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The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder
Department of Medical Epidemiology and Biostatistics and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
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2017 (English)In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 174, no 4, 341-348 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The authors sought to determine the risk of treatment-emergent mania associated with methylphenidate, used in monotherapy or with a concomitant mood-stabilizing medication, in patients with bipolar disorder.

Method: Using linked Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The cohort was divided into two groups: those with and those without concomitant mood-stabilizing treatment. To adjust for individual-specific confounders, including disorder severity, genetic makeup, and early environmental factors, Cox regression analyses were used, conditioning on individual to compare the rate of mania (defined as hospitalization for mania or a new dispensation of stabilizing medication) 0-3 months and 3-6 months after medication start following nontreated periods.

Results: Patients on methylphenidate monotherapy displayed an increased rate of manic episodes within 3 months of medication initiation (hazard ratio=6.7, 95% CI=2.0-22.4), with similar results for the subsequent 3 months. By contrast, for patients taking mood stabilizers, the risk of mania was lower after starting methylphenidate (hazard ratio=0.6, 95% CI=0.4-0.9). Comparable results were observed when only hospitalizations for mania were counted.

Conclusions: No evidence was found for a positive association between methylphenidate and treatment-emergent mania among patients with bipolar disorder who were concomitantly receiving a mood-stabilizing medication. This is clinically important given that up to 20% of people with bipolar disorder suffer from comorbid ADHD. Given the markedly increased hazard ratio of mania following methylphenidate initiation in bipolar patients not taking mood stabilizers, careful assessment to rule out bipolar disorder is indicated before initiating monotherapy with psychostimulants.

Place, publisher, year, edition, pages
Arlington, USA: American Psychiatric Publishing, 2017. Vol. 174, no 4, 341-348 p.
Keyword [en]
Mood Disorders, Bipolar disorder, Attention Deficit Hyperactivity Disorder, ADHD, Stimulants, Methylphenidate
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-54653DOI: 10.1176/appi.ajp.2016.16040467ISI: 000397921800010PubMedID: 27690517Scopus ID: 2-s2.0-85017027774OAI: oai:DiVA.org:oru-54653DiVA: diva2:1064505
Funder
Swedish Research Council, 2013-2280Swedish Foundation for Strategic Research , KF10-0039
Note

Funding Agencies:

Swedish Research Council through the Swedish Initiative for research on Microdata in the Social and Medical Sciences (SIMSAM)  340-2013-5867

Swedish Medical Research Council  K2014-62X-14647-12-51  K2010-61P-21568-01-4

NIMH  1R01MH102221

Agency for Healthcare Research and Quality  

Alkermes  

AssureRx  

Avanir  

Forest Pharmaceuticals  

Janssen  

Otsuka  

Shire  

American Psychiatric Foundation  

Guilford Publications  

Herald House  

Oxford University Press 

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2017-05-08Bibliographically approved

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CiteExportLink to record
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Citation style
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