Posted by: weaver | 2003/03/16

ADD/Bipolar overlapping symptoms or two diagnosis

My husband is very clearly ADD. Although we never identified it till recently, he also is clearly Bipolar. Although he's much more depressed than manic, and, in the last few years, his mania has been mostly irritable. I'm grateful for any kind of understanding of his behaviors, but have found very little about where these two diseases overlap like this. Since there's so much confusion over the two diseases in children, I wonder if there's any research on adults with both conditions. Also about appropriate treatments, since treating one area often seems to make other things worse.

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Our expert says:
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Weaver, I haven't come across any research on adults with both disorders. Much though we'd like there to be good reseach on many issues, problems that delay or prevent that include (a) the need for someone to be interested enough in the issue to put in all the hard work ; (b) funding for such work, which can be very costly ( which is why there is more research, due to more funding, for issues relating to drugs usable in common conditions, than in rarer conditions or combinations or in non-drug treatments ) ; and (c) the availability of a significant number of people with the complaint(s) at the same place where there is the interested person and the funding !
It's curious, that while ADD, though controversial, is reasonably well-establishd by professional consensus, as a problem in childhood, an Adult form is far more controversial, and there is less consensus that it exists, let alone on how to treat it. Bipolar Disorder, on he other hand, is very well established as an adult disorder, with much less agreement on its existence, extent, diagnosis and treatment in children.
Searching on the web, you should find lots of material about Bipolar Disorder in adults ; there will be less, and what there is will be far less reliable, on Adult ADD. Generally, treatment to soothe the mood swings of Bipolar Disorder, shouldn't exaggerate the other symptoms. Some people respond to some antidepressants with inceased irritability, and perhaps a degree of arousal that might be unhelpful ; but there are also more sedative antidepressants available.
Haven't the specialist(s) treating him been able to explain their rationale and plan adequately ? That's part of their job, after all.

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Posted by: weaver | 2003/03/16

He sees a psychiatrist and a psychologist. I don't think that they are working together at all. This doesn't help. But the psychiatrist is in better contact, at least with me. It has taken several years to get him on effective meds. After his mother died, and my husband's depression got pretty severe, he was put on antidepressants. He's been on Prozac now for maybe 5 years. That was sufficient to get him out of a very inactive, lethargic state, and he started being more active in life. But his rages came more and more often, till he has out of control maybe twice a week or so. And once he was active again, his ADD was more obvious. We got a diagnosis on that with only a Connor's test, but I have no doubt that that is an accurate diagnosis for him. The Ritalin was a great help, although remembering to take it was a tremendous challenge and the doctor has not tried to push him to an all day type stimulant. But, the Ritalin didn't help with the raging, that's for sure, and he was getting more and more paranoid, and really angry when he still was clearly depressed. Eventually I wrote a very detailed description of his behaviors, from when we met to the present, some 22 years at the time, and gave that to the doctor. He convinced my husband to try Zyprexa, which was a tremendous help. But it seems like now, if he misses any one of these meds he is instantly mean. I've read all I can about all of these meds, and about ADD and BP, and am aware of the controversies. Like giving stimulants to BP's. Or having someone on Zyprexa all the time, especially since his family has a history of diabetes. And the mere existence of adult ADD. But in articles on ADD it states that it is very commonly comorbid with Bipolar, including the article on this site. And if the stimulants help with "executive function" then why wouldn't they benefit other Bipolars to gain some control over their mood driven behaviors?

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