Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity and impulsivity that interfere with functioning and development. While stimulant medications like methylphenidate (Ritalin) and amphetamines (Adderall) are the most commonly used pharmacological treatments for ADHD, some research has explored whether mood stabilizers may also be helpful in managing ADHD symptoms in some cases.
Mood stabilizers are a class of medications traditionally used to treat bipolar disorder. They help regulate mood by decreasing the severity and frequency of manic and depressive episodes. Some commonly used mood stabilizers include lithium, anticonvulsants like valproate (Depakote) and lamotrigine (Lamictal), and the atypical antipsychotic risperidone (Risperdal).
Researchers have hypothesized that mood stabilizers may help reduce ADHD symptoms for several reasons:
Why mood stabilizers may work for ADHD
- ADHD and bipolar disorder share some overlapping symptoms like mood lability and impulsivity.
- There are high rates of comorbidity between ADHD and bipolar disorder, meaning many individuals have both conditions.
- Mood stabilizers help regulate signaling in the brain, which may improve symptoms of inattention, hyperactivity and impulsivity in ADHD.
- Some ADHD symptoms may actually be caused by underlying mood dysregulation.
This article will review the evidence on whether commonly used mood stabilizers like lithium, anticonvulsants and atypical antipsychotics are effective treatments for ADHD symptoms.
Do mood stabilizers improve ADHD symptoms?
Several randomized controlled trials and open-label studies have explored whether mood stabilizers can reduce ADHD symptoms either alone or as an adjunctive treatment to stimulants. Here is a summary of the research on specific mood stabilizing medications:
Lithium
Lithium is the oldest mood stabilizer used in psychiatry. Research on lithium for ADHD has shown mixed results:
- A randomized controlled trial in 30 children found that lithium was significantly better than placebo at reducing ADHD symptoms over an 8 week period when combined with stimulant medication.
- However, two other randomized controlled trials did not find a significant benefit of lithium over placebo for ADHD symptoms.
- A few small, open-label studies showed lithium reduced symptoms of impulsivity and aggression in youth with ADHD and comorbid bipolar or aggressive behavior when added to stimulants.
Overall, there is limited evidence that lithium may provide a modest benefit for ADHD symptoms in some cases, but more research is needed.
Anticonvulsants
Several anticonvulsant mood stabilizers like valproate, carbamazepine and lamotrigine have also been studied for ADHD:
- An 8 week randomized controlled trial of valproate found it was significantly more effective than placebo at reducing ADHD symptoms in children not responding fully to stimulants.
- Open-label trials showed carbamazepine reduced ADHD symptoms in youth with comorbid aggression and behavior dyscontrol.
- Lamotrigine did not significantly improve ADHD symptoms compared to placebo in 2 randomized controlled trials.
Valproate shows the most promising results for adjunctive treatment of ADHD. More rigorous research is still needed though.
Atypical antipsychotics
The atypical antipsychotics risperidone and aripiprazole have also been studied as treatments for ADHD:
- Risperidone improved symptoms of inattention, hyperactivity, oppositionality, conduct problems and tics in youth with ADHD in several open-label trials and one 6 week randomized controlled trial.
- However, risperidone also caused significant weight gain as a side effect.
- Aripiprazole showed modest benefits over placebo for ADHD symptoms in one 6 week randomized controlled trial in youth with ADHD and aggression.
Risperidone and aripiprazole may provide some benefit for ADHD, particularly in those with aggression and conduct problems. However, the risks of weight gain and other metabolic side effects should be considered carefully before use.
How do mood stabilizers compare to stimulants for ADHD?
While some mood stabilizers show promise for treating select ADHD symptoms, research clearly shows that stimulant medications like methylphenidate and amphetamines remain first-line pharmacological treatments for ADHD.
The largest review comparing mood stabilizers to stimulants analyzed data from 3 randomized controlled trials with over 300 children and youth. The study found:
- Stimulants were significantly more effective than mood stabilizers at reducing ADHD symptoms of inattention, hyperactivity and impulsivity.
- Between 68-78% of youth had improved ADHD symptoms on stimulants, compared to only 37-46% on mood stabilizers.
- Discontinuation rates due to lack of efficacy or side effects were also much higher for mood stabilizers.
Other reviews of randomized trials concur that stimulant medications consistently show superior efficacy and tolerability compared to mood stabilizers for the core symptoms of ADHD.
Are there any risks to using mood stabilizers for ADHD?
While mood stabilizers may help manage select cases of ADHD, they have notable risks and side effects that should be carefully weighed against potential benefits:
- Mood stabilizers can cause sedation, gastrointestinal upset, tremors, blurred vision and other anticholinergic side effects.
- Lithium requires regular monitoring of blood levels and can impair kidney function and thyroid activity with long-term use.
- Valproate is associated with weight gain, hair loss and polycystic ovary syndrome in females.
- Risperidone frequently causes substantial weight gain, metabolic dysfunction and increased prolactin levels.
Additionally, there are concerns that mood stabilizers may worsen psychiatric symptoms when used in youth with undiagnosed or untreated bipolar disorder. Screening for bipolar symptoms and monitoring of mood changes is important when prescribing these medications.
Overall, mood stabilizers tend to have lower tolerability and more safety concerns compared to first-line ADHD medications like stimulants and atomoxetine.
Conclusion
Some mood stabilizing medications like valproate, risperidone and possibly lithium may offer modest benefits in reducing ADHD symptoms for some patients who do not respond fully to standard treatments. However, the evidence is still quite limited and inconsistent. More rigorous, large scale randomized controlled trials are needed to better evaluate the efficacy and safety of mood stabilizers for ADHD.
Currently, stimulant medications remain first-line pharmacological treatments for ADHD given their superior efficacy and tolerability demonstrated in many studies. Mood stabilizers should generally be considered as adjunctive or secondary options for select cases of ADHD with aggression, mood lability or lack of response to standard ADHD medications. Their risks and side effects need to be carefully weighed against potential benefits when considering these medications for ADHD treatment.