CNSPulse

COMORBIDITY POLYPHARMACY: SIMULTANEOUS VS. SUCCESSIVE INTRODUCTION OF CO-PHARMACOTHERAPIES

Anita Clayton — University of Virginia SOM

2026 ASCP Annual Meeting

Among the considerations in diagnoses are co -morbidities vs. symptoms consistent with single disorder (e.g., Attention Deficit Hyperactivity Disorder [ADHD] +/- bipolar disorder +/ - substance use disorder when impulsivity, restlessness and emotional dysregulation are present); risk of initial medication triggering onset of another condition (e.g., stimulants or antidepressants inducing mania); severity of symptoms/functional impairment; past treatments and responses; and family history of psychiatric disorders. Common comorbidities include ADHD and substance use disorder (SUD), bipolar disorder (BPAD), antisocial personality disorder (ASPD), anxiety disorder, eating disorder; and major depressive disorder (MDD) +/ - BPAD, SUD, anxiety disorder, personality disorders. Individuals with > 2 comorbid conditions may experience significant disease burden, prolonged illness duration and reduced therapeutic response to treatments, increasing the need for rapid definitive intervention(s). Bidirectional symptom overlap may be related to shared neurobiological mechanisms, common/overlapping traits/symptoms (MDD, anxiety disorders, SUD, ADHD all impact concentration/cognition), impact of SUD on presenting symptoms (e.g., effect of chronic daily cannabis use may mimic symptoms of ADHD), and/or 1 disorder is a risk factor a second disorder. An initial treatment plan must include patient education about diagnosis(es), obtain a detailed family history of psychiatric illness and treatment, agreement on a blueprint for monitoring over the course of treatment, consideration of the severity and trajectory of each disorder, discussion of risks/benefits with each treatment choice, and stabilizing the most severe and/or potentially harmful condition initially (e.g., bipolar disorder before ADHD, SUD before anxiety disorder). However, if comorbidities are present, but neither are severe or endangering, initiation of 2 simultaneous treatments may improve both. Consideration of medication + psychotherapy is the safest prescription but usually not the fastest.

References

  1. Won-Seok Choi, Young Sup Woo, Sheng-Min Wang, Hyun Kook Lim, Won-Myong Bahk. The prevalence of psychiatric comorbidities in adult ADHD compared with nonADHD populations: A systematic literature review. Plos One. Published: November 4, 2022 https://doi.org/10.1371/journal.pone.0277175 2. Xinyu Fu, Wiege Wu, Yuru Wu, Xiaofu Liu, Wanting Liang, Rongchuan Wu, Yun Li. Adult ADHD and Comorbid Anxiety and Depressive Disorders: A Review of Etiology and Treatment. Frontiers in Psychiatry. Published 06 June 2025. DOI: 10.3389/fpsyt.2025.1597559