Efficacy and safety of established and off-label ADHD drug therapies for cognitive impairment or attention-deficit hyperactivity disorder symptoms in bipolar disorder: A systematic review by the ISBD Targeting Cognition Task Force.

Journal: Bipolar disorders

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Affiliated Institutions:  Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Department of Psychology, University of Copenhagen | Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark. Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland. Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain. Department of Psychology, Queen's University, Kingston, Canada. Department of Medicine, University of Valencia, Valencia, Spain. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA. IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Geelong, Victoria, Australia. Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands. Department of Psychological Medicine, University of Otago, Christchurch, New Zealand. Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK. Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark. Bipolar Disorder Research Program, Institute of Psychiatry, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Research Group in Psychiatry, Department of Psychiatry, Universidad de Antioquia, Medellín, Colombia. Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery Foundation, University of Toronto, Toronto, Canada. Department of Psychiatry, University of Alberta, Edmonton, Canada. Department of Psychiatry, University of Toronto, Toronto, Canada. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan. Department of Psychiatry, University of British Columbia, Vancouver, Canada. Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton, Australia.

Abstract summary 

Abnormalities in dopamine and norepinephrine signaling are implicated in cognitive impairments in bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD). This systematic review by the ISBD Targeting Cognition Task Force therefore aimed to investigate the possible benefits on cognition and/or ADHD symptoms and safety of established and off-label ADHD therapies in BD.We included studies of ADHD medications in BD patients, which involved cognitive and/or safety measures. We followed the procedures of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed, Embase and PsycINFO from inception until June 2023. Two authors reviewed the studies independently using the Revised Cochrane Collaboration's Risk of Bias tool for Randomized trials.Seventeen studies were identified (N = 2136), investigating armodafinil (k = 4, N = 1581), methylphenidate (k = 4, N = 84), bupropion (k = 4, n = 249), clonidine (k = 1, n = 70), lisdexamphetamine (k = 1, n = 25), mixed amphetamine salts (k = 1, n = 30), or modafinil (k = 2, n = 97). Three studies investigated cognition, four ADHD symptoms, and 10 the safety. Three studies found treatment-related ADHD symptom reduction: two involved methylphenidate and one amphetamine salts. One study found a trend towards pro-cognitive effects of modafinil on some cognitive domains. No increased risk of (hypo)mania was observed. Five studies had low risk of bias, eleven a moderate risk, and one a serious risk of bias.Methylphenidate or mixed amphetamine salts may improve ADHD symptoms in BD. However, there is limited evidence regarding the effectiveness on cognition. The medications produced no increased mania risk when used alongside mood stabilizers. Further robust studies are needed to assess cognition in BD patients receiving psychostimulant treatment alongside mood stabilizers.

Authors & Co-authors:  Miskowiak Obel Gugliemo Bonnin Bowie Balanzá-Martínez Burdick Carvalho Dols Douglas Gallagher Kessing Lafer Lewandowski López-Jaramillo Martinez-Aran McIntyre Porter Purdon Schaffer Stokes Sumiyoshi Torres Van Rheenen Yatham Young Vieta Hasler

Study Outcome 

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Statistics
Citations :  Nierenberg AA, Miyahara S, Spencer T, et al. Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biol Psychiatry. 2005;57(11):1467-1473. doi:10.1016/j.biopsych.2005.01.036
Authors :  28
Identifiers
Doi : 10.1111/bdi.13414
SSN : 1399-5618
Study Population
Male,Female
Mesh Terms
Other Terms
ISBD task force;attention-deficit hyperactivity disorder, cognitive impairment;bipolar disorder;medication;recommendations;systematic review
Study Design
Study Approach
Country of Study
Mali
Publication Country
Denmark