Attention-deficit hyperactivity disorder, its pharmacotherapy, and the risk of developing bipolar disorder: A nationwide population-based study in Taiwan. (January 2016)

• Record Type: Journal Article
• Authors: Wang, Liang-Jen; Shyu, Yu-Chiau; Yuan, Shin-Sheng; Yang, Chun-Ju; Yang, Kang-Chung; Lee, Tung-Liang; Lee, Sheng-Yu
• Is Part Of: Journal of psychiatric research. Volume 72(2016:Jan.)
• Page Start: 6
• Page End: 14
• Publication Date: 2016-01
• Subjects: ADHD -- Comorbidity -- Cohort study -- Epidemiology -- Mood disorders -- Stimulant; Psychiatry -- Periodicals; Mental Disorders -- Periodicals; Maladies mentales -- Périodiques; Psychiatry; Electronic journals; Periodicals; 616.89005
• DOI: 10.1016/j.jpsychires.2015.10.014
• Languages: English
• ISSNs: 0022-3956

Abstract

Abstract: In this study, we aimed to evaluate the relationship between attention-deficit/hyperactivity disorder (ADHD) during childhood and subsequent diagnoses of bipolar disorder (BD), as well as to determine whether the pharmacotherapy for ADHD (methylphenidate and atomoxetine) influence the risks of developing BD. A nationwide cohort of patients newly diagnosed with ADHD (n = 144, 920) and age- and gender-matching controls (n = 144, 920) were found in Taiwan's National Health Insurance database from January 2000 to December 2011. Both patients and controls were observed until December 31, 2011. To determine the effect that the duration of methylphenidate and atomoxetine exposure had on BD, the difference in the risk of developing BD was compared among non-users, short-term users (≤365 days), and long-term users (>365 days). In comparison to the control group, the ADHD group showed a significantly increased risk of developing BD (ADHD: 2.1% vs. controls: 0.4%; aHR: 7.85, 95% CI: 7.09–8.70), and had a younger mean age at the time of first diagnosis (ADHD: 12.0 years vs. controls: 18.8 years). Compared to ADHD patients that had never taken methylphenidate, patients with long-term use of methylphenidate were less likely to be diagnosed with BD (aOR: 0.72, 95% CI: 0.65–0.80). However, the duration of exposure to atomoxetine did not have a significant relationship to a BD diagnosis. The results suggested that a previous diagnosis of ADHD was a powerful indicator of BD, particularly juvenile-onset BD. Nevertheless, the exact mechanisms of the relationships among ADHD, its pharmacotherapy, and BD require further clarification in the future. Highlights: Comparing to non-ADHD controls, children with ADHD had over 7-fold increased risks of developing BD in their later lives. Children with ADHD who were prescribed long-term methylphenidate (>365 days) had a lower risk of being diagnosed with BD. The duration of atomoxetine use was not associated with the risk of BD. Common psychiatry comorbidities of ADHD were also associated with high risks of developing BD.