Adult ADHD and its comorbidities, with a focus on bipolar disorder
Abstract
Attention deficit hyperactivity disorder (ADHD) is a syndrome that most often presents in childhood. However, the condition is also relatively common in adults, with prevalence rates reaching 5% in the general population, with more than half the children affected by ADHD retaining the condition during their adult years. While the disorder in children is most often described as a disorder involving hyperactivity and impulsiveness, ADHD presents with very different characteristics in adulthood, notably with less externalizing symptoms and with a higher rate of psychiatric comorbidities, including major depressive disorder, bipolar disorder (BD), anxiety disorders and substance abuse. This review will focus on the evidence relating to bipolar disorder BD and its potential link with ADHD, looking at epidemiological, familial and neuroimaging studies. The comorbid presentation of people suffering with ADHD and BD (ADHD/BD) is associated with a more severe disease course, more severe mood disorder symptoms, and lower functional scores. Importantly, the co-segregation of these two conditions makes ADHD diagnosis challenging because its symptoms are often mistakenly assumed to be part of BD. As a result, patients with comorbid ADHD/BD are under-diagnosed and under-treated. Optimal diagnosis, understanding and treatment of the comorbid condition are important, as ADHD/BD has been associated with significant functional impairment and suboptimal treatment responses when compared to ADHD or BD populations alone.
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Recent studies have demonstrated that similar regions of the brain are involved in ADHD and psychiatric disorders.
“Recent studies have demonstrated that similar regions of the brain are involved in ADHD and psychiatric disorders [17].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [17]
There are strong familial links between ADHD and psychiatric comorbidities such as bipolar disorder, suggesting a genetic contribution.
“There are strong familial links between ADHD and psychiatric comorbidities such as bipolar disorder, suggesting a genetic contribution [17].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [17]
Effective treatment of ADHD has been shown to improve comorbid disorders including SUD, bipolar disorder, depression, and anxiety disorders.
“Effective treatment of ADHD has been shown to improve comorbid disorders including SUD [69,95,132], bipolar disorder [17], depression [69], and anxiety disorders [114,133].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [17]
A review of previous studies supports stimulants as a first-line therapy for ADHD symptoms in individuals with concurrent ADHD and bipolar disorder, given a lack of strong evidence that stimulants are linked to mania.
“A review of previous studies supports stimulants as a first-line therapy for the treatment of ADHD symptoms in individuals with concurrent ADHD and bipolar disorder, given a lack of strong evidence that stimulants are linked to mania [17].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [17]
The consensus in the literature is that the most severe, functionally impairing or destabilizing illness should be treated first, and comorbidities should be addressed in a stepwise fashion once the patient has responded to treatment.
“The consensus in the literature is that the most severe, functionally impairing or destabilizing illness should be treated first, and comorbidities should be addressed in a stepwise fashion once the patient has responded to treatment [17,69,107].”
From Adult ADHD and comorbid disorders: clinical implications of a dimensional approach (2017) · cites this paper as [17]
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Adult ADHD and comorbid disorders: clinical implications of a dimensional approach
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- Authors
- Klassen, L. J., Katzman, M. A., & Chokka, P.
- Affiliations
- University of Manitoba (CA)
- University of Toronto (CA)
- University of Alberta (CA)
- Corresponding author
- Klassen, Larry J.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 124
- Issue
- 1-2
- Pages
- 1-8
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2029553044
- Cited by
- 205
- References
- 10
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 8 · 2023: 12 · 2022: 11 · 2021: 10 · 2020: 10 · 2019: 19 · 2018: 11 · 2017: 8 · 2016: 17 · 2015: 10 · 2014: 26 · 2013: 10 · 2012: 18
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- adult ADHD, bipolar disorder, comorbidities, psychiatric comorbidity, major depressive disorder, anxiety disorders, substance abuse, familial aggregation, neuroimaging, underdiagnosis, functional disability, treatment response
- MeSH terms
- Adult, Anxiety Disorders, Attention Deficit Disorder with Hyperactivity, Bipolar Disorder, Cross-Sectional Studies, Major Depressive Disorder, Depressive Disorder, Major, Diagnosis, Differential, Humans, Risk Factors, Comorbidity, Substance-Related Disorders
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