ADD and Bipolar
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ADD and Bipolar
(Sabrina)

Q: My son has been diagnosed by a psychiatrist with ADHD. The medications he has been taking are Depakote, Adderall, and Zoloft. Because his condition has become worse, we have been taking him to a psychologist in addition to the psychiatrist. The psychologist has diagnosed him with ADHD and Bipolar. Can you send me a general list of medications that would treat the two disorders? Also, can the medications he is on for ADHD counteract with the Bipolar?

Dear Sabrina --
Ahh, you have entered a very difficult territory -- and a common one.  What is the relationship of ADD and Bipolar?  Some experts see them as separate, though we know they occur together more often than would be expected by chance: i.e. there are more bipolar people in the ADD group than there are bipolar people in the general population.

Some experts think that at least some of "ADD" is a precursor of bipolar, or even -- this is the most extreme view -- that "ADD" is in some kids not "ADD" at all but "bipolar", in a pre-pubertal form.  For an example of this debate, go to www.bpkids.org, and at the bottom of the home page you'll find their search form.  Enter ADHD, and you'll find a very relevant set of articles for your son.  The first is the classic debate, worth reading for anyone wondering about this relationship between bipolar and ADHD.

So, much more important than the "general list of medications" is a general understanding of the circumstance.  However, as far as medications go, here is the general idea: stimulants are thought by some experts, but not by all, to have the capacity to make bipolar disorder in a young child worse (or even to make it emerge from what looked like "ADHD").  There are risks to using mood stabilizers, unfortunately: particularly liver risks with Depakote in kids under 12; and we don't have a lot of experience using lithium in kids of that age.  So there are risks in "both directions", i.e. using a stimulant if your son is "bipolar"; or using mood stabilizers if he's really "just" ADHD.

Do some reading from the references on bpkids and see if you can discuss this issue with his psychiatrist; his psychologist may be able to help you sort out options if the pdoc is not really thinking "bipolar" (and he might be right; this is a tough call).

Dr. Phelps


Published October, 2000
 

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