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Attention Deficit Hyperactivity Disorder

ADHD/Bipolar: Is the Medication/Diagnosis?

07/06/2010

Question:

I am a 33 year old mother with a 7 year old son. I have been on some kind of antidepressant since I was about 18. My son was diagnosed ADHD in kindergarten. He now takes 20mg of Methylin twice a day. It works @ school but we hate to see him on it @ home. During his diagnosis process I was also diagnosed and am now taking 20mg of Adderall XR and 300mg of Wellbutrin XL. I recently went to the Dr. and she mentioned the possibility of me being Bipolar. I immediately thought of my son. I want what`s best for both of us & I`m not sure what to do. Is the medication/diagnosis right or wrong? How do you know?

Answer:

This question brings up a controversial area that is receiving much attention from clinicians and investigators. There is a good deal of symptom overlap between ADHD and bipolar disorder. In fact, all of the ADHD symptoms can also be found in bipolar disorder but not all bipolar symptoms are found in ADHD. Besides the prominent mood symptoms in bipolar disorder, the disorders are distinguished by their pattern over time.

ADHD is chronic and dates from preschool or kindergarten age.

Bipolar disorder is more episodic and variable and usually begins later. Most children and adolescents with bipolar disorder also have ADHD, but the reverse is not true.
Because ADHD is about 5 times as common as bipolar disorder, most with ADHD do not have bipolar disorder.

The exact rate of bipolar disorder in people with ADHD is not settled. A prominent group of investigators at Harvard has reported an incidence of bipolar disorder over 20% in follow-up of a sample that started with just ADHD. However, other experts view their report with some skepticism.

Many research groups are currently studying this problem, including the LAMS study at Case-Western Reserve, OSU, University of Cincinnati, and University of Pittsburgh. We should have answers that are more definite in 5-10 years.

Whether someone has bipolar disorder, just depression or just ADHD has important treatment implications. Someone who has bipolar disorder for sure should probably not be taking a stimulant without also taking a mood stabilizer. In your case, it sounds as if your doctor is not sure you have bipolar disorder. If so, you might want to ask her to refer you for a consultation or second opinion to try and settle whether you do.

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Response by:

L Eugene Arnold, MD, MEd L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University