July 18, 2003

Studies focus on diagnosis, treatment for adults with ADHD and bipolar disorder

Two studies from MGH researchers address the challenges of diagnosing
and treating individuals with both attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD). Published in the July issue of Biological Psychiatry, one report clearly identifies symptoms of both disorders in study participants, supporting the theory that some individuals truly suffer from both disorders. The second study finds that the antidepressant bupropion may be helpful in treating those with both ADHD and BPD.

"The question of whether ADHD and BPD can exist together has been controversial, with some believing that such diagnoses reflected particularly bad ADHD or that the manic symptoms of bipolarity were simple hyperactivity," says Timothy Wilens, MD, (left) of the MGH Pediatric Psychopharmacology Unit, lead author of both papers.

In the first study, adult patients who had come to the MGH to participate in ADHD clinical trials went through an extensive clinical assessment of psychiatric symptoms. Of those evaluated for this study, 51 met full criteria for ADHD diagnosis, and 24 of them met criteria for both ADHD and BPD. Along with their BPD symptoms, participants with both disorders had a greater number of ADHD symptoms than those with ADHD alone. Sixty percent of those with both disorders reported having BPD symptoms starting at a young age.

Bupropion — an atypical antidepressant — is already used to treat individuals with ADHD and to treat depressive symptoms in BPD. During the six-week study period, 30 participants diagnosed with both disorders began taking a daily 100 mg. dose and increased their dosage to a maximum of 200 mg given twice daily. Most of the study participants showed significant improvement in their symptoms of both disorders, with 70 percent reporting that symptoms were "much improved" or "very much improved." Further research is needed to confirm the study's findings.

"I have followed a number of those participating in this study," Wilens says, "and they have noted major life changes associated with improved functioning and well-being. Many went from being incapacitated and unable to sustain relationships to being employed and reporting improved relationships and overall well-being."

Wilens' coauthors for the first study are Joseph Biederman, MD; Janet Wozniak, MD; Samantha Gunawardene, Jocelyn Wong and Michael Monuteaux. The second study was coauthored by Biederman, Jefferson Prince, MD; Thomas Spencer, MD; Stephaine Van Patten; Robert Doyle, MD, DDS; Kristine Girard, MD; Paul Hammerness, MD; Sarah Goldman and Sarah Brown.