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ADHD Medication Use, Particularly Stimulants, Tied to Fewer Hospitalizations
In a recent cohort study, use of medication for attention-deficit/hyperactivity disorder (ADHD), especially lisdexamphetamine and other stimulants, was associated with fewer hospitalizations for psychiatric and non-psychiatric reasons, and lower suicidal behavior, according to results published in JAMA Network Open.
“Considering the high prevalence of psychiatric comorbidity in persons with ADHD, these results suggest that ADHD medication use can reduce morbidity in adolescents and adults with ADHD,” noted lead author Heidi Taipale, PhD, Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, and co-authors.
>>QUIZ: Women with ADHD are diagnosed how many years after men?
This nationwide cohort study in Sweden examined individuals aged 16 to 65 diagnosed with ADHD between 2006 and 2021, using various registers for health care, sickness absence, and disability pension. Researchers analyzed data from November 2022 to August 2023 to assess the association between the use of specific ADHD medications and outcomes such as psychiatric hospitalization, suicide attempts or death by suicide, nonpsychiatric hospitalization, and work disability. The analysis employed a within-individual design, comparing outcomes during periods of ADHD medication use to non-use, using stratified Cox models.
A total of 221,714 individuals diagnosed with ADHD were included in the study cohort, with a mean age of 25 years. During the follow-up, methylphenidate was the most commonly used medication (68.5%), followed by lisdexamphetamine (35.2%). Various medications were associated with decreased risk of psychiatric hospitalization, including amphetamine (adjusted hazard ratio [aHR], 0.74; 0.61-0.90), lisdexamphetamine (aHR, 0.80; 0.78-0.82), ADHD drug polytherapy (aHR, 0.85; 0.82-0.88), dexamphetamine (aHR, 0.88; 0.83-0.94), and methylphenidate (aHR, 0.93; 0.92-0.95). Similarly, decreased risk of suicidal behavior was linked to dexamphetamine (aHR, 0.69; 0.53-0.89), lisdexamphetamine (aHR, 0.76; 0.68-0.84), and methylphenidate (aHR, 0.92; 0.86-0.98).
Conversely, no medications showed an increased risk of nonpsychiatric hospitalization, with several, including amphetamine, lisdexamphetamine, polytherapy, dexamphetamine, methylphenidate, and atomoxetine, being associated with decreased risk. Regarding work disability, significant results were observed only for atomoxetine (aHR, 0.89; 0.82-0.97), particularly among adolescents and young adults aged 16 to 29 years (aHR, 0.82; 0.73-0.92).
The study's limitations stem from the nature of the data sources used, primarily nationwide registers, which can lack detailed clinical data on symptom severity, comorbid conditions, and nonpharmacological treatments like psychoeducation. Additionally, researchers noted that the analysis of work disability was hindered by the inability to accurately identify individuals in the labor market and shorter-term events like parental leave. Suicide attempts may be underreported, and the generalizability of the results is limited to health care systems similar to Sweden's, potentially not fully representing global population diversity.
