Beyond focus — medication cuts suicide attempts, substance misuse, accidents, and crime
STUDY: Zhang L et al, BMJ 2025;390:e083658,
STUDY TYPE: Target trial emulation using national registry data
FUNDING: Swedish Research Council for Health
Background
ADHD medications reduce core symptoms — but do they change the outcomes that matter most to patients and families? This large Swedish registry study is the first to use a target trial emulation design to answer that question in the full ADHD population.
The Study
Researchers identified 148,581 individuals aged 6–64 with a new ADHD diagnosis and compared those who started medication within three months to those who didn’t, following both groups for two years. The primary outcomes were: suicidal behavior, substance misuse, accidental injuries, transport accidents, and criminality. Methylphenidate was the most prescribed drug (88%).
Results
ADHD meds were associated with lower rates of recurrent events across all outcomes, particularly in people who had a history of those events before starting treatment. The risk reduction was around 10-15% for each event, and was greater for stimulants than non-stimulants.
The two main limitations were lack of randomization, and comparing meds to “care as usual” rather than placebo.
Practice Implications
- ADHD meds do more than treat symptoms. They change meaningful outcomes in life, particularly stimulants, which are more effective in ADHD overall.
- We’ve known this for children, but few studies have tested that in adults, and this one reached to age 64.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
What’s Your Take? Share in Comments
- Are you seeing meaningful changes when ADHD is treated?
