Central Stimulants May Reduce Suicide Risk in Adults With Bipolar Disorder and ADHD

­Treatment with a central stimulant may reduce the risk of suicide attempt and nonsuicidal self-injury in adults with a dual diagnosis of bipolar disorder and attention-deficit/hyperactivity disorder (ADHD), according to a study published online in Therapeutic Advances in Psychopharmacology. 

“Based on our findings, clinicians should not withhold central stimulant treatment from patients with concomitant ADHD for fear of deterioration of the underlying bipolar disorder,” researchers wrote. “However, to minimize the risk of manic episodes and to err on the side of caution, concomitant mood stabilizer treatment and close monitoring remains warranted.” 

The findings stem from a retrospective, mirror-image study involving 206 patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD. Researchers looked at suicide attempts and nonsuicidal self-injury events 6 months and 2 years before and after central stimulant initiation.

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Within 6 months of central stimulant initiation, the number of patients with suicide attempts and nonsuicidal self-injury events decreased significantly, according to the study. The number of suicide attempts and nonsuicidal self-injury events, too, dropped significantly.

Both effects persisted 2 years after central stimulant initiation, researchers reported, even when the stimulant had been discontinued.

“To our knowledge, this is the first study ever evaluating effects of central stimulants on suicidal behavior in patients with  bipolar disorder and ADHD,” researchers wrote. “Our study adds further support to findings that central stimulants can safely be used in patients with a dual diagnosis of bipolar disorder and ADHD. However, as 91% of included patients had a diagnosis of bipolar disorder-II/other bipolar disorder, our results are applicable mainly to this group and cannot automatically be extrapolated to patients with BD-I/schizoaffective disorder.”

—Jolynn Tumolo

Reference 

Öhlund L, Ott M, Lundqvist R, Sandlund M, Salander Renberg E, Werneke U. Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort. Therapeutic Advances in Psychopharmacology. 2020 August 6;[Epub ahead of print].