ADHD Questions
Questions
Can someone with bipolar and ADHD take Adderall?
By Charles Li, MD
December 19, 2022
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Adderall is one of the most commonly prescribed treatments for ADHD.
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For patients with ADHD and Bipolar Disorder, it can potentially cause manic episodes.
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However, if the symptoms of Bipolar Disorder are adequately treated, studies show that Adderall can be a good treatment option.
Adderall is one of the most commonly prescribed medications for ADHD. Treatments like Adderall stimulate both the mind and the body. They are effective treatments for ADHD, but they can carry some significant side effects.
One of the concerns when treating ADHD symptoms among individuals with bipolar disorder is potentially causing a manic episode with ADHD medications like Adderall.
As you can see in the list below, some of the most common side effects of Adderall overlap with what someone may experience in a manic episode.
Dry mouth and decreased appetite are the most common side effects of Adderall XR, affecting 35% and 33% of patients. Insomnia is the third most common side effect affecting 27% of patients.
A manic episode is a distinct period where one experiences an abnormally elevated or irritable mood and goal-directed behavior, for at least one week, nearly every day.
The FDA has even placed a warning label on Adderall alerting healthcare workers to the risk of causing a manic episode in patients who have bipolar disorder:
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Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible
induction of mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms
should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history,
including a family history of suicide, bipolar disorder, and depression.
This warning instructs clinicians to screen patients with depressive symptoms to see if they have undiagnosed Bipolar Disorder.
What is mania?
Benefits of Adderall in Bipolar Disorder
Fortunately, it is possible to use Adderall in patients with Bipolar Disorder, as long as their Bipolar Disorder symptoms are stabilized first, for example, with a mood stabilizer.
A clinical trial on 30 patients found that children with Bipolar Disorder could be safely treated with amphetamines, the generic form of Adderall, provided they were first treated with divalproex sodium, a mood stabilizer.
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For the 30 subjects who entered the placebo-controlled crossover trial, mixed amphetamine salts was significantly more effective than placebo for ADHD symptoms. No significant side effects or worsening of manic symptoms was observed...Pediatric patients with bipolar disorder and concurrent ADHD can be safely and effectively treated with mixed amphetamine salts after their manic symptoms are stabilized with divalproex sodium.
A scientific review of studies on ADHD medications in adults with Bipolar Disorder concluded that these medications could be safely used if the patient’s bipolar disorder is first stabilized.
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Although systematic trials on the use of stimulants and ATX in ADHD-BD comorbidity in adulthood are necessary, both treatments should be considered possible options to be carefully evaluated once the patient has been stabilized.
In fact, some experts recommend the use of stimulants in Bipolar Disorder if standard treatments aren't working well:
The risks involved in prescribing Adderall are still a topic being debated and actively researched in the scientific community.
It is generally regarded as a treatment option to consider, but there are concerns about the risk of worsening bipolar symptoms and Adderall dependency.
If you are considering taking Adderall for ADHD and you may have bipolar disorder, it’s essential to talk to your doctor to see whether it is right for you.