Social anxiety disorder (SAD) occurs frequently in adults with attention-deficit/hyperactivity disorder (ADHD), with a comorbidity rate as high as 40%. But few studies have specifically investigated ADHD comorbidity in patients with SAD. One report by investigators in Turkey described two cases in which treatment for adult ADHD also improved anxiety.
To further investigate this effect, the same researchers performed a retrospective case series of 18 adult patients with comorbid SAD and ADHD. Led by Ahmet Koyuncu, MD, from the Academy Social Phobia Center, Istanbul, Turkey, the researchers treated these patients with extended-release methylphenidate and reported improvement of both SAD and ADHD symptoms. They published their results in Therapeutic Advances in Psychopharmacology.
“In our study, methylphenidate was associated with a high rate of response in SAD patients who have comorbid ADHD,” Dr. Koyuncu and colleagues noted.
Patients included in this case series had received diagnoses of SAD and current adult ADHD. They were treated with monotherapy of extended-release methylphenidate (mean dose 27.5 mg/day, mean duration 6.66 weeks). The mean age of patients was 26.60 years, 45% were female, 25% had previous psychiatric referral history and antidepressant treatment, and 75% had prior contact with psychiatry before enrollment. Most patients (90%) were single. Patients were assessed with clinical interviews and other standard diagnostic tools to determine diagnoses of SAD and ADHD.
Among the 20 patients retrospectively evaluated, 18 received treatment. Two discontinued the medication due to adverse effects. Clinical improvement for both ADHD and SAD symptoms was observed in 17 of 18 patients. The medication was generally well tolerated.
“The observation that ADHD treatments also improve comorbid SAD symptoms in our cases may be a result of a psychopathological and etiological relationship between the two disorders,” the authors speculated.
Limitations of the study include not having a placebo arm, evaluating treatment outcomes retrospectively in an unblinded manner, and the small study sample. In addition, patients were told they would receive an ADHD medication that might also improve social anxiety symptoms, possibly resulting in bias.
“Further studies are required to comprehensively investigate the relationship between ADHD and SAD and the treatment approaches in the presence of their comorbidity,” Dr. Koyuncu and colleagues concluded.