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Lithium, Carbamazepine (Tegretol), and Valproic Acid (Depakote) have been used when mood disorders co-exist with ADHD. One frequently sees bipolar patients with supposed comorbid ADHD or diagnosed solely with ADHD. This is becoming increasingly common in adults as well as kids thanks to the popularity of the ADHD diagnosis. The problem is that just about all bipolar patients have a disorder of attention. To differentiate between the two, it is sometimes helpful to look for symptoms that are seen in bipolar disorders but not usually in ADHD, for example:

  • racing thoughts
  • not needing to sleep or hypersomnia
  • changes in energy parallel to the above
  • tangential thinking
  • overspending, overcommitting
  • grandiosity
  • grandiose thrill seeking (eg, jumping off of high places)
  • psychosis.

When ADHD and Bipolar Disorder are comorbid, starting treatment with a stimulant in these patients will often exacerbate the hyperactivity, flatten affect, and greatly decrease appetite. Some doctors start instead with either clonidine or guanfacine plus one of the following mood stabilizers: lithium, carbamazepine, valproic acid, or lamotrigine.

Once the patient is stable on therapeutic doses, a stimulant can be added if ADHD symptoms remain; if necessary, an antidepressant is sometimes added as well.

The boundary between persistent hypomania and ADHD is unclear. The usual practice is to treat such cases with stimulants before puberty and with mood-stabilizing agents in adulthood.

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