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Eur Child Adolesc Psychiatry. 2019 Mar 4. doi: 10.1007/s00787-019-01301-z. [Epub ahead of print]

Childhood methylphenidate adherence as a predictor of antidepressants use during adolescence.

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Faculty of Social Sciences, School of Education, Bar-Ilan University, 5290002, Ramat Gan, Israel.
Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.
Geha Mental Health Center, Petah Tikva, Israel.
Department of Pediatrics and Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA.


Methylphenidate (MPH) is a common and effective treatment for attention deficit hyperactivity disorder (ADHD), but little is known about the relationship between early childhood intake of MPH and onset of antidepressant treatment during adolescence. The study aimed to examine whether adherence to MPH during early childhood predicts the initiation of antidepressants during adolescence. This is a 12-year historical prospective nationwide cohort study of children enrolled in an integrated care system who were first prescribed MPH between the ages of 6 and 8 years (N = 6830). We tested for an association between their adherence to MPH during early childhood (as indicated by medication possession ratio from MPH onset through the age of twelve) and the likelihood of being prescribed any antidepressant during adolescence (age 13-18). As all country citizens are covered by mandatory health insurance, and full services are provided by one of the four integrated care systems, data regarding patients' diagnoses, prescriptions, and medical purchases are well documented. Logistic regression analysis indicated that those with higher adherence to MPH had a 50% higher risk (95% CI 1.16-1.93) of receiving antidepressants during adolescence when controlling for other comorbid psychiatric conditions and parental use of antidepressants. In this large-scale longitudinal study, MPH adherence during early childhood emerged as a predictor for antidepressant treatment during adolescence, which may reflect increased emotional and behavioral dysregulation in this group. The highly adherent patients are at higher risk and should be clinically monitored more closely, particularly into adolescence.


Adherence; Antidepressants; Anxiety; Attention deficit hyperactivity disorder; Depression; Longitudinal analysis; Methylphenidate


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