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Sunday, December 8, 2013
Attention Deficit Hyperactivity Disorder
I am 24 years old I have been off meth for 4 years. I was told I had A.D.D. and Type II bipolar and depression when I was younger however because I did drugs I never took the meds. Now that I am older I realized that I still need treatment for my A.D.D. and my bipolar disorder. My depression is the only thing I have been getting treated for and I am still having a lot of problems.
Now with telling you some of my history my question is, the doctor that I am seeing has told me that he is unsure about treating me for my A.D.D. because of my past even though the A.D.D. is my biggest problem from what he has even told me. Why? How am I ever going to get this powerful mind of mine figured out? I drive myself crazy and it literally makes me very tired all the time.
The reluctance of your doctor to give you a stimulant for your ADHD is very understandable and well-grounded. Not only might a stimulant risk re-addiction, but also could trigger a manic "flip" in your bipolar depression.
However, there are other strategies that might be explored. E.g., several nonstimulant drugs have good controlled evidence of effectiveness for ADHD even though they don't have FDA approval for such use. These include guanfacine and several anti-depressants. Of course, anti-depressants could also risk a manic flip. A common strategy is to first treat the bipolar disorder with a mood stabilizer (some of which also help ADHD symptoms some), and then if necessary treat the ADHD symptoms with an appropriate secondary medication.
Non-pharmacological support should also be considered. Omega-3 fatty acids (e.g., fish oil) seems to have a mild to moderate effect on depression and does not carry a risk of a manic flip. Some studies have also reported mild to moderate improvement of ADHD symptoms with a mix of omega-3 acids (EPA and DHA, fish oil) and gamma-linolenic acid (evening primrose oil). Vitamins such as the B vitamins are also necessary for optimal brain function, and have sometimes been reported deficient in depression. Further, some medications can cause a vitamin deficiency. Therefore a daily multivitamin/mineral may be useful.
Life style and habit hygiene could also be useful: regular routine and bedtime, wholesome breakfast, coaching from another person who has experienced success, development of one good habit at a time, etc. Habit development is extremely important for people with ADHD because once you have a good habit, you don't have to think about it anymore, and lack of attention is not as big of a problem. Good habits are also important in depression because they can carry you through when you don't feel like doing things.
L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University