ADHD with Comorbid Bipolar Disorders: A Systematic Review of Neurobiological, Clinical and Pharmacological Aspects Across the Lifespan

Abstract

Background: Attention deficit hyperactivity (ADHD) disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, disruptive behaviour, and impulsivity. Despite considered typical of children for a long time, the persistence of ADHD symptoms in adulthood gained increasing interest during the last decades. Indeed, its diagnosis, albeit controversial, is rarely carried out even because ADHD is often comorbid with several other psychiatric diosrders, in particular with bipolar disorders (BDs), a condition that complicates the clinical picture, assessment and treatment. Aims: The aim of this paper was to systematically review the scientific literature on the neurobiological, clinical features and current pharmacological management of ADHD comorbid with BDs across the entire lifespan, with a major focus on the adulthood. Discussion: The pharmacology of ADHD-BD in adults is still empirical and influenced by the individual experience of the clinicians. Stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants are useful when a substance abuse history is detected, although they require some weeks in order to be fully effective. In any case, an in-depth diagnostic and clinical evaluation of the single individual is mandatory. Conclusions: The comorbidity of ADHD with BD is still a controversial matter, as it is the notion of adult ADHD as a distinct nosological category. Indeed, some findings highlighted the presence of common neurobiological mechanisms and overlapping clinical features, although disagreement does exist. In any case, while expecting to disentangle this crucial question, a correct management of this comorbidity is essential, which requires the co-administration of mood stabilizers. Further controlled clinical studies in large samples of adult ADHD-BD patients appear extremely urgent in order to better define possible therapeutic guidelines, as well as alternative approaches for this potentially invalidating condition.

Clinical correlates of comorbid attention deficit hyperactivity disorder in adults suffering from bipolar disorder: A meta-analysis

“…The identification of factors associated with comorbid ADHD could be useful to clarify if these subjects might represent a clinical subpopulation with specific unmet needs, thus requiring tailored treatments. In particular, we hypothesized that individuals with co-occurring BD and ADHD might be characterized by specific clinical features, for example, in terms of number of mood episodes, suicidal behaviors and additional comorbid conditions, such as anxiety and substance or alcohol use disorders (Bond et al, 2012; Hegerl et al, 2010; Klassen et al, 2010; Mucci et al, 2019; Sandstrom et al, 2021; Schiweck et al, 2021). To shed light on this topic, we performed a systematic review and meta-analysis of observational studies aimed at identifying sociodemographic and clinical correlates of ADHD among adults with BD and assessing the quality of existing evidence.…”

Attention-Deficit Hyperactivity Disorder and Comorbid Mental Health Conditions Associated with Increased Risk of Injury

“…The majority of ADHD cases have comorbid mental health problems. Other studies have also observed a high level of comorbid mental illness among ADHD cases [7][8][9][10][11][12][13][14][15][16]. Because depression and anxiety are comparatively more common among the mental health problems, a higher percentage of ADHD cases had these comorbid conditions.…”

“…Common comorbid problems associated with ADHD include autistic spectrum disorder (ASD), mania, schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD), depression, anxiety, learning disorders, sleep disorders, oppositional-defiant disorder (ODD), substance use disorders, and personality disorders [7][8][9][10][11][12][13][14]. A systematic review of the literature from 2019 found that bipolar disorder is a common comorbid condition for ADHD, with overlapping symptoms and complex treatment [15].…”

Effectiveness of clozapine, oxcarbazepine and rivastigmine combination in a bipolar disorder patient with initial cerebral atrophy

“…Bipolar disorders (BDs) are psychiatric conditions characterized by mood, psychomotricity, and biorhythmicity disturbances. Bipolar disorder of type I (BDI) and of type II (BDII) represent the most severe types of BDs: the first is characterized by alternating depressive and manic episodes of great severity that frequently require hospitalization, while the second by depressive and hypomanic episodes . Currently, the debate concerning whether BDs should be primarily regarded as developmental or a neurodegenerative disorders is still open, although the two hypotheses do not appear necessarily mutually exclusive .…”

“…Bipolar disorder of type I (BDI) and of type II (BDII) represent the most severe types of BDs: the first is characterized by alternating depressive and manic episodes of great severity that frequently require hospitalization, while the second by depressive and hypomanic episodes. 1 Currently, the debate concerning whether BDs should be primarily regarded as developmental or a neurodegenerative disorders is still open, although the two hypotheses do not appear necessarily mutually exclusive. 2,3 Indeed, postmortem studies highlighted different neuropathological abnormalities of glial and neuronal cells (in particular a loss of oligodendrocytes), albeit these alterations appear more limited than those observed in major neurodegenerative disorders.…”