Finding the right medications is important in any treatment. Medications for patients with bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) could aggravate symptoms of the co-occurring illness. Currently, per the NIMH, bipolar disorder affects 2.6% of the US adult population and 82% of these cases are classified as severe. According to the same source, ADHD affects 4.1% of the US adult population and around 41.3% of these cases are classified as severe. Patients with both conditions usually take maintenance medication, and could be at risk of bipolar disorder symptom aggravation caused by methylphenidate monotherapy.

A study which was recently published in the November 2016 issue of the American Journal of Psychiatry in Advance has found that the drug methylphenidate in fact may increase the risk for mania in people with bipolar disorders when the said drug is used alone without a mood-stabilizing agent.

To carry out the study, Alexander Viktorin, Ph.D., of Karolinska Institutet in Sweden and his colleagues used data found in Swedish national registries to find the risk of manic events in 2,307 individuals with bipolar disorder who started therapy with methylphenidate between 2006 and 2014.

The patients were segregated into two groups – those using and those not using concomitant mood-stabilizing treatments. The patients were treated with methylphenidate for a period of six months, and then the researchers compared the rate of mania before and after treatment.

When comparing data, the researchers found that methylphenidate monotherapy increased the risk of mania among patients in the initial three months after treatment and in the following three months. But among patients who were treated with methylphenidate monotherapy and a concurrent mood stabilizer, the risk of mania was decreased in the initial three months after treatment and in the following three months.

These findings were gladly received by Matthew Macaluso, D.O., the Director of Clinical Trials and Research in the Department of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine-Wichita, who was not associated with this study.

Macaluso noted that it can often be difficult to optimize treatment for bipolar disorders with comorbid ADHD. He commented that methylphenidate can destabilize bipolar disorders and can predispose to mania and other untoward behaviors.

He remarked that about 20 percent of patients with bipolar disorder have comorbid ADHD and that the recent data may be a guide for more research towards this issue. He recommends careful assessment to rule out bipolar disorders before starting methylphenidate as single-treatment. As there was no relation between treatment emergent mania and bipolar disorders receiving mood stabilizing agents, it can be said that concomitant therapy with methylphenidate and a mood-stabilizing agent is safe and effective in preventing other behavioral changes.


The Risk of Treatment-Emergent Mania With Methylphenidate in Bipolar Disorder.Alexander Viktorin, Ph.D., Eleonore Rydén, M.D., Ph.D., Michael E. Thase, M.D., Zheng Chang, Ph.D., Cecilia Lundholm, The American Journal of Psychiatry. Accessed on 29 November 2016.