Tricyclic antidepressants updated on 07-01-2025

ADHD (Attention deficit hyperactivity disorder): Diagnosis/Risk

R analysis
id Study   Lib. in paper Exposition period    Study type  Control type 
 
Tags OR 95%CI x1/n1 x0/n0 no cases no exposed ROB Ref.
S18373
R77495
Heuvelman, 2023 Attention deficit hyperactivity disorder -Medical codes or therapy records that indicated that the child had been prescribed ADHD medication - Mean age at end of follow-up 10.04 years, range 4–22 years during pregnancy (anytime or not specified) retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: intermediate history of illness/treatment (3-12 months before pregnancy) 1.24 [0.83;1.85] -/2,148   -/16,330 - 2,148
ref
S18136
R76890
Hartwig, 2022 Attention-deficit/hyperactivity disorder (ADHD) - Children receiving medication for ADHD before the age of 16 years - Follow up from at least 4 years old during pregnancy (anytime or not specified) case control sibling Adjustment: Yes Monotherapy: no or not specified 1.43 [0.75;9.26] -/-   0/- - -
ref
S18247
R76891
Suarez (Controls unexposed, discontinuers), 2022 Attention Deficit Hyperactivity Disorder - ≥ 2 dates with ICD-9 Dx 314.xx or ≥ 2 dispensings or 1 diagnosis and 1 dispensing - At ≥ 2 years of age 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed, sick Adjustment: Yes Monotherapy: no or not specified Unexposed sick: recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 1.08 [0.83;1.41] 172/4,307   180/5,710 352 4,307
ref
S18248
R76892
Suarez (Controls unexposed, general pop), 2022 Attention Deficit Hyperactivity Disorder - ≥ 2 dates with ICD-9 Dx 314.xx or ≥ 2 dispensings or 1 diagnosis and 1 dispensing - At ≥ 2 years of age 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) excluded Adjustment: Yes Monotherapy: no or not specified 1.01 [0.86;1.18]
excluded (control group)
174/4,357   52,361/2,965,988 52,535 4,357
ref
S10946
R46862
Boukhris (Controls exposed to SSRIs), 2017 Infants with attention deficit hyperactivity disorder (ADHD-ICD9: 314.0; 314.01; 314.9; ICD10:F90;F90.0;F90.1;F90.2; F90.8;F90.9 or ADHD medications) - Mean 6-7 years old (0-11 years) 2nd and/or 3rd trimester retrospective cohort (claims database) exposed to other treatment, sick excluded Adjustment: No Monotherapy: TCA only 1.30 [0.75;2.26] C
excluded (control group)
16/227   86/1,561 102 227
ref
S10948
R46863
Boukhris (Controls unexposed, NOS), 2017 Infants with attention deficit hyperactivity disorder (ADHD-ICD9: 314.0; 314.01; 314.9; ICD10:F90;F90.0;F90.1;F90.2; F90.8;F90.9 or ADHD medications) - Mean 6-7 years old (0-11 years) 2nd and/or 3rd trimester retrospective cohort (claims database) unexposed (general population or NOS) Adjustment: Yes Monotherapy: TCA only 1.80 [1.00;3.10] 16/227   4,430/141,905 4,446 227
ref
S11328
R46864
Laugesen, 2013 Attention deficit hyperactivity disorder ADHD (diagnosis of ADHD or a redemption of a prescription for ADHD medication) - Median 8 years old (1-14 years) during pregnancy (anytime or not specified) population based cohort retrospective unexposed (general population or NOS) Adjustment: Yes Monotherapy: TCA only 1.10 [0.60;2.00] -/716   -/816,792 - 716
ref
Total 5 studies 1.19 [0.98;1.45] 4,798 7,398
x1: number of endpoints among exposed, n1: number of exposed; x0: number of endpoints among non exposed, n0: number of non exposed; C: calculated odds ratio from numbers of events and effectives

Forest plot

StudyTE95% CIn casesn exposedweightROBABCDEF Heuvelman, 2023Heuvelman, 2023 1.24[0.83; 1.85]-2,14823%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: criticalROB mesure: moderateROB reporting: low Hartwig, 2022Hartwig, 2022 1.43[0.75; 9.26]--2%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: unclearROB mesure: criticalROB reporting: moderate Suarez (Controls unexposed, discontinuers), 2022Suarez, 2022 1 1.08[0.83; 1.41]3524,30753%ROB confusion: seriousROB selection: lowROB classification: moderateROB missing: lowROB mesure: moderateROB reporting: moderate Boukhris (Controls unexposed, NOS), 2017Boukhris, 2017 2 1.80[1.00; 3.10]4,44622712%ROB confusion: moderateROB selection: lowROB classification: moderateROB missing: unclearROB mesure: moderateROB reporting: moderate Laugesen, 2013Laugesen, 2013 1.10[0.60; 2.00]-71610%ROB confusion: seriousROB selection: lowROB classification: criticalROB missing: lowROB mesure: moderateROB reporting: moderate Total (5 studies) I2 = 0% 1.19[0.98; 1.45]4,7987,3980.55.01.0ROB: A: confusion, B: selection, C: classification, D: missing, E: measurement, F: reportinglow,moderate,serious,critical,unclear,

1: Controls unexposed, discontinuers; 2: Controls unexposed, NOS;

Sensitivity analysis

SubsetTE95% CIn casesn exposedkI2 Type of studies cohort studiescohort studies 1.19[0.98; 1.44]4,7987,3980%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 Boukhris (Controls unexposed, NOS), 2017 Laugesen, 2013 4 case control studiescase control studies 1.43[0.41; 5.02]-- -NAHartwig, 2022 1 RCTRCT 1.43[0.41; 5.02]-- -NAHartwig, 2022 1 Type of controls unexposed (disease free or unspecified)unexposed (disease free or unspecified) 1.42[0.88; 2.30]4,44694327%NABoukhris (Controls unexposed, NOS), 2017 Laugesen, 2013 2 unexposed, sickunexposed, sick 1.13[0.90; 1.40]3526,4550%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 2 sibling designsibling design 1.43[0.41; 5.02]-- -NAHartwig, 2022 1 Tags Adjustment   - Yes  - Yes 1.19[0.98; 1.45]4,7987,3980%NAHeuvelman, 2023 Hartwig, 2022 Suarez (Controls unexposed, discontinuers), 2022 Boukhris (Controls unexposed, NOS), 2017 Laugesen, 2013 5 Monotherapy   - no or not specified  - no or not specified 1.13[0.91; 1.41]3526,4550%NAHeuvelman, 2023 Hartwig, 2022 Suarez (Controls unexposed, discontinuers), 2022 3   - TCA only  - TCA only 1.42[0.88; 2.30]4,44694327%NABoukhris (Controls unexposed, NOS), 2017 Laugesen, 2013 2 Unexposed sick   - intermediate history of illness/tre ...  - intermediate history of illness/treatment (3-12 months before pregnancy) 1.24[0.83; 1.85]-2,148 -NAHeuvelman, 2023 1   - recent illness/treatment (during o ...  - recent illness/treatment (during or juste before pregnancy or treatment stopped in view of pregnancy) 1.08[0.83; 1.41]3524,307 -NASuarez (Controls unexposed, discontinuers), 2022 1 All studiesAll studies 1.19[0.98; 1.45]4,7987,3980%NAHeuvelman, 2023 Hartwig, 2022 Suarez (Controls unexposed, discontinuers), 2022 Boukhris (Controls unexposed, NOS), 2017 Laugesen, 2013 50.55.01.0

Publication bias and p-hacking diagnosis

funnel plot
0.0-1.51.70.7690.000Heuvelman, 2023Hartwig, 2022Suarez (Controls unexposed, discontinuers), 2022Boukhris (Controls unexposed, NOS), 2017Laugesen, 2013

Asymetry test p-value = 0.3229 (by Egger's regression)

slope=-0.0171 (0.1815); intercept=0.9755 (0.8263); t=1.1806; p=0.3229

p values plot
0.01.00.01.0

Sub-groups analysis using all included studies

excluded 10946, 18248

Sub-groupsTE95% CIn casesn exposedkI2ROB type of controls unexposed controls (disease free or unspecified)unexposed controls (disease free or unspecified) 1.17[0.84; 1.62]56,9815,30046%NASuarez (Controls unexposed, general pop), 2022 Boukhris (Controls unexposed, NOS), 2017 Laugesen, 2013 3 unexposed, sick controlsunexposed, sick controls 1.13[0.90; 1.40]3526,4550%NAHeuvelman, 2023 Suarez (Controls unexposed, discontinuers), 2022 2 exposed to other treatment, sick controlsexposed to other treatment, sick controls 1.30[0.75; 2.26]102227 -NABoukhris (Controls exposed to SSRIs), 2017 1 siblingssiblings 1.43[0.41; 5.02]-- -NAHartwig, 2022 10.510.01.0