Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence

Krinzinger, Helga; Hall, Charlotte L.; Groom, Madeleine J.; Ansari, Mohammed T.; Banaschewski, Tobias; Buitelaar, Jan K.; Carucci, Sara; Coghill, David; Danckaerts, Marina; Dittmann, Ralf W.; Falissard, Bruno; Garas, Peter; Inglis, Sarah K; Kovshoff, Hanna; Kochhar, Puja; McCarthy, Suzanne; Nagy, Peter; Neubert, Antje; Roberts, Samantha; Sayal, Kapil; Sonuga-Barke, Edmund; Wong, Ian C.K.; Xia, Jun; Zuddas, Alexander; Hollis, Chris; Konrad, Kerstin; Liddle, Elizabeth B.

Abstract

Methylphenidate (MPH), the most common medication for children with Attention Deficit/Hyperactivity Disorder (ADHD) in many countries, is often prescribed for long periods of time. Any long-term psychotropic treatment in childhood raises concerns about possible adverse neurological and psychiatric outcomes.

We aimed to map current evidence regarding neurological and psychiatric outcomes, adverse or beneficial, of long-term MPH (> 1 year) treatment in ADHD. We coded studies using a “traffic light” system: Green: safe/favours MPH; Amber: warrants caution; Red: not safe/not well-tolerated. Un-categorisable study findings were coded as “Unclear”.

Although some evidence suggests an elevated risk of psychosis and tics, case reports describe remission on discontinuation. Several studies suggest that long-term MPH may reduce depression and suicide in ADHD. Evidence suggests caution in specific groups including pre-school children, those with tics, and adolescents at risk for substance misuse.

We identified a need for more studies that make use of large longitudinal databases, focus on specific neuropsychiatric outcomes, and compare outcomes from long-term MPH treatment with outcomes following shorter or no pharmacological intervention.

Citation

Krinzinger, H., Hall, C. L., Groom, M. J., Ansari, M. T., Banaschewski, T., Buitelaar, J. K., Carucci, S., Coghill, D., Danckaerts, M., Dittmann, R. W., Falissard, B., Garas, P., Inglis, S. K., Kovshoff, H., Kochhar, P., McCarthy, S., Nagy, P., Neubert, A., Roberts, S., Sayal, K., …Liddle, E. B. (2019). Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience and Biobehavioral Reviews, 107, 945-968. https://doi.org/10.1016/j.neubiorev.2019.09.023

• Journal Article Type: Article
• Acceptance Date: Sep 13, 2019
• Online Publication Date: Sep 20, 2019
• Publication Date: Dec 1, 2019
• Deposit Date: Oct 22, 2019
• Publicly Available Date: Oct 29, 2019
• Journal: Neuroscience and Biobehavioral Reviews
• Print ISSN: 0149-7634
• Electronic ISSN: 1873-7528
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 107
• Pages: 945-968
• DOI: https://doi.org/10.1016/j.neubiorev.2019.09.023
• Keywords: Long-term methylphenidate treatment; ADHD; Adverse neuropsychiatric events; Mood; Anxiety; Suicidal ideation; Bipolar; Psychosis; Substance use disorder; Tics; Seizures; Sleep disorders
• Public URL: https://nottingham-repository.worktribe.com/output/2919852
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0149763419302350?via%3Dihub
• Contract Date: Oct 29, 2019