ADHD and Bipolar Disorder in Adulthood: Clinical and Treatment Implications

Abstract

Attention deficit hyperactivity disorder (ADHD) is a condition that usually has its onset in childhood. Although the disorder persists into adulthood in half of cases, adult ADHD is often not recognized due to different psychopathological characteristics, quite often overlapping with other diagnoses such as mood, anxiety and personality disorders. This is especially true for bipolar disorder (BD), which shares several symptoms with adult ADHD. Moreover, besides an overlapping clinical presentation, BD is often co-occurring in adults with ADHD, with comorbidity figures as high as 20%. This review will focus on the comorbidity between ADHD and BD by exploring the magnitude of the phenomenon and evaluating the clinical and functional characteristics associated with ADHD–BD comorbidity in adults. Finally, the review will address the implications of pharmacologically treating the ADHD–BD comorbidity, providing suggestions in how to treat these complex patients and addressing the issue of treatment-induced manic switch with the use of stimulants and other medications for ADHD.

Attention Deficit Hyperactivity Disorder and Bipolar Disorder: Diagnosis, Treatments, and Clinical Considerations: A Narrative Review

“…Attention-deficit Hyperactivity Disorder is one of the most common childhood mental health disorders, affecting about 5.6% of the population worldwide, without respect to socioeconomic factors [1]. It is characterized by significant motor hyperactivity and inattentiveness that can affect social functioning and cause impairment in other settings [2]. Symptoms result from dysfunction in the frontal cortex and basal ganglia, with treatment to regulate neurotransmission in these areas [3].…”

“…It is now established that symptoms can persist into adulthood in up to 65% of those diagnosed [3]. Children diagnosed with attention-deficit hyperactivity disorder (ADHD) are more likely to experience additional mental health issues in adulthood [2]. These disorders include mood disorders, such as bipolar disorder (BD), and personality and anxiety disorders.…”

“…These disorders include mood disorders, such as bipolar disorder (BD), and personality and anxiety disorders. The prevalence of adults seeking treatment for at least one additional disorder following an ADHD diagnosis can vary from 57 to 97% [2].…”

“…Several studies have specifically shown a high prevalence of comorbid mood disorders, such as depression and BD, in those diagnosed with ADHD [1,2]. In a survey conducted in the US, the National Comorbidity Survey-Replication found the prevalence of comorbid BD in patients diagnosed with ADHD to be 21.2% [2]. Several common symptoms of ADHD are also found in BD, which are characterized by alternating periods of euthymia and mood disturbances.…”

“…Several common symptoms of ADHD are also found in BD, which are characterized by alternating periods of euthymia and mood disturbances. The inattention and impulsivity of ADHD can be seen in BD's manic and hypomanic episodes [2]. Patients with BD can also present from resulting cognitive dysfunction during the premorbid phase into the early course of the disease.…”