ADHD and OCD are two conditions that seem to have underlying connections.
Both involve impairments in the ability to self-regulate one’s thoughts in a top-down way, and the two may even have genetic links. Whatever the exact nature of their overlap, ADHD and OCD can often be found together.
The link between the two conditions suggests that treating ADHD might help with OCD as well, and a new case study in the journal Frontiers in Psychiatry highlights that possibility.
In the case study, psychiatrists at University of Leipzig Medical Center describe a 33-year-old patient who came to them for help after being treated for OCD since the age of 10, with little improvement. His OCD symptoms included:
When the psychiatrists evaluated this patient’s mental health symptoms, they found that besides having OCD he had symptoms of ADHD. For example, he told them that “he could hardly sit still or stay in one place for a longer period of time.” He also struggled with sustaining attention on tasks and with organization.
After administering several questionnaires, performing an interview, and reviewing report cards from childhood, the psychiatrists settled on a diagnosis of comorbid ADHD and OCD. As a result, they switched him to a new medication for OCD and started him on the stimulant methylphenidate for ADHD.
According to the psychiatrists, the difference with those new medications was night-and-day:
At this time, the patient stated that his OCD had almost completely disappeared and that the time he spent with obsessive thoughts and compulsive actions had decreased severely. Furthermore, he felt more balanced and reported that he did not get into conflicts so quickly anymore.
The story doesn’t quite end there, though, because after about a month, he decided to lower the dosage of his ADHD medication without consulting his doctors. When that happened, his ADHD and OCD symptoms sharply increased. But when he returned to the original dosage of stimulant medication, his improvement was again dramatic.
This case study is only the latest example of stimulant medication for ADHD helping with a comorbid condition. In 2018, psychiatrists at Wayne State University School of Medicine described a 31-year-old women, Ms. A, who they had treated.
Ms. A sought help for generalized anxiety disorder. She tended to worry “about everything,” and her anxiety led her to avoid being in crowded places and going to gym. Thus far, treatment of her anxiety had not been successful.
When the psychiatrists found that Ms. A had ADHD and started her on stimulants, her anxiety also showed profound improvement. She was no longer afraid to go to the large city nearby, and she began visiting museums and crowded events.
The new case report of the man with OCD follows a strikingly similar pattern: someone seeks help for a condition other than ADHD that has resisted treatment. When mental health professionals discover ADHD and prescribe stimulants, progress finally occurs on the other condition as well.
Sometimes psychiatrists are reluctant to prescribe stimulants to people who have accompanying anxiety or OCD due to concerns that ADHD medication could exacerbate those other conditions. In this case, however, the psychiatrists write that:
treatment with a stimulant did not cause a worsening of the OCD symptoms. Rather, the patient reported a severe decrease in OCD symptoms, which was also observable by the treatment team.
According to the psychiatrists, that result highlights the importance of looking for underlying ADHD in people with conditions like OCD who have not responded to treatment so far. As they put it, “untreated ADHD as a comorbid condition to OCD may reduce the treatment response on the OCD.”
Of course, that doesn’t necessarily mean that stimulant medications are right for everyone who has both ADHD and OCD. Different people respond to medications differently, and the generalizations that can be drawn from a case study of one patient are limited.
The broad takeaway, though, is that when ADHD occurs alongside another condition, identifying and addressing ADHD can be the key to making improvement in that other condition possible.
Image: Flickr/Jesper Sehested