"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 participating 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.

Source: Massachusetts General Hospital Press Release

Other Related Stories

• More young children diagnosed with mental illnesses
• Adult ADHD Often Missed

back to top | news index