Wednesday, October 5, 2016

Methylphenidate Monotherapy May Increase Risk of Mania in Patients With Bipolar Disorder, ADHD

Determining the best medications for patients with co-occurring bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) can be challenging, as evidence suggests that pharmacotherapies for ADHD can worsen symptoms of bipolar disorder and vice-versa.

A study appearing this week in AJP in Advance now suggests methylphenidate may increase the risk of treatment-emergent mania in patients with bipolar disorder when it is used without a concomitant mood-stabilizing treatment.

Using Swedish national registries, the authors identified 2,307 adults with bipolar disorder who initiated therapy with methylphenidate between 2006 and 2014. The patients were divided into two cohorts—those with and those without concomitant mood-stabilizing treatment. The authors then compared the rate of mania during a six-month period before the start of methylphenidate treatment with a six-month period following the start of methylphenidate treatment.

The authors found that the relative risk of mania following methylphenidate treatment among patients treated with methylphenidate monotherapy was increased in both the initial three months after treatment and in the subsequent three months. By contrast, among patients treated with a concurrent mood stabilizer, the risk of mania was reduced in the initial three months and slightly reduced in the subsequent three months.

“On the basis of this finding, we recommend careful assessment to rule out bipolar disorder before initiating methylphenidate as a monotherapy,” Alexander Viktorin, Ph.D., of the Karolinska Institutet and colleagues wrote. “As no association with treatment-emergent mania was observed among bipolar patients who were concomitantly receiving a mood-stabilizing medication, it would appear that concomitant therapy of ADHD is both safe and feasible in the context of ongoing preventive therapy.”

For related information, see the Psychiatric News article “Mania Risk Seen in Treating Bipolar Patients With Antidepressants Alone.”

(Image: iStock/Zerbor)


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