From the FDA Drug Label
Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Such symptoms may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication [seeWarnings and Precautions (5. 2)].
Seroquel (Quetiapine) may cause self-harm behaviors, as it can increase the risk of suicidal thoughts and behaviors, especially in patients with depression or other mental illnesses. Concerta (Methylphenidate) is not mentioned in the provided drug label, therefore, no conclusion can be drawn about its potential to cause self-harm behaviors based on this information 1.
From the Research
Both Quetiapine (Seroquel) and Methylphenidate (Concerta) can potentially increase the risk of self-harm behaviors in some individuals, particularly when treatment is initiated or dosages are changed. Quetiapine, an atypical antipsychotic, carries a black box warning for increased suicidal thoughts and behaviors, especially in children, adolescents, and young adults 2. This risk is highest during the first few weeks of treatment. Similarly, Methylphenidate, a stimulant medication used for ADHD, may occasionally worsen or trigger mood symptoms, agitation, or aggressive behaviors that could lead to self-harm in vulnerable individuals.
Key Considerations
- Patients taking either medication should be closely monitored for new or worsening thoughts of self-harm, unusual changes in behavior, increased agitation, or symptoms of depression, particularly during the initial treatment period or following dose adjustments.
- Any concerning changes should be reported to a healthcare provider immediately.
- The underlying mechanism involves these medications' effects on neurotransmitters that regulate mood and behavior, which can sometimes produce paradoxical reactions in certain patients.
- This risk must be balanced against the potential benefits of these medications in treating their respective conditions.
Management Strategies
- Comprehensive safety precautions can be successfully developed and implemented to reduce the risk of self-harm, as seen in studies such as 3.
- Psychotherapies, including dialectical behavioral therapies and mentalization-based therapies, have shown promise in reducing self-harm and suicidal ideation among children and adolescents 2.
- GPs play a crucial role in the management of patients with self-harm behavior, and their training, improved communication, and service provision are essential for effective management 4.