Bipolar and ADHD medication Combos

Discussion in 'General Parenting' started by tandcg, Sep 23, 2009.

  1. tandcg

    tandcg New Member


    The rollercoaster ride continues!

    My son was diagnosed with bipolar and ADHD last December. We've been through the ringer (like everyone else here!) over the last couple of years of middle school with his impulsive ODD behavior and mood swings, angry outbursts, poor choices, trouble with school, etc.

    Docs plan was to get the bipolar under control first before addressing the ADHD and the trouble with focusing. After several medication changes, he has been doing well recently on Depakote ER and Abilify. He actually had a pretty good summer - we kept him busy with a couple sports camps and I started allowing myself to be a bit optimistic. We also finally found a great therapist who is really able to relate to him and that has been helping too.

    He began high school with the best intentions and the first couple weeks were great. However, he has quickly become overwhelmed with the homework, which he will do anything to avoid. He has completely given up and is now failing all his core classes.

    His therapist believes that the time is probably right to get him started on some medications for the ADHD. Has anyone had any experience with mixing ADHD medications along with Depakote and Abilify? Aren't most of the ADHD medications stimulants? I'm worried that these will counteract the benefits of the mood stabilizers. Does this happen? We already tried Strattera at one point with absolutely disasterous results, so I am so worried.

    He has also developed hand tremors from the Depakote which are affecting his ability to keep up with note taking in class and the amount of time written work takes. We have tried reducing the Depakote dosage just a bit to see if that helps. There seems to be a small improvement but they are not completely gone. The doctor also mentioned another alternative, which would be adding Inderal to eliminate the tremors. But then how will this impact the combo of the Bipolar and ADHD medications?? I hate the fact that he might ending up taking four different medications, but I don't know what else to do????

    Has anyone else run into any of this?
  2. whatamess

    whatamess New Member

    I'm not sure about advice regarding the medications, but it sounds like he was doing well and was/is really trying to do well in school. Perhaps over the years of getting behavior and everything else under control, he wasn't able to work on organizational skills and how to note-take efficiently, etc. Maybe since he's behind now on work, it all seems too daunting. Can you work with the school to get his back-work load lessened so he has a chance of catching up? Is there a resource person at school that can help him organize?
  3. klmno

    klmno Active Member

    Yes, and unfortunately, it is the typical roller-coaster ride. What your psychiatrist is telling you is the same that I heard- not the exact medications but the route taken. My son did better with the higher dose being an older mood stabilizer- lithobid (a form of lithium) with depakote as an add-on. That allowed a lower dose of depakote, thus, less side effects. You might want to ask about that.
  4. smallworld

    smallworld Moderator

    My son has taken Inderal (generic is Propranolol) for migraine prevention for 6 years. It has not interferred in any way with his mood stabilization medications.

    Most of the medications for ADHD are stimulants. My son did not do particularly well on them in the long run for two reasons: first, they tended to depress him, and second, they caused fluctuations in his mood when they wore off in the afternoons.

    ADHD medications do not necessarily help with executive functioning, which is what you are really describing as your son's central issue. Does your son have an IEP? What help does he have available to him at school? Can you get him a tutor to help with homework?
  5. compassion

    compassion Member

    My daughter was recently put on Straterra for her focus issues. It seems to be helping. She also takes abilify and Lactimal. Strateera is for ADHD type issues but is not a stimulant. Compassion
  6. gcvmom

    gcvmom Here we go again!

    Although my difficult child 2 initially started out on stimulants, as his bipolar disorder emerged, the stimulants made his symptoms worse. As we've gotten his medications better adjusted, especially his Depakote, his focus and attention have gotten better. When's the last time your son's Depakote blood levels were checked?
  7. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I wanted to bring up that medications can cause cognitive dulling which make it harder to learn. My daughter was in college when she was put on Depakote. She could not learn on it and stopped taking it saying (in her words exactly) "It makes me stupid." It could be that the Depakote is slowing down his ability to think. In my daughter's case it was extreme. Abilify can do the same thing. Also, Abilify can also make ones hands shake (just as an aside). Straterra is an antidepressant, which CAN make bipolar even worse so that it has to be taken with great care. The right medications is a crapshoot.

    I've taken mood disorder medications most of my life now (age 23 to now age 56), and don't believe you can medicate away every symptom. I personally wouldn't want to be on four medications because I feel doped up if I'm on too many. Then I get very depressed, tired, and can't barely keep my eyes open or function at all. Of course, everyone is different, but four medications is going to have a strong effect on a child's thinking. Heck, even one of these medications will. I know. I've probably tried most of If this were me or my child, I would keep the medications that stabilize him and use alternative methods to help with school, such as little or no homework, longer time to turn in assignments, somebody explaining things to him. I'm in a support group for people with mood disorders...for some reason, bipolars/depressives tend to have bad memories anyway. We talk about that a lot.

    Many bipolars can't tolerate ADHD medication. It's your Mom Gut call, but as a "differently wired" child on medication, he is probably going to need interventions to help with his school work. Good luck, whatever you decide to do.
    Last edited: Sep 23, 2009
  8. horserider

    horserider New Member

    I'm kind of new to the boards also but thought I would share our experiences as my difficult child is also ADHD, BiPolar (BP) diagnosis. He was on a combination of Abilify and Vyvanse (newer stimulant). The difference we found with Vyvanse that was very helpful is it is time relased and would last until around dinner time. This was helpful for my son's last few hours at school where he struggled the most. It by far was the best stimulant he has been on, we have tried many. He had a serious problem with Straterra though where he became manic with strange behaviors, I had to take him to the ER yrs. ago. He unfortunatley is non-medication compliant right now - but that is not because of the medications he was on, just got tired of taking medications, wants to be independent, make his own decisions, etc., almost 17 yr. old.

    We have always been very cautious with medications also. Our son has never been on more then 3 medications at once. But each child is different. We are lucky to have great medication. coverage with our insurance. I heard some insurance co. will not cover Vyvanse yet. He did have some weight gain from the Abilify, but overall it was a good combination.

    Take care

    me - hanging in their on Xanax to help
    difficult child - 16, BiPolar (BP) adhd,
    husband- adopted difficult child at 5, Type 1 diabetic
  9. graceupongrace

    graceupongrace New Member

    My difficult child has been on Vyvanse for a couple of years now, and it has been very effective in controlling his ADHD symptoms. About a year ago psychiatrist considered adding a bipolar diagnosis, and added Depakote. We had no problems with the combination, but the Depakote did nothing to change his behavior, so we discontinued it and ruled out bipolar.

    Not sure if that helps much... But let me add my empathy for the medication-go-round. It's understandable from a clinical perspective, but extremely frustrating. :tongue:
  10. Wiped Out

    Wiped Out Well-Known Member Staff Member

    We have found that with my difficult child he cannot take any stimulants or ADs because of his bipolar. For him he gets way too violent. He's been off of them now for years (after trying almost all of them). Last summer a camp counselor accidentally gave him someone else's medications-turned out to be a stimulant. We ended up with an extra hole in our bedroom door that night.

    The Clonidine we give him during the day does help with ADHD. It's not perfect because it can tend to make him somewhat sleepy but with-o it he is a non stop child who can't sit for two seconds straight.
  11. jcox

    jcox New Member

    My son E has a mix of alphabet soup including BiPolar (BP) and ADHD. He was tried on Ritalin at age 3 which gave him his worst, longest rage ever. Five hours of nonstop kicking, hitting, biting, spitting, throwing things, thrashing his body, cussing, screaming, etc. We only gave him that one day and never had the courage to try him on anything else for his "ADHD" for a while. Finally this year during a dicussion with his psychiatrist I brought up the school's concerns about his ADHD symptoms. She told me the only two medications she would even consider with him because of his mix were Straterra and Tenex. After careful research her gut told her to go with Tenex. She started him on that in August and so far so good. He is doing better in school able to concentrate more, less hyper, lowered anxiety, more focus, his sentences are improving, etc.
  12. miles2go

    miles2go Member

    My 8 y.o. son was first diagnosed with ADHD, but now we are quite sure of the BiPolar (BP) diagnosis. AFAIK, BiPolar (BP) also has difficulty with focusing on tasks and impulse control (as the prefrontal cortex gets damaged), so when I see these symptoms I attribute them to BiPolar (BP) not to another diagnosis. He's on Abilify. Our psychiatrist suggested Strattera or Clonidine, but I ve been reluctant to try either.
    Do you find that the lack of focus and poor impulse control come in phases, like bipolar phases do?