Active suicidal ideation in an adolescent with autism spectrum disorder receiving methylphenidate: a case report

Abstract Background Methylphenidate is a psychostimulant treatment widely prescribed in children and adolescents with attention deficit hyperactivity disorder. Although published studies are reassuring regarding the safety and tolerability of this treatment in the short and long term, there are case studies that have reported the possibility of serious adverse effects following methylphenidate initiation in children and adolescents. Case presentation In the present study, we illustrate the case of a 13-year-old adolescent, who was diagnosed with autism spectrum disorder, attention deficit hyperactivity disorder, and other psychiatric comorbidities. The patient developed active suicidal ideation a few weeks after initiating methylphenidate. He also presented irritability accentuation, insomnia, decreased appetite, and an increase in temper tantrums after initiation of this treatment. Psychiatric evaluation, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), did not reveal major psychiatric disorders that could explain them, particularly mood disorders. The risk of suicide was assessed as high indicating a hospitalization and the immediate discontinuation of this treatment. The evolution was marked by a disappearance of suicidal thoughts 2 days after discontinuation of methylphenidate and a clear decrease in symptoms of poor tolerance. The authors were unable to establish a cause-and-effect link between the prescription of methylphenidate and the appearance of suicidal thoughts in this patient, but the results of studies already published seem to provide clues that could explain this link. Conclusions The purpose of this work is to alert clinicians to the possibility that young people who have multiple neurodevelopmental disorders may experience suicidal thoughts after starting methylphenidate even in the absence of mood disorders. The link between the prescription of this treatment and the onset of suicidal ideation is not as clear and requires more controlled studies. This suggests particular attention, such as informing the young people and their families beforehand and planning rigorous psychiatric evaluations after the prescription.