Expert: Ivan Goldberg, M.D. - 3/17/2009

Question
My son, 17, is in recovery from a drug/alcohol abuse. He's been clean for a few months or so(may have slipped about a month ago but no proof). Anyway, because of questionable behaviors (he's been on probation for a year) he was called back to court. My son has mentioned every now and then that he might be depressed and more recently, "flat". He's seeing a therapist and when I asked the therapist, he said he possibly could have depression. Well, I mentioned to the judge about the possibility of my son having depression and told him that we had an appointment with a psychiatrist, the judge suggested my son have a psychological test, too.

Just before my son's appointment with the psychiatrist, my son told me that he is interested in being put back on an ADD medication. He was on Concerta years ago and hated the side effects. His school performance skyrocketed. He's doing very poorly now and told me he can't concentrate. Anyway, when we met with the doctor, we told him of my son's ADD and were thinking of trying a different ADD medication and he didn't think it was a good idea. He told us it could trigger drug cravings. The doctor asked about our family mental health history and I told him that my mother had two siblings with bipolar. Next thing we know he's prescribing Wellbrutrin for bipolar. He also gave me information on Lamictal. He said he wished he had a crystal ball because he's not sure where my son's future is. What? I understand that it's not easy to diagnose a younger person with bipolar but both my son and I don't think he has it. No strange behaviors. He's always been a seemingly happy kid and a social butterfly. Very likable, except when he was on illegal drugs.

My son has a very long list of criminal offences in a short period of time when he was using drugs but the doctor said that people who use drugs and have a problem don't have the long list of charges like my son. What?

When I told the judge that my son has a psych appt. he suggested a psychological test, too. Would this give us a much better idea as to whether our son has bipolar? Even if he doesn't, the doctor said that this would help his cigarette cravings.  

This is confusing. My son seems "pretty normal" now that he's off the drugs. Has had some dry drunk behavior now and again but that is about it. Honestly, I'm afraid to rock the boat (side effects) because my other son (who had depression) went into a tailspin when he was put on Lexapro and wanted to kill himself.  

Do we trust the doctor and try the meds? My son is finally starting to do some homework - what if this throws him off?

Answer
Hi Karen . . .

The relationship between attentional problems (ADD / ADHD) and bipolar disorder is a complicated one. See: http://www.psycom.net/depression.central.bipolar-ADD.html

I cannot give specific medical advice, bit people with possible bipolar disorder should not take antidepressants unless they also take mood stabilizers. When there is even a slight possibility of bipolar disorder, Lamictal is a much better choice than Wellbutrin.

Best regards . . .

Ivan
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