Expert: Joyce A. Anthony - 11/8/2009

Question
QUESTION: My son is still in the "unknown stage" but he is 12 years old and the doctor is not sure at this point if it is ADHD or bipolar.  He has tried many medications and now is putting him on 5 mg. of Alderall to see if there is an immediate change in his actions. He seems to be cycling and has great trouble controlling his behavior. I would appreciate knowing if Alderall would be harmful if he is bipolar?
I appreciate any information as we are greatly concerned about the medication and do want it to set him off into even stronger abnormal behavior.
Thank-you in advance or any help given,
         Audreanna

ANSWER: Audreanna:

What will happen if your son is bipolar is the Alderall will send him into extreme mania.  If you see any adverse behavior when he takes it, call the doctor immediately.  It is very often the way in which a psychiatrist can make the final diagnosis between ADHD and bipolar.  The ADHD medications will cause a reaction after only one or two doses.  If the mania worsens immediately, or control issues become worse, the chances that your son is bipolar are great and the medication will need to be stopped and a mood stabilizer prescribed.  I hope that helps?

         Joyce A. Anthony

---------- FOLLOW-UP ----------

QUESTION: Hi Joyce,
Since my last questions to you my son has been put on the Alderall. It is the fourth day and I do see he is more talkative but do not see much more than that at the moment.  When he would get up in the morning he would be very quiet and not very happy.  As for the focus part I do see a little difference in that but he is going to be tested for learning disabilities soon so that will be a big help. My question is since no one knows yet if he is bipolar or not at the age of 12 could this medicine creep up on him to cause a manic attack? I have seen antidepressants do that to him and all of a sudden he was hyper so I am just concerned that this could happen again with this medicine or is that not possible?
Thank-you again in advance for your excellent help in this matter.  I do appreciate it since you have dealt with it in every direction.
         Take care,
         Audreanna

ANSWER: Hi Audreanna :-)

After four days, the chances of the Adderal causing mania are very slim. Anti-depressants are a different class of medication, so they work over a longer period.  Adderal tends to work immediately, or not at all.  I would say to watch your son, but not worry.  It seems he's found a good "fit" where medication is concerned :-)
         Joyce A. Anthony

---------- FOLLOW-UP ----------

QUESTION: Dear Joyce,
I e-mailed you that my son was put on the Adderall and we saw no change. Since the jury is out on if he is bipolar or not at this point we are still concerned.  He took 5mg. for a week and the doctor increased it to 10mg. on Friday to be given on Saturday. Today on Sunday he says in his own words he feels "weird, funny, its hard to breath, feels ugly." He has no patience,angry, and agitated. I ask him a little later to do some school work with me. He said"no,I can't I am trying to deal with this--you do not know how I feel". I feel very concerned to keep giving him this medication with what is going on.  The doctor and people that work with him seem to want to push this medicine and because of a history of bipolar in his grandfather the concern is greater. He will be 13 this month and I am very concerned with the pressure of continuing this medicine and how he feels--it has not help him focus at all.
Again I appreciate your input on this matter because I feel with him being on Lithium and Seroquel it may hold him but he certainly is not doing better on the Adderall and I am concerned why it is being pushed. Again I thank-you for your reply in advance and I respect your knowledge in a case where I do not think this is the medication for my son and I am fighting the system.       Thank-you so much and Gods continued Blessings to you in your life
         Audreanna

Answer
Audreanna:

As his mother, you have every right to say no!  Don't allow them to bully you into this.  He is telling you something is wrong, you see the change--there are no two people closer to the situation.  I would call tomorrow morning and tell the doctor this is not working, he's getting worse and you can't give him the Adderall.  Tell the doctor you are willing to continue with the Lithium and Seroquel--and may consider Lamictal if it will be prescribed.  Right now, you are your son's only and greatest advocate--and you know what you are seeing.  

Stay calm and matter-of-fact when you call.  Sound confident, even if you are nervous.  Please keep me informed of the situation!  God bless you also!
         Joyce A. Anthony