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March 5, 2026
Background:
Non-suicidal self-injury (NSSI) means intentionally hurting yourself without trying to end your life. Common examples include cutting, scratching, or burning yourself. This behavior is most common in teenagers, affecting 13-20% of adolescents. It’s also called self-harm or deliberate self-injury.
Young people who struggle with managing emotions, act impulsively, or have mental health conditions like depression are more likely to self-harm.
Because ADHD involves impulsivity and often occurs alongside emotional difficulties, researchers have suspected a link between ADHD and self-injury. However, previous studies have tended to be small, unrepresentative, and inconsistent, making it hard to draw clear conclusions.
The Study:
Researchers combined results from 14 different studies involving nearly 30,000 people to get a clearer picture. They looked at children, teenagers, and adults with ADHD from various settings—including hospitals, community programs, and general population studies.
To be included, studies had to confirm ADHD diagnosis through professional evaluation or validated testing methods.
Key findings
Conclusion:
The researchers concluded that roughly one in four people with ADHD have engaged in non-suicidal self-harm. The findings suggest that ADHD and self-harm share overlapping vulnerabilities.
Overall, this meta-analysis strengthens evidence that people with ADHD face a significantly elevated risk of non-suicidal self-injury, likely reflecting overlapping challenges with impulsivity, emotional regulation, and co-occurring mental health conditions. Importantly, this does not mean self-harm is inevitable in ADHD. It does, however, highlight the need for early screening, supportive environments, and targeted mental-health care to help reduce risk and support healthier coping strategies.
Liliane Smaniotto, Arthur Tolentino, Felipe M.R. Barros, Eduardo Barreto, Barbara Colnaghi, Lais Ker, Eloisa Helena Rubello Valler Celeri, Osmar Della-Torre, Renata C.S. Azevedo, “Non-suicidal self-injury in individuals with attention-deficit/hyperactivity disorder: A systematic review and Meta-analysis with Age- and Sex-stratified findings,” Psychiatry Research 358 (2026) 116975, published online, https://doi.org/10.1016/j.psychres.2026.116975.
Suicide is one of the most feared outcomes of any psychiatric condition. Although its association with depression is well known, a small but growing research literature shows that ADHD is also a risk factor for suicidality. Suicide is difficult to study. Because it is relatively rare, large samples of patients are needed to make definitive statements.
Studies of suicide and ADHD must also consider the possibility that medications might elevate that risk. For example, the FDA placed a black box warning on atomoxetine because that ADHD medication had been shown to increase suicidal risk in youth. A recent study of 37,936 patients with ADHD now provides much insight into these issues (Chen, Q., Sjolander, A., Runeson, B., D'Onofrio, B. M., Lichtenstein, P. & Larsson, H. (2014). Drug treatment for attention-deficit/hyperactivity disorder and suicidal behavior: a register-based study. BMJ 348, g3769.). In Sweden, such large studies are possible because researchers have computerized medical registers that describe the disorders and treatments of all people in Sweden. Among 37,936 patients with ADHD, 7019 suicide attempts or completed suicides occurred during 150,721 person-years of follow-up. This indicates that, in any given year, the risk for a suicidal event is about 5%. For ADHD patients, the risk for a suicide event is about 30% greater than for non-ADHD patients. Among the ADHD patients who attempted or completed suicide, the risk was increased for those who had also been diagnosed with a mood disorder, conduct disorder, substance abuse, or borderline personality. This is not surprising; the most serious and complicated cases of ADHD are those that have the greatest risk for suicidal events. The effects of the medication were less clear. The risk for suicide events was greater for ADHD patients who had been treated with non-stimulant medication compared with those who had not been treated with non-stimulant medication. A similar comparison showed no effect of stimulant medications. This first analysis suffers from the fact that the probability of receiving medication increases with the severity of the disorder. To address this problem, the researchers limited the analyses to ADHD patients who had some medication treatment and then compared suicidal risk between periods of medication treatment and periods of no medication treatment. This analysis found no increased risk for suicide from non-stimulant medications and, more importantly, found that for patients treated with stimulants, the risk for suicide was lower when they were taking stimulant medications. This protective effect of stimulant medication provides further evidence of the long-term effects of stimulant medications, which have also been shown to lower the risks for traffic accidents, criminality, smoking, and other substance use disorders.
A Chinese research team performed two types of meta-analyses to compare the risk of suicide for ADHD patients taking ADHD medication as opposed to those not taking medication.
The first type of meta-analysis combined six large population studies with a total of over 4.7 million participants. These were located on three continents - Europe, Asia, and North America - and more specifically Sweden, England, Taiwan, and the United States.
The risk of suicide among those taking medication was found to be about a quarter less than for unmediated individuals, though the results were barely significant at the 95 percent confidence level (p = 0.49, just a sliver below the p = 0.5 cutoff point). There were no significant differences between males and females, except that looking only at males or females reduced sample size and made results non-significant.
Differentiating between patients receiving stimulant and non-stimulant medications produced divergent outcomes. A meta-analysis of four population studies covering almost 900,000 individuals found stimulant medications to be associated with a 28 percent reduced risk of suicide. On the other hand, a meta-analysis of three studies with over 62,000 individuals found no significant difference in suicide risk for non-stimulant medications. The benefit, therefore, seems limited to stimulant medication.
The second type of meta-analysis combined three within-individual studies with over 3.9 million persons in the United States, China, and Sweden. The risk of suicide among those taking medication was found to be almost a third less than for unmediated individuals, though the results were again barely significant at the 95 percent confidence level (p =0.49, just a sliver below the p = 0.5 cutoff point). Once again, there were no significant differences between males and females, except that looking only at males or females reduced the sample size and made results non-significant.
Differentiating between patients receiving stimulant and non-stimulant medications once again produced divergent outcomes. Meta-analysis of the same three studies found a 25 percent reduced risk of suicide among those taking stimulant medications. But as in the population studies, a meta-analysis of two studies with over 3.9 million persons found no reduction in risk among those taking non-stimulant medications.
A further meta-analysis of two studies with 3.9 million persons found no reduction in suicide risk among persons taking ADHD medications for 90 days or less, "revealing the importance of duration and adherence to medication in all individuals prescribed stimulants for ADHD."
The authors concluded, "exposure to non-stimulants is not associated with a higher risk of suicide attempts. However, a lower risk of suicide attempts was observed for stimulant drugs. However, the results must be interpreted with caution due to the evidence of heterogeneity ..."
Drivers with ADHD are far more likely to be involved in crashes, to be at fault in crashes,to be in severe crashes, and to be killed in crashes. The more severe the ADHD symptoms, the higher the risk. Moreover, ADHD is often accompanied by comorbid conditions such as oppositional-defiant disorder, depression, and anxiety that further increase the risk.
What can be done to reduce this risk? A group of experts has offered the following consensus recommendations:
· Use stimulant medications. While there is no reliable evidence on whether non-stimulant medications are of any benefit for driving, there is solid evidence that stimulant medications are effective in reducing risk. But there is also a rebound effect in many individuals after the medication wears off, in which performance actually becomes worse than if had been prior to medication. It is therefore important to time the taking of medication so that its period of effectiveness corresponds with driving times. If one has to drive right after waking up, it makes sense to take a rapid acting form. The same holds for late night driving that may require a quick boost.
· Use a stick shift vehicle wherever possible. Stick shifts make drivers pay closer attention than automatic transmissions. The benefits in alertness are most notable in city traffic. But using a stick shift is far less beneficial in highway driving, where shifting is less frequent.
· Avoid cruise control. Highways can be monotonous, making drivers more prone to boredom and distraction. That is even more true for those with ADHD, so it is best to keep cruise control turned off.
· Avoid alcohol. Drinking and driving is a bad idea for everyone, but, once again, it's even worse for those with ADHD. Parents should consider a no-questions-asked policy of either picking up their teenager anytime and anywhere, or setting up an account with a ride-sharing service.· Place the smartphone out of reach and hearing. Cell phone use is as about as likely to impair as alcohol. Hands-free devices only reduce this risk moderately, because they continue to distract. Texting can be deadly. Sending a short text or emoticon can be the equivalent of driving 100 yards with one's eyes closed. Either turn on Do Not Disturb mode, or, for even greater effectiveness, place the smart phone in the trunk.
· Make use of automotive performance monitors. These can keep track of maximum speeds and sudden acceleration and braking, to verify that a teenager is not engaging in risky behaviors.
· Take advantage of graduated driver's licensing laws wherever available. These laws forbid the presence of peers in the vehicle for the first several (for example, six) months of driving. Parents can extend that period for teenagers with ADHD, or set it as a condition in states that lack such laws.
· Encourage practicing after obtaining a learner's permit. Teenagers with ADHD generally require more practice than those without. A pre-drive checklist can be a good place to start. For example:check the gas, check the mirrors, make sure the view through the windows is unobstructed, put cell phone in Do Not Disturb mode and place it out of reach, put on seat belt, scan for obstacles.
· Consider outsourcing. Look for a driving school with a professional to teach good driving skills and habits.
Experts do not agree on whether to delay licensing for those with ADHD. On the one hand, teenagers with ADHD are 3-4 years behind in the development of brain areas responsible for executive functions that help control impulses and better guide behavior. Delaying licensing can reduce risk by about 20 percent. On the other hand, teens with ADHD are more likely to drive without a license, and no one wants to encourage that, however inadvertently. Moreover, graduated driver's licensing laws only have legal effect on teens who get their licenses at the customary age.
The Background:
Over the past two decades, diagnostic rates for adult ADHD have roughly doubled, and stimulant prescriptions in the United States skyrocketed by more than 50% between 2012 and 2023, particularly among girls and women. While these medications help many individuals manage their symptoms, a landmark 2026 article published in European Neuropsychopharmacology tackles an important question that is rarely discussed: When should doctors and patients consider stopping them?
The Discussion:
To answer this, the American Society of Clinical Psychopharmacology (ASCP) gathered a task force of 45 international experts spanning 12 countries. Through a rigorous evaluation process, they reached an overwhelming agreement on a framework for "deprescribing", the planned, supervised reduction or cessation of a medication. Here are the core insights from these ground-breaking guidelines and what they mean for adults navigating long-term ADHD treatment.
When the Treatment Isn’t Yielding Benefits
One of the most straightforward reasons to consider stopping a stimulant is if it simply isn’t doing its job. The task force agreed that if a patient does not experience an optimal response, measured by actual symptom reduction, improved daily functioning, and a better quality of life, even after trying a high, optimized dose, it may be time to step back and look at alternative options.
Sometimes, the issue goes back to the initial evaluation. The criteria for diagnosing ADHD have expanded over the years, and brief psychiatric evaluations can occasionally lead to diagnostic inaccuracies. If a thorough reevaluation reveals that the original ADHD diagnosis was incorrect, the expert consensus is clear: stimulant deprescribing is appropriate unless another stimulant-responsive condition is evident. Furthermore, if a patient develops a persistent tolerance to the drug that cannot be resolved by safe dose adjustments, a temporary taper or drug holiday may be recommended.
When the Risks to Health Outweigh the Rewards
Our bodies and health needs naturally shift over time, meaning a medication that worked safely years ago might pose a threat to your health today. The experts concluded that deprescribing should be heavily considered if stimulants exacerbate a concurrent medical or psychiatric illness. For example, although rare, stimulants can unintentionally trigger mania or psychosis in adults with unstable or unrecognized comorbid bipolar disorder.
Physical health developments are equally critical. If an adult develops a newly arising or unstable cardiovascular condition, such as a cardiac arrhythmia, ischemia, or cardiomyopathy, the risk-benefit balance changes dramatically. Additionally, if severe side effects occur that cannot be managed by reducing the dosage, or if dangerous new drug-drug interactions emerge, stopping the medication under medical supervision protects the patient's long-term well-being.
Addressing Misuse and the Complex Role of Cannabis
Because stimulant medications target brain reward and wakefulness circuitry, they can foster a propensity for misuse. Studies indicate that more than 1 in 5 adults prescribed stimulants have misused them, and 1 in 6 have diverted their medication to others. The task force emphasizes that deprescribing is warranted if a patient persistently takes doses higher than prescribed against medical advice, uses the medication purely for unauthorized performance enhancement, or has an untreated, coexisting substance use disorder.
And what about cannabis? This topic sparked the most debate among the experts, falling just short of an official consensus with 71% agreement that regular cannabis use alone shouldn't automatically trigger a stimulant stoppage. Recognizing the complexity, such as how chronic cannabis use can overlap with ADHD executive function deficits, the task force proposed a structured monitoring approach instead of an immediate cutoff. Clinicians are encouraged to track the patient every 1 to 3 months using standardized symptom tools and random urine drug screens to verify whether cannabis use is actively neutralizing the stimulant's therapeutic benefits.
The Path Forward: Safe Tapering and Lifestyle Support
If you and your doctor decide that stopping a stimulant is the right path, it shouldn’t happen overnight. The task force strongly recommends that medications be gradually tapered off at a rate tailored to the individual to minimize potential disruptions and distinguish between transient withdrawal and a true return of ADHD symptoms.
Crucially, stopping a medication doesn't mean stopping treatment. The experts highlight that the success of any deprescribing plan is significantly enhanced when patients focus on optimizing modifiable lifestyle factors. Prioritizing sleep hygiene, staying physically active, and implementing structured behavioral strategies can support executive functioning and help sustain your cognitive gains even as the medication is reduced or eliminated.
The Takeaway:
The decision to continue or stop an ADHD medication is a deeply personal one that requires balancing real-world efficacy, safety, and individual health changes. These new consensus recommendations provide an essential roadmap to help adults navigate their long-term mental health journeys safely and effectively.
Are you or a loved one currently evaluating your long-term relationship with ADHD medication? Consider scheduling a check-in with your healthcare provider to discuss whether your current treatment plan still perfectly matches your health needs today.
Girls are diagnosed with ADHD at less than half the rate of boys, but this gap closes significantly by adulthood. ADHD also looks different in females than in males, with distinct patterns in symptoms, development, functional impairment, economic impact, and long-term outcomes. Despite this, sex differences in how ADHD relates to physical health have been poorly studied.
Prior research has established that both children and adults with ADHD face elevated risk for a range of physical health conditions. But that work has been hampered by small samples, retrospective designs, and limited population coverage.
The Study:
Denmark's single-payer national health system makes it possible to conduct truly population-wide research. This study drew on Danish national registers to follow more than 825,000 individuals, born between 1984 and 1995, from birth through adolescence and into young adulthood, tracking them across 13 categories of physical disease. Only individuals free of a relevant physical diagnosis at birth were included, and ADHD diagnosis was treated as something that could be acquired over time rather than a fixed characteristic.
The Results:
Across both sexes, people diagnosed with ADHD consistently showed higher disease risk than the general population, with cancer being the one notable exception. The absence of a meaningful cancer signal is expected, given that cancer predominantly affects older age groups than those captured in this study.
For most other disease categories (including infectious, endocrine, metabolic, respiratory, digestive, musculoskeletal, and genitourinary diseases), elevated risk emerged in early adolescence. For the remaining categories, elevated risk was present at all ages studied.
The magnitude of these risks was often substantial:
By early adulthood, individuals with ADHD showed at least 20% greater risk across every disease category except cancer, regardless of sex.
Sex Differences Shift With Age
One of the study's more nuanced findings concerns how sex interacts with ADHD diagnosis over time. In the general population, females tend to have higher physical disease risk from the teenage years onward, while males show higher risk in early childhood. ADHD diagnosis disrupted these patterns unevenly, amplifying risk in some groups and age windows more than others.
Perhaps most notably, the transition into young adulthood appeared to reduce the ADHD-associated gap between the sexes for endocrine, nutritional, and metabolic diseases (from a ninefold female-to-male disparity down to roughly 4.5-fold). The authors suggest this may reflect ADHD's influence on sex hormone activity during this developmental period.
Takeaway
This large, population-representative study confirms that an ADHD diagnosis is associated with meaningfully elevated risk across nearly all categories of physical disease, and that this relationship is neither uniform across sexes nor static across the lifespan. The findings underscore the need for sex-sensitive, developmentally informed approaches to the physical healthcare of people with ADHD.
Antidepressants are the primary drug treatment for depressive disorders, which affect 15–20% of pregnant women. They are among the most widely prescribed medications worldwide, and their use has increased in recent decades. Understanding their reproductive safety is critical to support informed, evidence-based prescribing during pregnancy.
A new meta-analysis sheds important light on one of the most debated concerns: whether children born to mothers who took antidepressants during pregnancy face a higher risk of ADHD.
The Study:
Pooling 14 studies covering more than 14 million participants, the analysis found that prenatal antidepressant exposure was associated with a 35% higher rate of ADHD in offspring compared to no exposure. A separate look at SSRIs (the most widely prescribed class of antidepressants, including Prozac and Zoloft) across 11 studies and over four million pregnancies found an even higher apparent risk (44%) after correcting for publication bias. On the surface, these are striking numbers.
Both associations came with an important caveat: enormous variation between individual studies, a statistical red flag suggesting the results may not reflect a true underlying effect. More tellingly, the apparent risk evaporated entirely when researchers applied a more rigorous method — comparing siblings within the same family, where one child was exposed to antidepressants in the womb, and another was not.
This sibling-comparison design is particularly powerful because it automatically controls for factors that run in families: shared genes, household environment, parenting, and socioeconomic conditions. When those influences are held constant, the link between antidepressant exposure and ADHD disappears. The same pattern held for SSRIs specifically.
Two other antidepressant classes, SNRIs (serotonin norepinephrine reuptake inhibitors) and tricyclics, showed no significant association in any analysis.
“Confounding by Indication”:
The probable driver of the initial association is what researchers call confounding by indication. The very condition being treated (depression) is itself a risk factor for ADHD in offspring, independently of any medication. Mothers with more severe depression are also more likely to be prescribed antidepressants, meaning the drug and the underlying illness are difficult to disentangle in standard analyses. Sibling studies cut through this problem cleanly.
The Take-Away:
The authors concluded that the association between antidepressants and ADHD risk was non-significant across all analyses designed to account for these confounding factors. This doesn’t mean antidepressants are without any reproductive considerations, but it does suggest that ADHD risk, at least, is driven by heritable and family-level factors rather than medication exposure itself.
For clinicians and patients weighing the risks of treating or not treating depression during pregnancy, this distinction matters considerably.
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