Bipolar + ADHD = SOL?

October 16, 2012 7:25 AM

Probable ADHD, probable bipolar II. Unhelpful psychiatrist. Help!

I am 99% sure that I have ADHD. I've had issues my entire life, and apparently teachers talked to my parents when I was in school, but they never did anything. I continue to have problems to this day, and would like to be tested and begin getting help. However, I also have a probable diagnosis of bipolar II and am taking Lamictal for it, which is working fabulously. According to my psychiatrist, there's no possibility for me to take any sort of stimulant medication for the ADHD because of the possibility of triggering a manic episode.

Is this accurate? He seems to be of the "ADHD is overdiagnosed, thus you probably don't have it" school of thought, so I don't know if he's using this as an "excuse" to not test me. I just have a hard time believing that bipolar people with ADHD are just screwed.

posted by altopower to Health & Fitness (12 answers total)

Best answer: Different psychiatrists have different standards of practice. Some will, under no circumstances, give stimulants to someone with a history of mania/hypomania. Some may start on a very low dose and very slowly work their way up to an effective dose. There's also non-stimulant medication for ADHD although it may be contraindicated with either your condition or the other medication you're on. There's no one answer to this, because we don't know your medical history. Your psychiatrist might be genuinely unhelpful in this, or he may be doing the exact right thing based on what he knows.
posted by griphus at 7:30 AM on October 16, 2012

Also, it doesn't sound like he's in the "ADHD is overdiagnosed" school, it sounds like he's in the "stimulants may trigger manic/hypomanic episodes and we don't want that" school, which is a legitimate medical reason to not prescribe stimulants.
posted by griphus at 7:31 AM on October 16, 2012 [4 favorites]

I have a friend who has ADHD and Bipolar II. She is currently taking mood stabilizers for the Bipolar (Abilify I think, though it could have changed since I talked to her last), and is on the max dose of Adderall. So - anecdotally - some psychiatrists will prescribe stimulants to people with Bipolar II. She tends to the depressed side and very rarely has hypomania though (even when not on medication) - so perhaps that was part of the equation.

I have a different friend who is almost always hypomanic when not on medication, I'm not sure if treating her would be different. Bipolar II manifests very differently in different people, and treatment probably varies (IANAD, of course).
posted by insectosaurus at 7:45 AM on October 16, 2012

Response by poster: griphus, I should have made that clearer...he actually did say ADHD is overdiagnosed, but didn't explicitly say the second part. His body language kind of implied it, though, FWIW. And he did mention Strattera, which I believe is the non-stimulant ADHD med, but I believe it was contraindicated due to my migraine meds, if I remember right.

And liketitanic, I do know about those options and am working on integrating them into my lifestyle.
posted by altopower at 8:04 AM on October 16, 2012

My understanding is that ADHD and hypomania can be really difficult to tell apart, so if you've never had a formal evaluation for ADHD, he may have reason to think that it wouldn't be an accurate diagnosis for you. Or not - we can't read his mind.

You are allowed to consult with a different psychiatrist if you feel like you could use a second opinion. Someone who specializes in adult ADHD might have better alternatives for you. The "stimulants triggering mania" thing sounds like a pretty rational fear, but there might be something off-label that could work well for you.
posted by catalytics at 8:17 AM on October 16, 2012

I'd suggest talking to an ADD/ADHD specialist (1) about what your psychiatrist said and (2) see what non-medication strategies she think might help your ADHD.
posted by emilynoa at 8:19 AM on October 16, 2012 [1 favorite]

Another anectdata: my 15-yo daughter is bipolar/ODD and has been taking trileptal for several years now. The ADHD possibility has been raised on several occasions in the past, but she was only treated with Strattera several years ago, without any useful effect. For a long time we just focused on the mood aspect because it was the biggest issue. Lately she has been doing great with the mood issues, which made the ADHD symptoms all the more apparent.

When we talked with the psychiatrist, it became clear that her inner mental landscape was every bit as scattered, distracted and chaotic as the outward signs of ADHD, and her psychiatrist was completely on board with starting her on a lowish dose of Focalin. We were warned to keep an eye out for possible overstimulation/triggering, but so far so good. And I mean good. She's able to read textbooks, study for tests, think about cleaning and organizing, and actually listen to instructions and report them to me with some degree of accuracy, rather than coming home from practice saying "the coach said something about something but I don't remember what it was about. Can you e-mail her and find out?"

And she's certainly not the only person out there taking a mood stabilizer for bipolar and a stimulant for ADHD. It's a "precede with caution" situation, but not a "none shall pass" bar. Try a different pdoc.
posted by SomeTrickPony at 9:09 AM on October 16, 2012

Best answer: Just as a note: Bipolar II can create some deficits and challenges that are very similar to ADHD/ADD. It is not unusual for BPII (and I believe type I as well) to bounce between being highly distractible s and hyperfocusing. If you are in a hypomanic or mixed episode state it can make you physically, mentally and emotionally restless.
posted by Librarygeek at 10:20 AM on October 16, 2012 [1 favorite]

Best answer: My dad, who is apparently bipolar (I just learned this last month) had a manic episode triggered by ADD meds and it was deeply unpleasant for all involved. He does most likely have ADD too, which sort of sucks for everyone as well, but the manic episode was worse.
posted by restless_nomad at 10:38 AM on October 16, 2012

If you have access to a bipolar support group you might check it out. My partner finds it a good place to get information on how med combos have worked for other people, and also a sort of pre-screen for doctors. If you ask other local bipolar people how their doctors approach stimulants you might begin to get a sense for approaches you could try and doctors who might work with you.
posted by Stacey at 11:00 AM on October 16, 2012

Response by poster: Thanks for all the thoughts, everyone. This bipolar diagnosis is very new for me yet; though it's been kicked around as a possibility for a while, I never really thought it would happen. So there has been some denial going on, and some thinking that nothing really has to change, etc. Obviously this isn't correct, and I'll need to reorganize my thinking about a lot of things. I'll also have to think about ADHD vs manifestations of the bipolar.
posted by altopower at 5:05 PM on October 16, 2012

I'm Bipolar II, not ADD. I originally went to a psych thinking I had ADD, but she said that people with Bipolar have symptoms that seem like ADD, but are actually due to bipolar. She also said that bipolar and ADD can be comorbid, but you have to treat the bipolar first.

She told me that I couldn't take a stimulant without being on a bipolar med; I'd have a panic attack and possibly go into hypomania. Once I was on Seroquel a few months and fairly stable, she gave me Adderall for unrelated reasons (fibromyalgia fatigue and IC pain), with the caveat that I can't take it without taking my Seroquel. I've had no trouble with the Adderall, and it does help with my fatigue and my attention span, as well. Getting stable on Seroquel also helped my attention span.
posted by hotelechozulu at 8:53 AM on October 17, 2012 [1 favorite]