Researchers from Karolinska Institutet have shown a link between use of medication for ADHD and a reduced risk of premature death. The risk of death due to unnatural causes, such as accidents and overdoses, can be reduced by a quarter, according to the new study published in JAMA.
Previous research has shown that people diagnosed with ADHD have an increased risk of premature death. However, it is not clear whether medications for ADHD affect this risk.
A registry study, published in JAMA, followed nearly 150,000 Swedes aged 6-64, who were diagnosed with ADHD between 2007 and 2018. The researchers investigated the risk of death up to two years after diagnosis and compared those who started medication within three months of diagnosis (56.7 percent) with those who did not.
"The study showed that there is a link between initiation of medication and a lower risk of death. This was true regardless of the cause of death, but the risk of dying from unnatural causes, such as alcohol and drug overdose, decreased the most. The association was not as strong for the risk of dying from natural causes as physical health condition", says Lin Li, postdoctoral researcher at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet and first author of the study.
The risk of dying from unnatural causes was reduced by a quarter in the medicated group. As this is an observational study, it cannot establish a causal relationship, but the results suggest that early initiation of medication may be important for people with ADHD. At the same time, there are other health aspects to consider when prescribing these medications. In an earlier study, published in JAMA Psychiatry 2023, the same research team showed that there is also a link between ADHD medication and increased risk of hypertension and arterial diseases.
In the next step, they aim to further explore the long-term effects of ADHD medication.
"It will be crucial to establish whether the benefits we have seen in this study will persist over time. We will also try to identify any additional adverse effects associated with long-term medication," says Zheng Chang, a senior researcher at the Department of Medical Epidemiology and Biostatistics and the last author of the study.
The research team will also study the effects and mechanisms of different types of ADHD medications and how doses, duration of treatment and sex differences may affect them.
"With such knowledge, doctors can tailor treatment plans for people with ADHD, in order to maximize the benefits of treatment and minimize the risks," says Zheng Chang.
This study was conducted in collaboration with colleagues from Örebro University, Indiana University, Bloomington (USA), and the University of Southampton (UK).
The study was funded by the Swedish Research Council for Health, Working Life and Welfare and the EU's Horizon 2020 research and innovation program.
Co-author Henrik Larsson has received grants from Shire Pharmaceuticals and honoraria from Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB and sponsorship for a conference on ADHD from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the current study. Other potential conflicts of interest listed in the article include reimbursement of travel and accommodation costs for lectures from several non-profit organizations.
Publication
"ADHD Pharmacotherapy and Mortality in Individuals With ADHD", Lin Li, Nanbo Zhu, Le Zhang, Ralf Kuja-Halkola, Brian M. D'Onofrio, Isabell Brikell, Paul Lichtenstein, Samuele Cortese, Henrik Larsson, Zheng Chang. JAMA (Journal of the American Medical Association), online 2024-03-12, doi: 10.1001/jama.2024.0851.
