What’s the best treatment for comorbid ADHD/bipolar mania?
How to stabilize mood without worsening ADHD symptoms.
Pharmacologic attributes may also determine which atypical antipsychotic is used. For example, ziprasidone’s serotonergic profile—with serotonin-1A receptor agonism and serotonin-1D antagonism—may make it useful for patients with mixed states and bipolar depression.26 Aripiprazole offers potential synergism of dopamine agonism with psychostimulant therapy, which could be useful for treating both disruptive behaviors and ADHD.
Table 3
Using atypical antipsychotics to treat comorbid ADHD/bipolar disorder
| Drug | Target dosage (mg/d) | Side effects | Useful in… |
|---|---|---|---|
| Aripiprazole | 10 to 15 | Nausea, vomiting | Comorbid disruptive behavioral disorders, maintenance stabilization |
| Olanzapine | 10 to 20 | Weight gain, hyperlipidemia, hyperglycemia, sedation | Maintenance stabilization |
| Quetiapine | 400 to 600 | Weight gain, sedation | Mixed states, bipolar depression |
| Risperidone | 1 to 2 | Weight gain, hyperprolactinemia, extrapyramidal symptoms | Comorbid disruptive behavioral disorders, including aggression |
| Ziprasidone | 80 to 120 | Cardiac abnormalities, akathisia | Mixed states, bipolar depression |
Related resources
- Child and Adolescent Bipolar Foundation. www.bpkids.org
- Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD). www.chadd.org
- Findling RF, Kowatch RA, Post RM. P ediatric bipolar disorders: a handbook for clinicians. London: Martin Dunitz Press, 2002.
Drug brand names
- Atomoxetine • Strattera
- Aripiprazole • Abilify
- Divalproex • Depakote
- Olanzapine • Zyprexa
- Quetiapine • Seroquel
- Risperidone • Risperdal
- Ziprasidone • Geodon
Disclosures
Dr. Patel is a consultant to Eli Lilly and Co. and a speaker for Eli Lilly and Co. and Pfizer Inc.
Dr. Sallee receives research support from Otsuka America Pharmaceutical, Pfizer Inc., and Bristol-Myers Squibb Co. and is a consultant or speaker for Eli Lilly and Co, Otsuka America Pharmaceutical, and Pfizer Inc.
