Use of psychiatric medications closely associated with the risk and progression of ALS: JAMA

A new study published in the Journal of American Medical Association showed that an increased risk of amyotrophic lateral sclerosis (ALS) was linked to prediagnostic use of sedatives, antidepressants, hypnotics, and anxiolytics.

While a number of studies have indicated that people with a history of mental illnesses are more likely to be diagnosed with ALS, there is little and conflicting evidence linking the use of popular psychiatric drugs to ALS. Thus, the purpose of this study was to investigate if the risk and course of ALS are related to the prescribed use of popular psychiatric drugs, such as antidepressants, hypnotics and sedatives, and anxiolytics.

Based on the Swedish Motor Neuron Disease Quality Registry, this nationwide register-based case-control study was carried out in Sweden among all patients diagnosed with ALS between January 1, 2015, and July 1, 2023. These patients were matched for age and sex with up to five people who did not have ALS, as well as their spouses and full siblings.

Following diagnosis, ALS patients were monitored for a median (IQR) of 1.33 (0.64-2.37) years. Conditional logistic regression models were used to compare patients with ALS to population or relative control participants in order to evaluate the probability of ALS diagnosis linked to prediagnostic prescription usage of popular mental drugs. Following diagnosis, ALS patients were monitored to see whether prediagnostic prescription usage of popular mental drugs was associated with the advancement of the disease.

In a research study with 1,057 ALS cases and 5,281 controls (mean age 67.5 years; 53.1% male), using psychiatric drugs before being diagnosed with ALS was associated with a higher chance of getting the condition. In particular, the strongest correlation (OR 6.10) was seen for hypnotic/sedative usage during the first year, followed by anxiolytic use (OR 1.60) and antidepressant use (OR 1.21) across longer time periods.

For all 3 medication groups, the increased risk remained even after excluding prescriptions written in the year before the diagnosis. With the exception of hypnotics and sedatives, similar correlations were found when comparing with relatives, allaying worries regarding hereditary influences. Additionally, ALS patients who had previously used antidepressants or anxiolytics had lower survival times.

Overall, the use of antidepressants, hypnotics and sedatives, or anxiolytics was linked to an increased chance of receiving an ALS diagnosis in the future. Among ALS patients, prediagnostic usage of several of these drugs was likewise linked to a worse survival rate and a quicker functional deterioration.

Reference:

Chourpiliadis, C., Lovik, A., Ingre, C., Press, R., Samuelsson, K., Valdimarsdottir, U., & Fang, F. (2025). Use of common psychiatric medications and risk and prognosis of amyotrophic lateral sclerosis. JAMA Network Open, 8(6), e2514437. https://doi.org/10.1001/jamanetworkopen.2025.14437