Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Scheffer, R. E. Articles by Rush, A. J. Search for Related Content PubMed Citation Articles by Scheffer, R. E. Articles by Rush, A. J. Attention Deficit Hyperactivity Disorder Other Childhood Disorders Anticonvulsants Other Somatic Therapy

Randomized, Placebo-Controlled Trial of Mixed Amphetamine Salts for Symptoms of Comorbid ADHD in Pediatric Bipolar Disorder After Mood Stabilization With Divalproex Sodium

OBJECTIVE: The purpose of this study was to determine whether adjunctive use of a psychostimulant (mixed amphetamine salts) was safe and efficacious for treatment of symptoms of attention deficit hyperactivity disorder (ADHD) in pediatric outpatients with bipolar I or bipolar II disorder and concurrent ADHD whose manic symptoms had been stabilized through treatment with divalproex sodium. METHOD: An 8-week open-label trial of divalproex sodium to control manic symptoms and to discern the effect of divalproex sodium on ADHD was followed by a 4-week randomized, double-blind, placebo-controlled crossover trial to determine if mixed amphetamine salts was safe and effective for treatment of ADHD symptoms. Patients in the crossover trial continued to receive divalproex sodium. Diagnoses, made by clinical interview, were confirmed with the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia. The Young Mania Rating Scale (for manic symptoms) and the Clinical Global Impression of improvement (for ADHD symptoms) were the primary outcome measures. RESULTS: Forty subjects ages 6–17 years with bipolar I disorder (77.5%) or bipolar II disorder (22.5%) and a Young Mania Rating Scale score 14 entered open treatment with divalproex sodium. With divalproex sodium, 32 subjects achieved 50% reduction in Young Mania Rating Scale baseline scores, but only three participants had significant improvement in ADHD symptoms. For the 30 subjects who entered the placebo-controlled crossover trial, mixed amphetamine salts was significantly more effective than placebo for ADHD symptoms. No significant side effects or worsening of manic symptoms was observed. CONCLUSIONS: Pediatric patients with bipolar disorder and concurrent ADHD can be safely and effectively treated with mixed amphetamine salts after their manic symptoms are stabilized with divalproex sodium. Divalproex sodium alone (8-week trial) is not an effective treatment for ADHD in the context of bipolar disorder.

This article has been cited by other articles:

				J. Biederman, M. C. Monuteaux, T. Spencer, T. E. Wilens, and S. V. Faraone Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study Pediatrics, July 1, 2009; 124(1): 71 - 78. [Abstract] [Full Text] [PDF]

				G. A. Carlson Treating the Childhood Bipolar Controversy: A Tale of Two Children Am J Psychiatry, January 1, 2009; 166(1): 18 - 24. [Full Text] [PDF]

				S. E. Meyer and G. A. Carlson Early-Onset Bipolar Disorder Focus, June 1, 2008; 6(3): 271 - 283. [Abstract] [Full Text] [PDF]

				C. Moreno, G. Laje, C. Blanco, H. Jiang, A. B. Schmidt, and M. Olfson National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth Arch Gen Psychiatry, September 1, 2007; 64(9): 1032 - 1039. [Abstract] [Full Text] [PDF]

				K. D. Chang and D. Shah The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder JAMA, July 4, 2007; 298(1): 96 - 97. [Full Text] [PDF]

				B. WASLICK Oxcarbazepine and Pediatric Bipolar Disorder Am J Psychiatry, December 1, 2006; 163(12): 2195 - 2195. [Full Text] [PDF]

				S. P. KRUSZEWSKI and R. PACZYNSKI Conclusions Inconsistent With Results With Amphetamines and Divalproex Am J Psychiatry, November 1, 2005; 162(11): 2197 - 2197. [Full Text] [PDF]

				J. Wozniak Adding mixed amphetamine salts to divalproex sodium improves ADHD symptoms in children with bipolar disorder and comorbid ADHD Evid. Based Ment. Health, August 1, 2005; 8(3): 78 - 78. [Full Text] [PDF]

				Stimulants and Stabilizers for ADHD and Bipolar Disorder Journal Watch Psychiatry, February 24, 2005; 2005(224): 1 - 1. [Full Text]

Get information about faster international access.

Privacy Policy

Copyright © 2005 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us