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Table 3 Summary of CADDRA guidelines for treatment of ADHD and comorbid psychiatric disorders [107]

From: Adult ADHD and comorbid disorders: clinical implications of a dimensional approach

Psychiatric comorbidity

Treatment priority

Bipolar disorder

Treat bipolar disorder first

Treat ADHD once bipolar disorder is stabilized

Refer to specialist

Depression

 Mild or dysthymia

Treat the most impairing condition first

Consider treating ADHD first

Consider cognitive behavioural therapy (CBT)

 Moderate or severe

Treat depression first and assess suicide risk

Stimulants can be combined with most antidepressants with monitoring

Consider CBT

Anxiety disorders

Treat the most impairing disorder first

“Start low, go slow” but titrate up to a therapeutic dose

Consider adjunctive CBT

Refer to specialist for augmentation with stimulants

SUD

Treat SUD first using multimodal interventions including CBT and self-help groups

Treat ADHD once SUD stabilized

Some cases may require concurrent treatment of SUD and ADHD

Personality disorders

 Borderline

Treating ADHD may facilitate psychological treatments for borderline personality disorder

 Antisocial

Complex, individualized and comprehensive intervention is recommended