Methylphenidate in the treatment of children and adolescents with bipolar disorder and attention-deficit/hyperactivity disorder.
OBJECTIVE
To examine the short-term efficacy of methylphenidate in the treatment of youths with bipolar disorder (BD) and comorbid attention deficit/hyperactivity disorder (ADHD).


METHODS
A 4-week double-blind, placebo-controlled trial in youths ages 5 to 17 years was conducted. Subjects met DSM-IV criteria for bipolar disorder and ADHD, were currently receiving a stable dose of at least one thymoleptic, and while euthymic continued to have clinically significant symptoms of ADHD. Patients received 1 week each of placebo, methylphenidate 5 mg twice daily, methylphenidate 10 mg twice daily, and methylphenidate 15 mg twice daily using a crossover design. Subjects were randomly assigned to receive one of six possible dosing orders. At study's end, and before the blind being broken, a "best dose week" for each subject was determined. The primary outcome measure was the total score on the parent-completed ADHD Rating Scale-IV.


RESULTS
Sixteen patients, with a mean age of 10.43 (SD 3.14) years completed the trial. Lower scores during best dose treatment compared to the week of placebo treatment were found on the ADHD Rating Scale-IV (p < .05), suggesting a therapeutic benefit. A large effect size (Cohen's d = 0.90) was found for methylphenidate. Treatment was generally well tolerated.


CONCLUSIONS
Euthymic youths with bipolar disorder and ADHD may benefit from short-term concomitant treatment with methylphenidate.
Findling
Robert L
RL
Department of Psychiatry, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, OH 44106-5080, USA. robert.findling@UHhospitals.org
Short
Elizabeth J
EJ
McNamara
Nora K
NK
Demeter
Christine A
CA
Stansbrey
Robert J
RJ
Gracious
Barbara L
BL
Whipkey
Resaca
R
Manos
Michael J
MJ
Calabrese
Joseph R
JR
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*
D000697:Central Nervous System Stimulants; D008774:Methylphenidate