and suicide related events in individuals with Attention-Deficit Hyperactivity Disorder

Attention-Deficit Hyperactivity Disorder (ADHD) is a common condition among the pediatric population with escalating use of psychostimulant agents to treat ADHD. No previous studies have directly aimed to evaluate the potential association between psychostimulant medications and suicide related events. Over the past decade there has been an increasing awareness for the potential of prescription medications to increase the risk of suicide related events, including agents such as antidepressants, leukotriene modifying agents, atomoxetine, and antiepileptics. Given the lack of data to support or refute the association between psychostimulants and suicide related events, additional, more definitive studies are warranted. Therefore, it was the objective of this dissertation to determine if a potential association exists between psychostimulants and suicide related events utilizing three different methodologies. This series of analyses were the first well-conducted observational studies investigating this association. We conducted an ecologic study utilizing Food and Drug Administration (FDA) adverse event data, a time series analysis describing overall Attention-Deficit Hyperactivity Disorder (ADHD) diagnosis and treatment characteristics as well as suicide attempt trends using aggregated medical claims data, and a nested case-control study utilizing person level medical claims data. Each aim provided additional insight on the potential association of suicide related events and psychostimulants. Our first analysis using FDA data indicated that psychostimulants had no statistically significant association with suicide related events with the exception of lisdexamfetamine. Our second study showed that the percentage of suicide attempts and psychostimulant coverage declined over time among our ADHD cohort. Our third analysis, a case control study in an ADHD cohort of children and adolescents showed that psychostimulants are not associated with an increased risk of suicide attempt. Based on our findings across all analyses and accounting for the limitations of each, we conclude that psychostimulant treatment is not associated with an increased risk of suicide related events. In fact, while not statistically significant our findings suggest a potentially protective role in this association thus further supporting the safety of these agents which play a beneficial in the treatment of ADHD.