Methylphenidate and suicidal ideation: Report of two cases
An 8-year-old male child, attending the Child Guidance Clinic at our institute was diagnosed as a case of ADHD, combined type as per DSM-IV TR by the consultant Psychiatrist. The patient had marked hyperactivity at school, home, and in social settings. The child reportedly also had impulsivity and poor concentration as was apparent from history, observation, and mental status examination. The patient had average Intelligent Quotient, but due to hyperactivity and inattention, he was not performing well in academics. He also had behavioral problems at home.\nThe patient was prescribed methylphenidate immediate release at the dose of 5 mg per day. Parents reported after a week as was scheduled. They mentioned that during the initial 2 days, the child reported suicidal ideation. In the evening when all family members were sitting and talking, the child said without any context (in vernacular language) on the first day “I wish to commit suicide” and on the second day he said “don't cremate me if I die”. During these two days, he was interacting well, playing adequately and his biological functioning was normal. Also there were no other behavioral problems or any other unusual behavior. No other side effects of methylphenidate were reported by the parents.\nParents were alarmed by child's utterances and stopped methylphenidate after 2 days and thereafter no suicidal ideation was expressed by the child. Following this, atomoxetine was prescribed, no side effects have been observed since then and the patient has been coming to child guidance clinic regularly. The case had no family history of mental illness or suicide.