Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Department of Psychology, University of Copenhagen | Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.
Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
Bipolar Disord. 2024 May;26(3):216-239. doi: 10.1111/bdi.13414. Epub 2024 Mar 3.
Abnormalities in dopamine and norepinephrine signaling are implicated in cognitive impairments in bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD). This systematic review by the ISBD Targeting Cognition Task Force therefore aimed to investigate the possible benefits on cognition and/or ADHD symptoms and safety of established and off-label ADHD therapies in BD.
We included studies of ADHD medications in BD patients, which involved cognitive and/or safety measures. We followed the procedures of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed, Embase and PsycINFO from inception until June 2023. Two authors reviewed the studies independently using the Revised Cochrane Collaboration's Risk of Bias tool for Randomized trials.
Seventeen studies were identified (N = 2136), investigating armodafinil (k = 4, N = 1581), methylphenidate (k = 4, N = 84), bupropion (k = 4, n = 249), clonidine (k = 1, n = 70), lisdexamphetamine (k = 1, n = 25), mixed amphetamine salts (k = 1, n = 30), or modafinil (k = 2, n = 97). Three studies investigated cognition, four ADHD symptoms, and 10 the safety. Three studies found treatment-related ADHD symptom reduction: two involved methylphenidate and one amphetamine salts. One study found a trend towards pro-cognitive effects of modafinil on some cognitive domains. No increased risk of (hypo)mania was observed. Five studies had low risk of bias, eleven a moderate risk, and one a serious risk of bias.
Methylphenidate or mixed amphetamine salts may improve ADHD symptoms in BD. However, there is limited evidence regarding the effectiveness on cognition. The medications produced no increased mania risk when used alongside mood stabilizers. Further robust studies are needed to assess cognition in BD patients receiving psychostimulant treatment alongside mood stabilizers.
多巴胺和去甲肾上腺素信号的异常与双相情感障碍 (BD) 和注意缺陷多动障碍 (ADHD) 的认知障碍有关。因此，国际双相情感障碍学会认知目标工作组进行了这项系统评价，旨在研究已确立的和非适应证 ADHD 治疗药物在 BD 中的改善认知和/或 ADHD 症状及安全性的可能性。
我们纳入了关于 BD 患者使用 ADHD 药物的研究，这些研究涉及认知和/或安全性测量。我们遵循了 2020 年系统评价和荟萃分析首选报告项目 (PRISMA) 的程序。从开始到 2023 年 6 月，在 PubMed、Embase 和 PsycINFO 上进行了搜索。两名作者使用修订后的 Cochrane 协作随机试验偏倚风险工具独立审查了研究。
共确定了 17 项研究（N=2136），其中涉及阿莫达非尼（k=4，N=1581）、哌甲酯（k=4，N=84）、安非他酮（k=4，N=249）、可乐定（k=1，N=70）、利斯的明（k=1，N=25）、混合安非他明盐（k=1，N=30）或莫达非尼（k=2，N=97）。有 3 项研究调查了认知功能，4 项研究调查了 ADHD 症状，10 项研究调查了安全性。有 3 项研究发现治疗相关的 ADHD 症状改善：2 项涉及哌甲酯，1 项涉及安非他命盐。有 1 项研究发现莫达非尼对某些认知领域有认知改善的趋势。未观察到（低）躁狂风险增加。有 5 项研究的偏倚风险低，11 项研究的偏倚风险中等，1 项研究的偏倚风险严重。
哌甲酯或混合安非他明盐可能改善 BD 中的 ADHD 症状。然而，关于认知的有效性的证据有限。当与心境稳定剂一起使用时，这些药物并没有增加躁狂的风险。需要进一步的严格研究来评估在心境稳定剂治疗的同时接受精神兴奋剂治疗的 BD 患者的认知功能。
