Increased Risk for Suicidal Events with Atomoxetine for ADHD?

Barbara Geller, MD

The risk was largely attenuated in patients without depression and substance abuse comorbidities.

Suicidal ideation has been associated with atomoxetine, a norepinephrine transporter blocker used to treat attention-deficit/hyperactivity disorder (ADHD) in a meta-analysis (J Am Acad Child Adolesc Psychiatry 2008; 47:209), and the FDA has mandated a black-box warning for the medication. To further test relationships between ADHD medications and suicide completions and attempts, researchers examined 2006–2009 data from Swedish national registries on 37,936 individuals with ADHD diagnoses born between 1960 and 1996.

Both population-level and within-patient analyses of treatment and no-treatment periods were performed, and the population was separated into two groups, ages 10–24 and 24–46. On the population level, risk for suicide-related events increased with ADHD treatment. In subanalyses, the increase was associated only with atomoxetine. Approximately 50% of patients with suicidal behaviors had comorbid depression. Excluding comorbid mood and substance disorders obviated much of the population-level significance. Within-patient analyses detected no medication-associated increase in suicidality and unexpectedly found that stimulants might be protective. Sensitivity analyses found no effect of antidepressant prescription.

Citation(s):

Chen Q et al. Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: Register based study. BMJ 2014 Jun 18; 348:g3769.