Research / Studies
Posted by: Kye Stone5 min read

ADHD Medication and Self-Harm: UK-Led Study Finds Risk Was Highest in the 90 Days Before Treatment Started

The riskiest stretch looked like the time before treatment, not the medication itself. Here's what the study does and doesn't show.

Posted by: Kye Stone5 min read
Patient’s hands resting on a desk as a clinician takes notes, with a medication blister pack nearby.

What the study did

A large study led by Aston University in Birmingham has looked at ADHD medication and self-harm, a worry that the researchers say can affect whether people start or keep taking treatment. Dr Adrienne Chan and Regius Professor Ian Wong at Aston Pharmacy School led the work with partners including UCL, the University of Hong Kong, the University of Auckland, Sungkyunkwan University in South Korea and National Cheng Kung University in Taiwan.

The team used health records from 461,024 people in Hong Kong, New Zealand, South Korea, Taiwan and the UK who had been prescribed ADHD medication between 2001 and 2020, including 127,894 people in the UK. They focused on the 6,847 people who had a self-harm event in that time. The study compared three stretches with times when people weren't taking medication: the 90 days before treatment began, the first 90 days of treatment, and the rest of the treatment period.

What it found

The risk of self-harm was highest in the 90 days before people started ADHD medication. It was lower in the first 90 days of treatment and lowest after that, although still a little higher than in periods without medication. The pattern held in all five healthcare systems, and it looked similar when stimulants and non-stimulants were analysed separately. Compared with time off medication, the paper's pooled figures put the rate of self-harm at:

  • 2.58 times as high in the 90 days before treatment
  • 1.78 times as high in the first 90 days of treatment
  • 1.27 times as high later in treatment

Link, not proof

This is an observational study based on routine health records, so it shows a link, not cause and effect. The authors point out that records can be coded wrongly, people don't always take medication as prescribed, and they "cannot rule out the effect of residual confounding", meaning other things they couldn't measure may play a part.

They also say the drop in risk after treatment starts "should also not be interpreted as reflecting the pharmacological effect of ADHD medication alone". Starting treatment usually comes with assessment, counselling and closer monitoring, and those may help too.

What researchers say

The press release says the findings "do not support ADHD medications as the main driver of self-harm". Dr Chan said: "People often worry that ADHD medication itself increases the risk of self-harm. What our findings suggest is that many people are already at their highest risk before treatment even begins. This highlights an important opportunity for earlier intervention. Recognising that vulnerable period could help us provide support earlier, when it may make the greatest difference."

Monitoring still matters

This isn't a "no risk at all" message. Risk stayed a little raised during treatment, and the paper says this highlights "the need for ongoing clinical monitoring and counselling before and during treatment". The authors also say their findings support "timely diagnosis and treatment of ADHD … rather than delaying treatment because of safety concerns".

The wait before treatment

If the hardest stretch is the time before treatment, the length of that wait matters. In its coverage of the Fonagy review on 9 October, BBC News reported that the average NHS wait for an ADHD assessment is eight years for adults and four years for children. This study didn't look at waiting lists, but the researchers want people whose symptoms are getting worse before treatment to be monitored closely, so support can come before self-harm happens.

What comes next

The team says future work will look at what happens when people stop or restart treatment, and whether ethnicity and socioeconomic disadvantage contribute to inequalities in ADHD care. For transparency, several of the authors have received research grants from pharmaceutical companies, including Takeda, which makes ADHD medicines. Most of these are stated as outside the submitted work.

Your own medication

If you take ADHD medication, or you're thinking about it, this study isn't a reason to start, stop or change anything on your own. If you have worries about how you're feeling before or during treatment, talk to your GP or prescriber.

If you're struggling

If you're struggling or having thoughts of self-harm, you don't have to deal with it on your own. You can call Samaritans free on 116 123, any time, day or night. You can also speak to your GP, or for urgent mental health help, call NHS 111 and choose the mental health option. If someone's life is at risk, call 999 or go to A&E.

Read next

ADHD and early death: what the new UK-led study found

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(Original source)

Rewritten for ADHDer from reporting by BMJ Mental Health (BMJ). Originally published 12 Sep 2026.

Read the original at BMJ Mental Health (BMJ) ↗