From the Research
The best management for ADHD in adults with stable bipolar disorder is a combination of pharmacotherapy and psychosocial interventions, with long-acting stimulants as the first-line medication option, as supported by the most recent and highest quality study available 1. The management of ADHD in adults with stable bipolar disorder requires careful consideration of the potential risks and benefits of different treatment options.
- The use of stimulants, such as extended-release methylphenidate (Concerta) or extended-release mixed amphetamine salts (Adderall XR), is generally recommended as the first-line medication option, with careful titration to optimal effect 1.
- These medications should be initiated only when the bipolar disorder is well-controlled on mood stabilizers, and close monitoring for mood destabilization is essential, with appointments every 2-4 weeks during initial treatment.
- If stimulants trigger mood symptoms, non-stimulant alternatives like atomoxetine (Strattera) or bupropion (Wellbutrin XL) should be considered, as they may be effective in treating ADHD symptoms with a lower risk of mood destabilization 2.
- Psychosocial interventions, including cognitive behavioral therapy focused on executive functioning, organizational skills training, and mindfulness practices, can significantly enhance medication effectiveness and improve overall outcomes 3.
- The goal of treatment is to balance effective ADHD symptom control while minimizing the risk of triggering manic or hypomanic episodes, and a hierarchical approach is often desirable, with mood stabilization preceding the treatment of ADHD symptoms 1, 4.