This article is more than 5 years old. Information may no longer be current.

Mood stabilizers lower risk for mania following methylphenidate treatment in bipolar disorder

Risk for mania following methylphenidate treatment was significantly lower among individuals with bipolar disorder who received mood stabilizers concomitantly, according to recent findings.

“There is a high rate of nonresponse and residual functional impairment in comorbid ADHD and bipolar disorder, and the pharmacological treatment of comorbid ADHD in bipolar disorder presents a challenge,” Alexander Viktorin, PhD, of Karolinska Institutet, Stockholm, and colleagues wrote. “Not only may the treatment for bipolar disorder worsen ADHD symptoms, clinicians have long worried that methylphenidate and other psychostimulants may also induce mania or even provoke psychosis. Some physicians even consider the use of psychostimulants to be contraindicated in bipolar disorder.”

Alexander Viktorin

To determine risk for treatment-emergent mania associated with methylphenidate used as monotherapy or concomitantly with a mood stabilizer, researchers analyzed data from linked Swedish national registries for 2,307 adults with bipolar disorder who initiated methylphenidate between 2006 and 2014.

Risk for mania following methylphenidate treatment was increased during the first 3 months after treatment initiation (HR = 6.7; 95% CI, 2-22.4) and subsequent 3 months (HR = 9.7; 95% CI, 2.9-31.7) among individuals who received methylphenidate monotherapy (n = 718).

Conversely, individuals who received mood stabilizers in conjunction with methylphenidate (n = 1,103) had lower risk for mania after starting methylphenidate within the first 3 months of initiation (HR = 0.6; 95% CI, 0.4-0.9) and subsequent 3 months (HR = 0.9; 95% CI, 0.5-1.7).

Results were similar when assessing mania risk from diagnoses only.

“This study suggests that methylphenidate may increase the risk of treatment-emergent mania in patients suffering from bipolar disorder when it is used without a concomitant mood-stabilizing treatment,” the researchers wrote. “On the basis of this finding, we recommend careful assessment to rule out bipolar disorder before initiating methylphenidate as a monotherapy. 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.” – by Amanda Oldt

Disclosure: Viktorin reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.