Expert: Dr Billy Levin - 11/3/2008

Question
I have a 29 year-old friend who was diagnosed with ADHD about 7 months ago - I was not surprised (she has always been easily distracted and highly disorganized and it made a lot of sense). She started medication and began complaining that when she didn't take her medication, she would sleep all day (I never asked her about the dosage, but apparently, she was taking 3, 20mg pills of Adderall a day - she weighs 115 lbs). About a month ago, she caused a scene in a restaurant - she was asked to leave after spending too much time in the bathroom - the owner thought she was using drugs (apparently, she had not eaten or slept for days and was acting goofy). Anyhow, she got indignant and refused to leave and her friend called her parents who came and got her. They took her to a psychiatrist who said she had exhibited a classic case of mania - I think the final diagnosis was type II bipolar (I was surprised by this diagnosis). My question: I know that ADD medication can catalyze manic episodes in people who are bipolar, but is it possible that her "episode" was caused by days of not sleeping, eating, and being hopped up on amphetamines? I know everybody is different, but when I took Adderall I was taking 20 mg a day and I've got 50 pounds on her. I suppose I'm concerned about her current diagnosis, because it is based on an isolated incident and there is no family history of bipolar disorder. What do you think?

Answer
There are too many factors to consider before reaching a conclusion in this case. I would need much more information. However one outburst is not a diagnosis of Mania. Moreover the dose of stimulants is based on response and not on weight or age.  If the outburst was in the evening her medication would have stopped working by then. If rating scales were used on a regular basis all would know if her stimulant medication was effective.  When Bipolar and ADHD exist together the treatment is more tricky and the stimulant may make bipolar worse.  Not an easy on to give an opinion without more information.