Concurrent use of methylphenidate, selective serotonin reuptake inhibitor generally safe

Using methylphenidate and a selective serotonin reuptake inhibitor (SSRI) together does not appear to pose any significant risk, with both agents having been shown to be safe in adolescent patients with attention deficit-hyperactivity disorder (ADHD) and depression, according to a new-user cohort study.

For the study, researchers used a nationwide claims database in South Korea and identified adolescents who received a diagnosis of both ADHD and depressive disorder. Safety outcomes were compared between those who used methylphenidate only and those who used both methylphenidate and an SSRI.   Safety outcomes were also evaluated among fluoxetine and escitalopram users to find a preferable treatment option.

Thirteen outcomes (eg, neuropsychiatric, gastrointestinal, and other events) were assessed, with respiratory tract infection as a negative control outcome. The user groups were matched using a propensity score. Subgroup and sensitivity analyses were conducted in a number of epidemiologic settings.

Cox proportional hazard models showed that the frequency of all outcomes were not significantly different among methylphenidate-only users and users of both methylphenidate and an SSRI.

With regard to SSRIs, fluoxetine was associated with a significantly lower risk of tic disorder as compared with escitalopram (hazard ratio, 0.43, 95 percent confidence interval, 0.25–0.71). None of the other outcomes examined significantly differed between the fluoxetine and escitalopram groups.

The findings suggest that methylphenidate may be used concurrently with an SSRI among adolescents with ADHD and depression.