Recognizing ADHD in adults with comorbid mood disorders: Implications for identification and management

The objective of this study was to assist those in psychiatric clinical practice in the identification and management of attention-deficit/hyperactivity disorder (ADHD) in adults, with an emphasis on ADHD in the presence of comorbid mood disorders in adults. PubMed was searched to identify relevant studies and critical reviews published in English between 1988 and 2008 on the prevalence, persistence, and consequences of ADHD in adults. Additionally, relevant studies and critical reviews pertaining to the treatment of adults with ADHD and the relationships between ADHD and mood disorders with regard to overlapping symptom profiles, comorbidity, and treatment options were identified. The symptoms of ADHD persist into adulthood for a high proportion of children with this disorder. Among adults, the estimated prevalence of clinician-assessed ADHD in the general population is 4% to 5%. Untreated ADHD can adversely affect school and work achievements, diminish self-esteem, damage interpersonal relationships, and significantly reduce quality of life for adults. A significant proportion of adults with mood disorders have comorbid ADHD, and a significant proportion of adults with ADHD have comorbid mood disorders. Few reports have described the outcome of treatment of individuals with ADHD and concurrent mood disorders and no controlled trials were identified. Attention-deficit/hyperactivity disorder in adults can be identified despite resembling, or coexisting with, other psychiatric disorders. The complexities of comorbid psychiatric conditions require careful diagnostic prioritization when developing a comprehensive sequential treatment plan. The current research literature offers little clinical guidance for constructing treatment algorithms.