Abstract
Background:
Attention deficit-hyperactivity disorder (ADHD) is related to depressive disorder, and adolescents with both present poor outcomes. However, evidence for the safety of concomitantly using a methylphenidate (MPH) and a selective serotonin reuptake inhibitor (SSRI) among adolescent ADHD patients is limited, a literature gap aimed to address through this investigation.
Methods:
We conducted a new-user cohort study using a nationwide claims database in South Korea. We identified a study population as adolescents who were diagnosed both ADHD and depressive disorder. MPH-only users were compared with patients who prescribed both a SSRI and a MPH. Fluoxetine and escitalopram users were also compared to find a preferable treatment option. Thirteen outcomes including neuropsychiatric, gastrointestinal, and other events were assessed, taking respiratory tract infection as a negative control outcome. We matched the study groups using a propensity score and used the Cox proportional hazard model to calculate the hazard ratio. Subgroup and sensitivity analyses were conducted in various epidemiologic settings.
Results:
The risks of all the outcomes between the MPH-only and SSRI groups were not significantly different. Regarding SSRI ingredients, the risk of tic disorder was significantly lower in the fluoxetine group than the escitalopram group [HR 0.43 (0.25-0.71)]. However, there was no significant difference in other outcomes between the fluoxetine and escitalopram groups.
Conclusion:
The concomitant use of MPHs and SSRIs showed generally safe profiles in adolescent ADHD patients with depression. Most of the differences between fluoxetine and escitalopram, except those concerning tic disorder, were not significant.
| Original language | English |
|---|---|
| Pages (from-to) | 4811-4819 |
| Number of pages | 9 |
| Journal | Psychological Medicine |
| Volume | 53 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 20 Jul 2023 |
Bibliographical note
Funding Information:This work was supported by the Health Insurance Review and Assessment Service (HIRA). The views expressed are those of the authors and not necessarily those of the HIRA. This research was also funded by the Bio Industrial Strategic Technology Development Program (20003883, 20005021) funded By the Ministry of Trade, Industry & Energy (MOTIE, Korea) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health &Welfare, Republic of Korea (grant number: HR16C0001).
Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press.
