ArticlePediatrics2016
Risk of Suicidal Events With Atomoxetine Compared to Stimulant Treatment: A Cohort Study.
Article in Pediatrics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies.Frontiers in psychiatry · 2022Pooled it
- Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases.Biological psychiatry · 2019Pooled it
- Pooled it
- Case Report: Suicidality response to treatment for attention deficit hyperactivity disorder in adult females with autism spectrum disorder: three cases.Frontiers in psychiatry · 2026Article
- Exploring the potential association between stimulant or atomoxetine use and suicidal or self-injurious behaviors in children with attention deficit hyperactivity disorder: real-world insights from the FAERS database.European child & adolescent psychiatry · 2025Article
- Comparison of serious adverse effects of methylphenidate, atomoxetine and amphetamine in the treatment of ADHD: an adverse event analysis based on the FAERS database.BMC pharmacology & toxicology · 2025Article
- An Evaluation of Whether Routine QTc Interval Screening Is Necessary Prior to Starting ADHD Medications: Experience from a Large Retrospective Study.Pediatric reports · 2024Article
- Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment.Journal of attention disorders · 2023Review
- Systematic Review of Suicidal Behaviors Related to Methylphenidate and Atomoxetine in Patients With Attention Deficit Hyperactivity Disorder.Journal of the Korean Academy of Child and Adolescent Psychiatry · 2023Review
- Effects of somatic treatments on suicidal ideation and completed suicides.Brain and behavior · 2021Review
- Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts.Biological psychiatry · 2020Article
- Suicidal and non-suicidal self-injurious behaviour 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.Therapeutic advances in psychopharmacology · 2020Article
- Association of symptoms of attention deficit-hyperactivity disorder and impulsive-aggression with severity of suicidal behavior in adult attempters.Scientific reports · 2019Article
- Brain doping: stimulants use and misuse among a sample of Italian college students.Journal of preventive medicine and hygiene · 2017Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundAntidepressant effects on increased suicidality in children have raised public concern in recent years. Approved in 2002 for attention-deficit/hyperactivity disorder treatment, the selective noradrenalin-reuptake-inhibitor atomoxetine was initially investigated for the treatment of depression. In post-hoc analyses of clinical trial data, atomoxetine has been associated with an increased risk of suicidal ideation in children and adolescents. We analyzed whether the observed increased risk of suicidal ideation in clinical trials translates into an increased risk of suicidal events in pediatric patients treated with atomoxetine compared with stimulants in 26 Medicaid programs.
methodsEmploying a retrospective cohort design, we used propensity score-adjusted Cox proportional hazard models to evaluate the risk of suicide and suicide attempt in pediatric patients initiating treatment with atomoxetine compared with stimulants from 2002 to 2006.
resultsThe first-line treatment cohort included 279 315 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.95 (95% CI 0.47-1.92, P = .88). The second-line treatment cohort included 220 215 patients. During the first year of follow-up, the adjusted hazard ratio for current atomoxetine use compared with current stimulant use was 0.71 (95% CI 0.30-1.67, P = .43).
conclusionsFirst- and second-line treatment of youths age 5 to 18 with atomoxetine compared with stimulants was not significantly associated with an increased risk of suicidal events. The low incidence of suicide and suicide attempt resulted in wide confidence intervals and did not allow stratified analysis of high-risk groups or assessment of suicidal risk associated with long-term use of atomoxetine.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.