The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder.
BACKGROUND
Patients with bipolar disorder (BD) and major depressive disorder (MDD) experience adult attention-deficit/hyperactivity disorder (ADHD) at rates substantially greater than the general population. Nonetheless, ADHD frequently goes untreated in this population.


METHODS
We reviewed the literature regarding the management of adult ADHD in patients with mood disorders. Because a limited number of studies have been conducted in adults, our treatment recommendations also are partly informed by research in children and adolescents with BD+ADHD or MDD+ADHD, adults with ADHD, and our clinical experience.


RESULTS
In individuals with mood disorders, ADHD is best diagnosed when typical symptoms persist during periods of sustained euthymia. Individuals with BD+ADHD, particularly those with bipolar I disorder (BD I), are at risk for mood destabilization with many ADHD treatments, and should be prescribed mood-stabilizing medications before initiating ADHD therapies. Bupropion is a reasonable first-line treatment for BD+ADHD, while mixed amphetamine salts and methylphenidate also may be considered in patients determined to be at low risk for manic switch. Modafinil and cognitive-behavioral therapy (CBT) are second-line choices. In patients with MDD+ADHD and moderate to severe depression, MDD should be the treatment priority, whereas in mildly depressed or euthymic patients the order may be reversed. First-line treatments for MDD+ADHD include bupropion, an antidepressant plus a long-acting stimulant, or an antidepressant plus CBT. Desipramine, nortriptyline, and venlafaxine are second-line options.


CONCLUSIONS
Clinicians should be vigilant in screening for comorbid ADHD in mood disorder patients. ADHD symptoms can respond to appropriately chosen treatments.
Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada. davidjbond@hotmail.com
David J
DJ
Bond
George
G
Hadjipavlou
Raymond W
RW
Lam
Roger S
RS
McIntyre
Serge
S
Beaulieu
Ayal
A
Schaffer
Margaret
M
Weiss
D000328:Adult; D026683:Advisory Committees; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy; D002170:Canada; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D019964:Mood Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*
D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants; D018020:Lithium Compounds