Recurrent Suicidality Following Rechallenge with Phosphatidylserine and Citicoline in a Pediatric ADHD Patient Treated with Methylphenidate: A Cautionary Case Report

Citicoline and phosphatidylserine are considered safe compounds with potential cognitive and behavioral benefits in the management of attentiondeficit/hyperactivity disorder (ADHD). However, their safety profiles have not been sufficiently characterized. A case is presented of a 7-year-old boy with ADHD who developed marked irritability, agitation, and a suicide attempt shortly after starting a combination of methylphenidate, phosphatidylserine (100 mg/day), and citicoline (250 mg/day). During the clinical stabilization period, when the family restarted the phosphatidylserine and citicoline combination against medical advice, the patient experienced similar side effects and suicidal thoughts; however, these symptoms completely resolved after discontinuation of the supplements. Although citicoline and phosphatidylserine are generally well-tolerated, this case highlights the potential for serious side effects in sensitive pediatric patients, particularly when used concomitantly with stimulants. The temporal relationship between the initiation of supplementation and the onset of symptoms, as well as the resolution of symptoms following discontinuation, suggests a possible causal relationship. It may be beneficial to review mood symptoms and conduct a risk assessment before adding such supplements.