Expert: Joyce A. Anthony - 10/9/2007

Question
Our son, age 13, was treated from age 4.5 for ADHD with Adderal and zoloft and clondine. He was eventually reduced to just Adderal With a psychotic break at age 10.5, diagnosis was made as Bipolar, NAS.  Following many medications and 2 2week hospitalizations, he was placed on a cocktail of Lithim, Abilify, Tenex, Lamictal, and Zoloft was brought in a year ago for anxiety control.  He has been needing 12 to 14 hours of sleep daily and as much as 16 hours at times.  He is quite intelligent and can be focused at times, but only on things of appeal or interest to him.  He is not easily directed to do schoolwork and frustration builds quickly.  The Psychiatrist is recommending treatment for the currently untreated ADHD.  Looking for guidance on this matter.

Answer
Hi Bill:

Very often bipolar disorder and ADHD are present at the same time.  While both need to be addressed, the bipolar disorder must be done first.  I'm concerned about the amount of medication they have your son on.  With the Lamictal, maybe you could talk to the doctor about replacing the rest with Seroquel?  That would help with the psychosis as well as anxiety.  

Then, I would think about treating the ADHD.  At this point, with the Zoloft and Abilify, ADHD medication could send him into mania--that you don't want.

My suggestion  would be to discuss the change in meds first, then after 4-6 month, consider the ADHD medication if it was still found necessary.
                  Joyce A. Anthony