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MGH studies clarify diagnosis, identify
possible treatment for adults with both ADHD and bipolar disorder
BOSTON - July 9, 2003 - Two studies from researchers at Massachusetts
General Hospital (MGH) address the challenges of diagnosing and
treating individuals with both attention-deficit hyperactivity disorder
(ADHD) and bipolar disorder (BPD). Published in the July, 2003,
issue of Biological Psychiatry, one report clearly identifies
symptoms of both disorders in study participants, supporting the
theory that some individuals truly suffer from both disorders. The
second study in the same issue finds that the antidepressant bupropion
may be helpful in treating those with both ADHD and BPD.
"The question of whether ADHD and BPD can exist together has
been controversial, with some believing that such diagnoses reflected
particularly bad ADHD or that the manic symptoms of bipolarity were
simple hyperactivity," says Timothy Wilens, MD, of the MGH
Pediatric Psychopharmacology Unit, lead author of both papers. "The
first study tells us these are distinct disorders that can occur
and be identified in adults.
"Treating adults with ADHD and BPD has been difficult because
the stimulants and many other medications used for ADHD may exacerbate
manic symptoms," he continues. "However, not addressing
both disorders in these individuals can make their lives more difficult."
In the first study, adult patients who had come to the MGH to participate
in ADHD clinical trials went through an extensive clinical assessment
of psychiatric symptoms. This included a complete medical history,
psychiatric evaluation, a diagnostic interview with a section addressing
ADHD, and tests of cognitive function. Data from the diagnostic
interview were subsequently reviewed by a team of mental health
professionals who were not informed of the patients' diagnoses,
to confirm whether the symptoms reported made a significant difference
in patients' functioning.
Of those evaluated for this study, 51 met full criteria for ADHD
diagnosis, and 24 also met established criteria for BPD. Along with
their BPD symptoms, participants with both disorders had a greater
number of ADHD symptoms than those with ADHD alone, and 60 percent
of those with both disorders reported having BPD symptoms starting
at a young age. Both groups also had additional psychiatric disorders,
but those with both conditions had a higher risk of additional disorders.
"Although the hyperactive/impulsive symptoms of ADHD tend to
lessen as patients mature, it appears that those who also have BPD
continue with those symptoms as adults. So if a youngster with ADHD
continues to have prominent hyperactivity and impulsivity while
growing up, it may indicate that accompanying BPD should be considered,"
Wilens says.
Bupropion - an atypical antidepressant - was chosen for the second
study because it already is used to treat individuals with ADHD
and to treat depressive symptoms in BPD. During the six-week study
period, 30 participants diagnosed with both disorders began taking
a daily 100 mg. dose of bupropion and increased their dosage to
a maximum of 200 mg given twice daily. Any participant who felt
that a particular dosage provided superior symptom relief could
return to that dosage.
Most of the study participants showed significant improvement in
their symptoms of both disorders, with 70 percent reporting that
symptoms were "much improved" or "very much improved."
A majority of study participants continued taking the medication
at the conclusion of the study.
"I have evaluated and followed a number of those participating
in this study," Wilens says, "and they have noted major
life changes associated with their improved functioning and well
being. Many went from being incapacitated and unable to sustain
relationships to being employed and reporting improved relationships
and overall well being." Wilens is an associate professor of
Psychiatry at Harvard Medical School.
He and his colleagues note, however, that because of this study's
small size, along with the facts that there was no control group
and all participants knew the dosages they were receiving, additional
large-scale controlled trials are necessary.
Both studies were supported by grants from the National Institutes
of Health. The bupropion study also received support from GlaxoSmithKline,
Inc., manufacturer of the Wellbutrin brand of bupropion. However,
the MGH researchers had complete control of the study design and
reporting.
Wilens' coauthors for the first study are Joseph Biederman, MD,
Janet Wozniak, MD, Samantha Gunawardene, Jocelyn Wong, and Michael
Monuteaux. The second study was coauthored by Biederman, Jefferson
Prince, MD, Thomas Spencer, MD, Stephaine Van Patten, Robert Doyle,
MD, DDS, Kristine Girard, MD, Paul Hammerness, MD, Sarah Goldman,
and Sarah Brown.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of more than $350 million
and major research centers in AIDS, cardiovascular research, cancer,
cutaneous biology, medical imaging, neurodegenerative disorders,
transplantation biology and photomedicine. In 1994, the MGH joined
with Brigham and Women's Hospital to form Partners HealthCare System,
an integrated health care delivery system comprising the two academic
medical centers, specialty and community hospitals, a network of
physician groups and nonacute and home health services.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
Information about Clinical Trials
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