Chang Zheng, D'Onofrio Brian M, Quinn Patrick D, Lichtenstein Paul, Larsson Henrik
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana.
Biol Psychiatry. 2016 Dec 15;80(12):916-922. doi: 10.1016/j.biopsych.2016.02.018. Epub 2016 Feb 23.
Attention-deficit/hyperactivity disorder (ADHD) is associated with high rates of psychiatric comorbidity, including depression. However, it is unclear whether ADHD medication increases or decreases the risk for depression.
We studied all individuals with a diagnosis of ADHD born between 1960 and 1998 in Sweden (N = 38,752). We obtained data for prescription of ADHD medication, diagnosis of depression and other psychiatric disorders, and sociodemographic factors from population-based registers. The association between ADHD medication and depression was estimated with Cox proportional hazards regression.
After adjustment for sociodemographic and clinical confounders, ADHD medication was associated with a reduced long-term risk (i.e., 3 years later) for depression (hazard ratio = 0.58; 95% confidence interval, 0.51-0.67). The risk was lower for longer duration of ADHD medication. Also, ADHD medication was associated with reduced rates of concurrent depression; within-individual analysis suggested that occurrence of depression was 20% less common during periods when patients received ADHD medication compared with periods when they did not (hazard ratio = 0.80; 95% confidence interval, 0.70-0.92).
Our study suggests that ADHD medication does not increase the risk of later depression; rather, medication was associated with a reduced risk for subsequent and concurrent depression.
注意力缺陷多动障碍（ADHD）与包括抑郁症在内的高精神共病率相关。然而，ADHD药物治疗是增加还是降低抑郁症风险尚不清楚。
我们研究了1960年至1998年在瑞典出生且被诊断为ADHD的所有个体（N = 38,752）。我们从基于人群的登记处获取了ADHD药物处方、抑郁症和其他精神疾病诊断以及社会人口学因素的数据。采用Cox比例风险回归估计ADHD药物与抑郁症之间的关联。
在对社会人口学和临床混杂因素进行调整后，ADHD药物治疗与抑郁症的长期风险（即3年后）降低相关（风险比 = 0.58；95%置信区间，0.51 - 0.67）。ADHD药物治疗持续时间越长，风险越低。此外，ADHD药物治疗与并发抑郁症的发生率降低相关；个体内分析表明，与未接受ADHD药物治疗的时期相比，患者接受ADHD药物治疗期间抑郁症的发生率低20%（风险比 = 0.80；95%置信区间，0.70 - 0.92）。
我们的研究表明，ADHD药物治疗不会增加后期患抑郁症的风险；相反，药物治疗与后续和并发抑郁症风险降低相关。
