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Q:  Stimulants-Antidepressants-Dopamine

I have been diagnosed with both bipolar and ADD.  I understand these disorders often overlap.  I have been begging my doctor to put me on a stimulant, but she is being very cautious about it even though stimulants helped me in the past.  I have read stimulants do not always make bp people manic.  Are they less likely than antidepressents to cause a switch to mania because they stimulate dopamine instead of serontonin?

My second question is I've noticed doctors sometimes presribe drugs that offset each other. If a doctor prescribed wellburtin for depression along with an antipsychotic wouldn't they both counteract each other since antipyshcotics supposedly inhibit dopamine?

I'm very interested in the relationship of dopamine to bipolar and add. I wonder if they are really the same disorder.

Dear Ms. S' -- 
Good questions.  I wish we really knew some of the answers.  First, re: trying stimulants.  Looks to me like there's less data implicating stimulants as "destabilizing" in bipolar disorder than for antidepressants causing that problem, so with caution I will indeed use them if a person is already on a mood stabilizer and doing well except for attention problems.  That has worked out pretty well so far, but I'm still cautious (seems like it can take a year or two or even more sometimes for antidepressants to become a bad thing in bipolar disorder, and there are other doctors reporting keeping people on antidepressants with mood stabilizers routinely and doing well -- so there is a precedent of sorts for proceeding with long term stimulants.  At least that's what I tell myself when I do this...). 

As to whether the fact that stimulants affect dopamine, where antidepressants affect serotonin (most do, but not all; and Wellbutrin, which also can cause mania/hypomania, affects dopamine and norepinephrine) means that they're safer somehow -- we don't understand how it all works well enough to think that way.  Ditto, therefore, the relationship between bipolar and add and dopamine: we have only the slightest understanding of how these neurochemicals are involved, and no where near enough to answer your question, unfortunately.  It is still a good question though, and that's why I look forward to my journals every month: "what did they figure out this time?!"

Dr. Phelps

Published September, 2001



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