ADHD Questions
Questions
How do you treat ADHD and bipolar disorder?
By Charles Li, MD
December 16, 2022
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A substantial amount of individuals with ADHD also have Bipolar Disorder.
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ADHD medications can work for ADHD symptoms in these individuals.
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However, clinicians should provide mood stabilizers to avoid causing additional manic episodes.
Having ADHD and bipolar disorder together can be challenging to manage, however, it is absolutely treatable with the right approach.
One of the primary concerns with treating ADHD in individuals who have bipolar disorder is the risk of mania. There is some evidence that medications used for ADHD can worsen symptoms of bipolar disorder.
For example, the FDA publishes a warning on the Adderall drug label for potential risks in individuals with bipolar disorder.
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Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible
induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms
should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history,
including a family history of suicide, bipolar disorder, and depression.
This warning also highlights risks to individuals who may not know that they have bipolar disorder.
The warning recommends that individuals with symptoms of depression should also be screened for potential bipolar disorder because of the risks outlined above.
What is mania?
Why doctors are concerned about mania
Healthcare professionals have been concerned about the risk of mania with stimulants for some time.
These risks were validated with studies such as the one below.
An observational study found that individuals with bipolar disorder had a nearly sevenfold higher risk of mania when given Ritalin without a mood stabilizer.
However, individuals who were treated with Ritalin and a mood stabilizer actually had a lower risk of mania.
These findings suggest that it is entirely possible to treat ADHD in individuals with bipolar disorder with a stimulant, as long as the symptoms of bipolar disorder are also treated adequately with mood stabilizers.
Treating ADHD with Strattera in Bipolar Disorder
Strattera is another treatment option used for ADHD. Unlike Ritalin and Adderall, Strattera is not a stimulant.
It can be an excellent treatment option for individuals who don’t do well on a stimulant.
It is also a first-line treatment when there is a concern about addiction or substance abuse. Unlike stimulants, Strattera is not addictive.
Like stimulants, Strattera also carries the risk of exacerbating bipolar disorder symptoms, if not, properly managed.
The FDA has placed a similar warning on the label of Strattera:
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In general, particular care should be taken in treating ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with STRATTERA, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.
Studies have found a risk of worsened bipolar disorder symptoms with Strattera:
However, it can be a good treatment option for some with proper monitoring and risk management.
Bipolar Disorder is quite common in ADHD
ADHD and bipolar disorder have a pretty significant overlap.
One study estimated that around 30% of individuals with ADHD might have some form of bipolar disorder.
Similarly, a substantial portion of individuals with bipolar disorder may have ADHD.
Having both ADHD and bipolar disorder may also affect your symptoms.
One study found that individuals with ADHD and bipolar disorder have more episodes of mania.
ADHD is common among individuals with bipolar disorder. Bipolar disorder is also common among individuals with ADHD. Having ADHD and bipolar disorder increases the chances that someone will experience many manic episodes. ADHD also correlates with an earlier start to a person’s manic episodes.
Summary: Treating ADHD in those with Bipolar Disorder
In summary, ADHD is treatable for those with bipolar disorder.
The medications used for ADHD can exacerbate symptoms of bipolar disorder if they are given alone.
However, as long as the symptoms of bipolar disorder are properly monitored and managed, any of the three top medications for ADHD can be safely used under the supervision of a medical professional.
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Although systematic trials on the use of stimulants and ATX in ADHD-BD comorbidity in adulthood are necessary, both treatments should be considered possible options to be carefully evaluated once the patient has been stabilized.