Evidence-Based Reviews

What’s the best treatment for comorbid ADHD/bipolar mania?

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References

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

DrugTarget dosage (mg/d)Side effectsUseful in…
Aripiprazole10 to 15Nausea, vomitingComorbid disruptive behavioral disorders, maintenance stabilization
Olanzapine10 to 20Weight gain, hyperlipidemia, hyperglycemia, sedationMaintenance stabilization
Quetiapine400 to 600Weight gain, sedationMixed states, bipolar depression
Risperidone1 to 2Weight gain, hyperprolactinemia, extrapyramidal symptomsComorbid disruptive behavioral disorders, including aggression
Ziprasidone80 to 120Cardiac abnormalities, akathisiaMixed 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.

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