ADHD is a common disorder with a prevalence rate of 3-5% in children, adults and older persons. In psychiatry, addiction centers and forensic psychiatry, the prevalence of ADHD in adults is estimated higher, around 20%. After careful assessment of ADHD and comorbid disorders, ADHD in adulthood can be effectively treated with psycho-education, medication, coaching and cognitive behaviour therapy.

To give an overview of the current state-of-the-art treatment of ADHD and comorbidity in adults.

Pharmacological treatment of ADHD usually comes after treatment of more acute or severe disorders like depressive or bipolar episodes, anxiety disorders and addiction. Because of the inattention problems of ADHD patients, antidepressant medication is usually preferred above cognitive behaviour therapy for anxiety or depression. Light therapy for seasonal affective disorder and melatonin treatment for the frequent delayed sleep phase syndrome are usually effective, though yet little studied. Available, but off-label medications used for ADHD in adults are stimulants (methylphenidate, dexamphetamine), atomoxetine, bupropion XL, modafinil and tricyclic antidepressants.

Based on 17 years of clinical experience and on efficacy and safety data in the literature, first and other choices of medication will be discussed, as well as common dosing schedules in adults, side effects, contra-indications and combined treatment of stimulants with antidepressants, mood stabilisers and melatonin.

All disorders must be addressed and treated in the right order, based on severity. Treatment of ADHD in adults is not just treatment of ADHD, but of a combination of disorders that cluster in our patients.