Meta-Analysis: Reduced Risk of Anxiety with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder

Coughlin, Catherine G.; Cohen, Stephanie C.; Mulqueen, Jilian M.; Ferracioli-Oda, Eduardo; Stuckelman, Zachary D.; Bloch, Michael H.

doi:10.1089/cap.2015.0075

Cited by 64 publications

(28 citation statements)

References 37 publications

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“…For anti‐ADHD medications, we included three NMAs 49,144,145 , 11 MAs 146‐156 , 12 RCTs 157‐168 also included in those NMA/MAs, five additional RCTs 169‐173 , and five cohort studies 99,174‐177 . There were 148,664 youth on anti‐ADHD medications, including 28,834 across 298 RCTs after eliminating duplicated RCTs in multiple NMA/MAs (27,188 in NMA/MAs, 1,646 in additional RCTs), and 119,830 in five cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

et al. 2020

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Mental disorders frequently begin in childhood or adolescence. Psychotropic medications have various indications for the treatment of mental disorders in this age group and are used not infrequently off‐label. However, the adverse effects of these medications require special attention during developmentally sensitive periods of life. For this meta‐review, we systematically searched network meta‐analyses and meta‐analyses of randomized controlled trials (RCTs), individual RCTs, and cohort studies reporting on 78 a priori selected adverse events across 19 categories of 80 psychotropic medications – including antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity disorder (ADHD) medications and mood stabilizers – in children and adolescents with mental disorders. We included data from nine network meta‐analyses, 39 meta‐analyses, 90 individual RCTs, and eight cohort studies, including 337,686 children and adolescents. Data on ≥20% of the 78 adverse events were available for six antidepressants (sertraline, escitalopram, paroxetine, fluoxetine, venlafaxine and vilazodone), eight antipsychotics (risperidone, quetiapine, aripiprazole, lurasidone, paliperidone, ziprasidone, olanzapine and asenapine), three anti‐ADHD medications (methylphenidate, atomoxetine and guanfacine), and two mood stabilizers (valproate and lithium). Among these medications with data on ≥20% of the 78 adverse events, a safer profile emerged for escitalopram and fluoxetine among antidepressants, lurasidone for antipsychotics, methylphenidate among anti‐ADHD medications, and lithium among mood stabilizers. The available literature raised most concerns about the safety of venlafaxine, olanzapine, atomoxetine, guanfacine and valproate. Nausea/vomiting and discontinuation due to adverse event were most frequently associated with antidepressants; sedation, extrapyramidal side effects, and weight gain with antipsychotics; anorexia and insomnia with anti‐ADHD medications; sedation and weight gain with mood stabilizers. The results of this comprehensive and updated quantitative systematic meta‐review of top‐tier evidence regarding the safety of antidepressants, antipsychotics, anti‐ADHD medications and mood stabilizers in children and adolescents can inform clinical practice, research and treatment guidelines.

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Section: Resultsmentioning

confidence: 99%

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

et al. 2020

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“…The comorbidity between OCD and anxiety symptoms has been demonstrated over the years, with some papers reporting that anxiety disorders are the most frequent comorbid conditions in OCD (Diniz et al, ), with frequencies that range from 62% (Torres et al, ) to 75.8% (Ruscio et al, ). Pediatric studies suggest ADHD is a common source of anxiety symptoms in children (Sciberras et al, ) and that successfully treating ADHD symptoms with psychostimulant medications significantly reduces anxiety (Coughlin et al, ).…”

Section: Discussionmentioning

confidence: 99%

The impact of attention deficit hyperactivity disorder in obsessive‐compulsive disorder subjects

et al. 2019

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Background: Recent findings suggest an association between attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Thus, we evaluated the clinical associated features of ADHD in a large sample of adult OCD patients. Methods:A cross-sectional study including 955 adult patients with OCD from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinical characteristics in adult OCD patients with and without comorbid ADHD were compared using Fisher's exact test, t-tests or Mann-Whitney tests.Bivariate analyses were followed by logistic regression analysis to identify clinical characteristics independently associated with ADHD comorbidity. Results:The lifetime prevalence of ADHD in adult OCD patients was 13.7%. The current results indicate that OCD + ADHD patients were more severe, had an earlier onset of the obsessive-compulsive symptoms, a higher history of rheumatic fever, with higher frequencies of sensory phenomena and comorbidity with Tourette syndrome. They also had an increased risk for academic impairment and suicide attempts.Conclusion: Adult OCD patients with ADHD present some specific clinical features and may represent a special subgroup of adult OCD. Future studies should focus on the development of interventions more tailored to the phenotype of this subgroup of patients.

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“…For example, a recent Cochrane Systematic Review of nonrandomized studies found that rates of anxiety, sadness, and irritability with MPH treatment were 18.4%, 16.8%, and 17.2%, respectively (Storebo et al 2018), whereas a Cochrane Systematic Review of randomized controlled trials (RCTs) found no significant effect of MPH on the AEs of ''worried or anxious'' (risk ratio, (Storebo et al 2016). Additional recent meta-analyses and individual studies found that MPH reduced risk of both anxiety (Gurkan et al 2010;Golubchik et al 2014aGolubchik et al , 2014bCoughlin et al 2015;Snircova et al 2016;Pozzi et al 2018) and irritability (Efron et al 1997;Sonuga-Barke et al 2009;Stuckelman et al 2017;Pozzi et al 2018;Winters et al 2018). Our findings illustrate that both scenarios can in fact be at play-MPH may worsen or improve these emotional symptoms, with the key to predicting direction of effect hinging upon baseline anxiety/depression and oppositionality levels.…”

Section: Discussionmentioning

confidence: 99%

Pre-Existing Comorbid Emotional Symptoms Moderate Short-Term Methylphenidate Adverse Effects in a Randomized Trial of Children with Attention-Deficit/Hyperactivity Disorder

Froehlich

Brinkman

Peugh

et al. 2020

Journal of Child and Adolescent Psychopharmacology

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Objective: We sought to ascertain whether baseline anxiety/depression and oppositional defiant disorder (ODD) symptoms impacted the experience of short-term methylphenidate (MPH) adverse effects (AEs) in 7-to 11-year-old children with attention-deficit/hyperactivity disorder (ADHD) (n = 171) undergoing a double-blind MPH crossover trial. Method: The Vanderbilt ADHD Diagnostic Parent Rating Scale measured baseline child anxiety/depression and ODD symptomology. The parent-completed Pittsburgh Side Effect Rating Scale assessed the AEs of anxiety, sadness, and irritability at baseline, on placebo, and on three MPH dosages. For each AE, we evaluated comorbidity main effects, dose main effects, and comorbidity • dose interactions. Results: Baseline anxiety/depression • dose and ODD • dose interactions were significant for the AEs of anxiety, sadness, and irritability. Compared with premedication baseline, these AEs attenuated on MPH for children with initially higher comorbidity symptoms, whereas those with initially lower comorbidity symptoms tended toward no change or increasing AE levels. Conclusion: Premedication anxiety/depressive and ODD symptoms may be important predictors of short-term MPH emotional AEs.

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Meta-Analysis: Reduced Risk of Anxiety with Psychostimulant Treatment in Children with Attention-Deficit/Hyperactivity Disorder

Cited by 64 publications

References 37 publications

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

Safety of 80 antidepressants, antipsychotics, anti‐attention‐deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders: a large scale systematic meta‐review of 78 adverse effects

The impact of attention deficit hyperactivity disorder in obsessive‐compulsive disorder subjects

Pre-Existing Comorbid Emotional Symptoms Moderate Short-Term Methylphenidate Adverse Effects in a Randomized Trial of Children with Attention-Deficit/Hyperactivity Disorder

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