ArticleBiological psychiatry global open science2026
Pharmacotherapies for Attention-Deficit/Hyperactivity Disorder and Risk of Suicidal Behavior: A Within-Individual Study of Stimulants, Atomoxetine, and Alpha-2 Agonists.
Article in Biological psychiatry global open science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for suicidal behavior. Stimulant and nonstimulant pharmacotherapies are widely prescribed for ADHD, but their effects on suicidal behavior remain unclear. Methods: In a U.S. commercial health care insurance claims database, we identified 830,352 individuals diagnosed with ADHD, ages 9 to 64 years, who used at least 1 stimulant, atomoxetine, or alpha-2 agonist medication between 2016 and 2021. We examined the proportions of patients with suicidal behavior (i.e., emergency department visits or hospitalizations for suicide attempts or intentional self-harm) in the months preceding and following treatment initiation. Then, we used a within-individual design to evaluate associations between each medication and risk of suicidal behavior, while accounting for time-varying covariates. Finally, we examined associations for stimulants among subgroups defined by sex, age, and race-ethnicity. Results: Compared with other off-treatment periods, rates of suicidal behavior were elevated during the 2 months before starting ADHD pharmacotherapy, particularly for atomoxetine (odds ratio [OR] = 2.63 [95% CI, 2.28-3.04]) and alpha-2 agonists (OR = 2.99 [2.64-3.40]). Compared with off-treatment periods (excluding pretreatment), the odds of suicidal behavior were slightly elevated during treatment (OR Conclusions: Within-individual comparisons suggested that risk of suicidal behavior was higher just before and, to a lesser extent, during ADHD medication treatment compared with off-treatment. Further research is needed to determine whether elevations in risk during treatment are attributable to medication effects or to unmeasured time-varying confounding factors, such as a continuation (although attenuated) of the increased risk observed before pharmacotherapy.
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