A systematic review of pharmacotherapy for attention-deficit/hyperactivity disorder in children and adolescents with bipolar disorders

ABSTRACT

Introduction

The data suggests that in children and adolescents, bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) may be strongly correlated. Even though drugs for ADHD and BD are largely accepted, there is relatively little research on the management of comorbidity in children and adolescents, particularly in terms of safety. We provide a synthesis of these findings because one hasn’t been made yet.

Areas covered

As a primary outcome, we wanted to determine whether stimulant or non-stimulant treatment of children and adolescents with ADHD and comorbid BD was effective. As a secondary outcome, we wanted to determine tolerability, especially the risk of mood switch.

Expert opinion

The findings of this systematic review suggest that methylphenidate, when used with a mood stabilizer, may be safe and not significantly increase the risk of a manic switch or psychotic symptoms when used to treat ADHD that co-occurs with a BD. In situations where stimulants are ineffective or have low tolerance, atomoxetine also seems to be a good alternative, and also in cases of co-morbid anxiety, oppositional defiant disorder, conduct disorders, ICT disorders, and substance use disorders. Additional research with a higher level of evidence is necessary to corroborate these preliminary findings.

KEYWORDS:

• ADHD
• adolescent
• atomoxetine
• bipolar disorder
• child
• methylphenidate
• stimulant

Article highlights

• Although the epidemiological statistics are quite inconsistent, the comorbidity of attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) in children and adolescents appears to be frequent.

• The pharmacological management of ADHD in this population is well established, but comorbid BD is far less well understood, which seems to be a weakness given the prevalence of comorbidity.

• The majority of pharmacological therapies use stimulants like methylphenidate, although there are still non-stimulant options like atomoxetine.

• The results of this scientifically conducted literature review also point to the medicines’ good efficacy in treating comorbid BD in children and adolescents.

• Furthermore, it does not appear that the use of these medications, particularly stimulants, increases the risk of mood switch, at least not without the concurrent use of a mood stabilizer medication with an anti-manic effect.

• Methylphenidate should be used in first-line treatment in cases of simple comorbidity between BD and ADHD. Atomoxetine could be used in first-line treatment in cases of comorbid anxiety, oppositional defiant disorder, conduct disorders, TIC disorders, and substance use disorder.

• To update the recommendations of learned societies, these findings should be supported by research with a higher level of scientific evidence and long-term follow-up of this population.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14656566.2023.2224920

Additional information

Funding

This paper was not funded.