Stimulants May Reduce Self-Injury in Patients with Bipolar Disorder and Comorbid ADHD

A study found that depression increases the risk for ADHD.
A study found that depression increases the risk for ADHD.
Researchers conducted a retrospective study to assess self-injury behavior in patients with bipolar disorder and comorbid ADHD after initiation of a central stimulant.

Central stimulant (CS) treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD), according to the results of a retrospective study published in Therapeutic Advances in Psychopharmacology.

Individuals who suffer from both BD and ADHD are at a higher risk for suicide attempt (SA) and self-harm. For this population, treatment must also address relapse and suicide prevention. Though up to 48% of individuals with BD are also diagnosed with ADHD and may benefit from the use of CS, the efficacy and safety of CS has not yet been evaluated.

To assess the impact of CS treatment on SA and non-suicidal self-injury (NSSI) in patients with pre-existing BD or schizoaffective disorder (SZD) and ADHD, data from 206 patients (66.5% women) were analyzed. Individuals at least 18 years of age who received a diagnosis of BD or SZD and received a diagnosis of ADHD, and were receiving a CS treatment were included. Mean age at initiation of CS treatment was 34.6±10.8 years and 90.8% (n=187) of individuals were diagnosed with BD-II/other BD. All but 1 patient received methylphenidate as their first ADHD medication and all but 9 patients received methylphenidate during the 2-year follow-up period. The number of patients treated with CS at their last follow up was 62%

Within 6 months of CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly in number of patients having such events (P =.013) and number of events experienced (P =.004). The decrease was still significant 2 years after CS initiation (P =.038; P =.028, respectively). The number of hospital admissions for in-patient psychiatric care decreased significantly (P =.029) within 6 months, but did not persist for the 2-year period. The number of intra-patient admissions did not change significantly between periods (P =.669).

The results of this study indicated that CS initiation may quickly alleviate suicidal behavior in patients with BD and ADHD. These effects could be maintained for 2 years after initiation even if CS treatment had been discontinued.

Limitations to this study include the lack of insight into the severity and current condition of BD when clinicians initiated CS. It is also possible that CS was initiated only after clinicians felt the patients BD was in a stable condition.

Further studies controlling for the status of patients’ BD should be conducted.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Öhlund L, Ott M, Lundqvist R, Sandlund M, Salander Renberg E, Werneke U. Suicidal and non-suicidal self-injurious behavior 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. Ther Adv Psychopharmacol. Published online August 6, 2020. doi: 10.1177/2045125320947502