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Safety outcomes of selective serotonin reuptake inhibitors in adolescent attention-deficit/hyperactivity disorder with comorbid depression: the ASSURE study

Published online by Cambridge University Press:  20 February 2023

Chungsoo Kim Open the ORCID record for Chungsoo Kim [Opens in a new window] ,
Dong Yun Lee ,
Jimyung Park ,
Su-Jin Yang ,
Eng Hooi Tan ,
Daniel Prieto-Alhambra ,
Yo Han Lee ,
Sangha Lee ,
Seong-Ju Kim  and
Jeewon Lee
...Show all authors
Chungsoo Kim
Affiliation:
Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
Dong Yun Lee
Affiliation:
Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
Jimyung Park
Affiliation:
Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
Su-Jin Yang
Affiliation:
Gwangju Smile Center for Crime victim support, Gwangju, South Korea
Eng Hooi Tan
Affiliation:
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Centre of Statistics in Medicines, University of Oxford, Oxford, UK
Daniel Prieto-Alhambra
Affiliation:
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Centre of Statistics in Medicines, University of Oxford, Oxford, UK Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
Yo Han Lee
Affiliation:
Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, South Korea
Sangha Lee
Affiliation:
Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
Seong-Ju Kim
Affiliation:
Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
Jeewon Lee
Affiliation:
Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
Rae Woong Park
Affiliation:
Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
Yunmi Shin*
Affiliation:
Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
*
Author for correspondence: Yunmi Shin, E-mail: ymshin@ajou.ac.kr
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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.

Keywords

Attention deficit disorder with hyperactivitymethylphenidateantidepressive agentscomparative effectiveness research
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 10 , July 2023 , pp. 4811 - 4819
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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Footnotes

*

Those authors contributed equally as co-first author.

†

Those authors contributed equally as co-senior author.

This article has been updated since its original publication. A notice detailing the updates can be found here: doi.org/10.1017/S0033291723001022

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