Symptoms of bipolar disorder and ADHD often overlap, and it is not unusual for these conditions to co-exist. Approximately 20 percent of children with ADHD are bipolar, and around two-thirds of children with bipolar disorder may have ADHD, according to the "Current Psychiatry" article "ADHD or Bipolar Disorder?" Signs suggesting your child has bipolar disorder include racing thoughts, overly happy mood, grandiosity and insomnia. Children with bipolar disorder and ADHD may seem irritable, overly sensitive and reactive, according to the "ADHD Parents Medication Guide."
Mood Stabilizers
Children who suffer from the comorbid conditions of ADHD and bipolar disorder may take different types of medications, including mood stabilizers, SSRIs, benzodiazepines and antipsychotics. Doctors prescribe mood stabilizers, such as lithium, the first mood stabilizer approved by the U.S. Food and Drug Administration in the 1970s, and anticonvulsant medications such as valproate, under the trade name Depakote, and carbamazepine, trade name Tegretol, to control mood cycling and help manage bipolar symptoms in children. Patients often take these mood stabilizers in conjunction with ADHD medications.
Children require periodic blood work to carefully monitor all medications to check the levels of the drugs in their system and to control any effects on the liver.
Psychostimulants
Doctors prescribe psychostimulants such as methylphenidate--with brand names Ritalin, Metadate, Methylin, Focalin XR, Concerta and Daytrana--and amphetamines--such as Adderall, Adderall XR, Dexedrine and Vyvanse--for ADHD in children. These stimulants may help children with ADHD become more focused and able to complete tasks, and may allow them to succeed in accomplishing more than they would be able to if their symptoms remained untreated.
Psychostimulants work quickly and leave the blood quickly, so kids can take them on the day they need them. According to psychiatrist and ADHD specialist Dr. Darvin Hege of Atlanta Psychiatry Services, 75 to 80 percent of people with ADHD improve with psychostimulants, but because they only work for four to 12 hours, additional doses may be required to alleviate poor concentration and focus in the late afternoon or evening.
Because stimulants may trigger or exacerbate manic symptoms, children who have both ADHD and bipolar disorder and take stimulants require careful observation. According to University of Miami psychiatrist and professor Arnold L. Lieber, M.D., "Stimulants such as methphenindate (Ritalin), which are the treatment of choice for ADHD, tend to worsen the symptoms of bipolar spectrum disorder."
Antipsychotics
Some doctors prescribe the antipsychotic medication risperidone to treat child bipolar disorder and disruptive behavior disorders, such as ADHD. The February 2008 article "Risperidone for the Treatment of ADHD in Children with Bipolar Disorder," suggested that risperidone, when given to children with ADHD and bipolar disorder, facilitated some improvement of inattentive, hyperactive and impulsive symptoms. However, some children continued to experience some symptoms of both disorders and did not experience significant clinical improvement, according to Massachusetts General Hospital child psychiatrist Joseph Biederman, M.D.
Selective Serotonin Reuptake Inhibitors
Psychiatrists may choose to prescribe selective serotonin reuptake inhibitors, or SSRIs, to help manage ADHD symptoms. Antidepressant medications such as fluoxetine and sertraline--also known as Prozac and Zoloft--may benefit children suffering from an inability to pay attention. SSRIs can be helpful for patients who are diagnosed with bipolar disorder and exhibit symptoms of anxiety or depression.
References
- Current Psychiatry Online: ADHD or Bipolar?
- ParentsMedGuide: ADHD Parents Medication Guide
- Evening Psychiatrist: Help for Adult Attention Deficit Disorder
- Depression Central: Bipolar Spectrum Disorder
- National Center for Biotechnology Information: Risperidone Treatment for ADHD in Children and Adolescents with Bipolar Disorder
