Systematic chart review of the pharmacologic treatment of comorbid attention deficit hyperactivity disorder in youth with bipolar disorder

The objective of this study was to evaluate pharmacological approaches for attention deficit hyperactivity disorder (ADHD) in children with bipolar di sorder and comorbid ADHD. The medical charts of 38 patients with diagnoses of both Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev ised ADHD and bipolar disorder were reviewed over multiple visits to assess improvement and prescription patterns. Logistic regression was used to mod el the probability of improvement at each visit, and robust standard errors were estimated in order to account for correlation among individuals using Huber's correction for clustered data. The proportion of visits at which A DHD symptoms were rated as improved following initial improvement in manic symptoms was 7.5 times greater than before initial improvement of manic sym ptoms. The recurrence of manic symptoms following their initial stabilizati on significantly inhibited ADHD response to medication. Although tricyclic antidepressants (TCAs) significantly increased the probability of ADHD impr ovement following mood stabilization, there was also a significant associat ion between treatment with TCAs and relapse of manic symptoms. Our results support the hypothesis that mood stabilization is a prerequisite for the su ccessful pharmacologic treatment of ADHD in children with both ADHD and man ic symptoms. Although TCAs can be helpful in the management of ADHD childre n with manic symptoms, these drugs should be used with caution since they c an also have a destabilizing effect on manic symptoms.