Bipolar and ADHD

[ballpointpen]

I have been diagnosed with bipolar for 5+ years. Clear manic episodes and diagnosed by about 4 different psychs. However, I was referred to the adhd service in a neighbouring borough and after testing was found to have adhd inattentive subtype. My problem is, my adhd psych (who is separate from my normal psych) argues with me that I do not in fact have bipolar at all. She is an adhd specialist so I’m not sure she has the ability to undo the last 5+ years of my life but she says my bipolar is actually down to trauma I experienced as a child.

Can adhd and bipolar not coexist? The trauma I experienced as a child has been laid to rest but now she has me questioning my bipolar diagnosis and I loathe medication and am wondering whether to stop taking my bipolar meds if it is not truly bipolar. She tried to tread my adhd with atomoxetine which didn’t work out so well (I became very withdrawn, lack of energy, motivation, low sec drive) and she claims this is because he atomoxetine forced me to focus but on the wrong things (my childhood). I didn’t think about my childhood at all but she is insisting that she will not try another drug, only atomoxetine because I have a history of drug abuse (I have been clean now for 13 years). I refuse to take strattera again because of the negative experience so does that mean I just have to live with unmedicated adhd and bipolar which I apparently don’t even have?

My life has been full of hospital admissions, manic psychosis, suicide attempts and now I just feel like my whole life is a lie. I have no idea what to do. So sorry this is so long, I’m still trying to get it straight in my head.

Any advice?

[Kunga Dorji]

Originally Posted by ballpointpen

I have been diagnosed with bipolar for 5+ years. Clear manic episodes and diagnosed by about 4 different psychs. However, I was referred to the adhd service in a neighbouring borough and after testing was found to have adhd inattentive subtype. My problem is, my adhd psych (who is separate from my normal psych) argues with me that I do not in fact have bipolar at all. She is an adhd specialist so I’m not sure she has the ability to undo the last 5+ years of my life but she says my bipolar is actually down to trauma I experienced as a child.

Can adhd and bipolar not coexist? The trauma I experienced as a child has been laid to rest but now she has me questioning my bipolar diagnosis and I loathe medication and am wondering whether to stop taking my bipolar meds if it is not truly bipolar. She tried to tread my adhd with atomoxetine which didn’t work out so well (I became very withdrawn, lack of energy, motivation, low sec drive) and she claims this is because he atomoxetine forced me to focus but on the wrong things (my childhood). I didn’t think about my childhood at all but she is insisting that she will not try another drug, only atomoxetine because I have a history of drug abuse (I have been clean now for 13 years). I refuse to take strattera again because of the negative experience so does that mean I just have to live with unmedicated adhd and bipolar which I apparently don’t even have?

My life has been full of hospital admissions, manic psychosis, suicide attempts and now I just feel like my whole life is a lie. I have no idea what to do. So sorry this is so long, I’m still trying to get it straight in my head.

Any advice?

With a history like that it seems hard to deny bipolar. Childhood trauma is also well recognised as causing or worsening PTSD.

See link:
https://journalbipolardisorders.spri...345-015-0042-0


However plenty of us have bipolar and ADHD.
I think nobody would advocate stimulants in active mania, but outside that period they are often co prescribed.


Im on Dexamphetamine 10mg BD
and slow release lithium 1350mg at night.

Many psychiatrists control against addiction by only allowing a weeks worth at a time to b e prescribed.

I know of very few ADHD individuals who have addiction problems with stimulants./.


They can be an issue in the upswing of mania- as you push your dose to keep it all together ( which doesnt work).

[undopaminergic]

It's bipolar I if you've had mania(*). What caused it, be it childhood trauma or genes, is irrelevant to the diagnosis.

Atomoxetine does not "force" you to focus.

(*) depending on the psychotic symptoms it could also be schizoaffective disorder.

-undopaminergic

[sarahsweets]

https://www.psychiatryadvisor.com/ho...rder-and-adhd/
Here is an excellent article I found and I encourage you to look at it beyond what I have quoted.

In community samples, almost 60% of pediatric ADHD patients have been found to have an affective illness.1 On the other hand, nearly 10% of bipolar patients are found to have comorbid ADHD.2

Studies indicate bipolar disorder should be treated first. ADHD symptoms tend not to ideally respond unless comorbid bipolar disorder is first treated optimally.3

In community samples, almost 60% of pediatric ADHD patients have been found to have an affective illness.1 On the other hand, nearly 10% of bipolar patients are found to have comorbid ADHD.2

Studies indicate bipolar disorder should be treated first. ADHD symptoms tend not to ideally respond unless comorbid bipolar disorder is first treated optimally.

Treatment of ADHD and Comorbid Bipolar Disorder
Treat bipolar symptoms first and if ADHD symptoms persist, titrate ADHD medications carefully
It may be safe to use stimulants if bipolar symptoms respond well to a mood-stabilizing agent
Some evidence suggests that atomoxetine can be used safely and effectively in combination with mood stabilizers
Stimulant use requires ongoing monitoring as it may destabilize the mood disorder

Originally Posted by ballpointpen

I have been diagnosed with bipolar for 5+ years. Clear manic episodes and diagnosed by about 4 different psychs. However, I was referred to the adhd service in a neighbouring borough and after testing was found to have adhd inattentive subtype. My problem is, my adhd psych (who is separate from my normal psych) argues with me that I do not in fact have bipolar at all. She is an adhd specialist so I’m not sure she has the ability to undo the last 5+ years of my life but she says my bipolar is actually down to trauma I experienced as a child.

Are you on medication from the bipolar doc? Are you discussing medications for adhd?

Can adhd and bipolar not coexist? The trauma I experienced as a child has been laid to rest but now she has me questioning my bipolar diagnosis and I loathe medication and am wondering whether to stop taking my bipolar meds if it is not truly bipolar. She tried to tread my adhd with atomoxetine which didn’t work out so well (I became very withdrawn, lack of energy, motivation, low sec drive) and she claims this is because he atomoxetine forced me to focus but on the wrong things (my childhood). I didn’t think about my childhood at all but she is insisting that she will not try another drug, only atomoxetine because I have a history of drug abuse (I have been clean now for 13 years). I refuse to take strattera again because of the negative experience so does that mean I just have to live with unmedicated adhd and bipolar which I apparently don’t even have?

You know hearing that you will not be considered for a stimulant due to past drug use really irritates me. Studies have shown over and over that treating adhd is actually better for someone with addiction issues because it targets executive function and decision making. It helps control impulsiveness and compulsive decisions. I am an alcoholic in recovery and I would never have gotten sober without medication.

[jmilly]

Research studies show that about 70 percent of people with the bipolar also have ADHD, and that 20 percent of people with ADHD will develop Bipolar Disorder.

[Kunga Dorji]

Originally Posted by jmilly

Research studies show that about 70 percent of people with the bipolar also have ADHD, and that 20 percent of people with ADHD will develop Bipolar Disorder.

Further stats show that at least 10% of bipolar is secondary to head injury, and head injury is also a factor in many late onset cases of ADHD- later childhood.

[daveddd]

Originally Posted by sarahsweets

https://www.psychiatryadvisor.com/ho...rder-and-adhd/
Here is an excellent article I found and I encourage you to look at it beyond what I have quoted.



Are you on medication from the bipolar doc? Are you discussing medications for adhd?

You know hearing that you will not be considered for a stimulant due to past drug use really irritates me. Studies have shown over and over that treating adhd is actually better for someone with addiction issues because it targets executive function and decision making. It helps control impulsiveness and compulsive decisions. I am an alcoholic in recovery and I would never have gotten sober without medication.

Still gotta be careful

All the studies are stimulants given to people with no addiction and the outcome being better

None about giving them to people with addiction already

[Kunga Dorji]

Originally Posted by daveddd

Still gotta be careful

All the studies are stimulants given to people with no addiction and the outcome being better

None about giving them to people with addiction already

This is a very grey area.

Untreated ADHD is a major source of drug seeking behaviour.

No surprise- the untreated gravitate either to stimulants (which can be very helpful if they come with good advice and a commitment to using the drugs as medication to treat dysfunctional behaviour, rather than chasing a dysfunctional high; or they gravitate to downers (opioids especially) to reduce their happiness.


However that relationship is not recognized in the literature.

Aggregating the research to metanalyses is really hard here as it is hard to be sure we are all even talking about the same thing.

The diagnostic system of DSM is an awful mess and we need to clarify that mess before we go further.

[Kunga Dorji]

Originally Posted by daveddd

Still gotta be careful

All the studies are stimulants given to people with no addiction and the outcome being better

None about giving them to people with addiction already

This is why we have clinicians- to ensure individualised attention by skilled practitioners for all patients. We have to move past diagnoses and focus on the individuals.