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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