Expert: Joyce A. Anthony - 4/21/2011

Question
Hello,
My son is 15 years old.  He has been treated for ADHD since age 4 and a "mood disorder" since age 13.
For the last two years, he has taken Adderall 40mg BID and Risperdal at bedtime (dosage continues to increase, currently at 6mg).  Everything seemed fairly well until the Fall of 2010 when he was taking Accutane.  The anger (which is a common side effect of Accutane) became out of control and we saw a new physician.  Since November, he has continued taking Risperdal.  His meds for ADHD have changed monthly.  At this very moment, he is taking Trileptal BID and Risperdal at hs.  By removing the stimulant, he seems to be doing better in school.  However, his anger is continually getting worse.
He becomes angry for no apparent reason and at any given time (ie, in the middle of church).  It is really starting to scare me because HE is worried about himself.  He's never been bothered by it in the past.  
Having said all that, is there a certain combination of meds that work best with ADHD and Bipolar disorder?  He is really concerned about gaining weight.  He has gained 12 pounds since December.  I am scheduled to see his psychiatrist tomorrow (without my son) to discuss this.  He is the type of doctor who will basically order whatever I ask for.  Can you please suggest something for me to ask for?
Thank you so much for your time!!

Answer
Michelle:

The best combination that seems to work for the majority of people with both ADHD and a mood disorder is a combination of Seroquel and Lamictal.  These will not cause weight increase, reduce violence almost completely, and even out moods.  The Risperdal could be causing your son to go too far "down" and this will cause violence.  Often the aforementioned combination also eliminates the necessity for sleep medication.  If one is still needed, a very small dosage of Trazadone will work.

Lamictal needs to be started at a very low dosage and gradually increased over several weeks, but it is well worth the time.  Talk with his doctor and see what his opinion is about this combination.

It is good you recognize your son's concern.  These kids want to be happy, don't want to lose control and are so confused and scared inside.  It appears your son has a mother who is there for him and willing to work hard.  Great job!
                                             Joyce A. Anthony