View Full Version : Help Bi-polar/ADD mix in teen!!!


barbyma
03-02-06, 11:34 PM
Moderator note:

This is a post split off from a now closed thread in general ADD. I was wondering if a discussion could address the points about Bi-polar and ADD mixes to be explained in post #3----sorry Barb
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Is there some where you have more information on this I would be very interested. My knowledge about bi-polar is very limited…. And how it “mixes” with ADD even more so….
Unfortunately, I don't find the empirical research on Bipolar disorder all that helpful in dealing with it. Unlike ADD, it hasn't pointed to a specific brain area or neurotransmitter. Norepinephrine bounces up & down a bit, but Serotonin is low in all phases. Dopamine appears to play a role, too, so we cover the "big three".

The fact that lithium (on BiPI) and anti-convulsants stabilize BiP moods suggests the proximal cause might be something else in the neural mechanisms, like the way the impulse travels down the axon.

Cortisol levels are also higher in bipolars, which may explain why your daughter is getting worse. She's a teenager, right? Cortisol is a part of the hormonal system. Thyroid problems are common among bipolars, too.

Basically, it's a mess. The ADD literature at least sheds some light on what's physically going on.


Most of my knowledge about the bipolar disorder comes from more than a decade of reading mostly mainstream books on the topic and extensive interactions with other bipolars. The latter is the most helpful. The range of problems is vast, but there are commonalities that are fascinating. Many are also ADD traits.

As far as how it interacts with ADD, I can only speak from experience. When I was first dxed with BiP, we all thought that ADD was a common precurser to BiP or that many of us were simply misdiagnosed as children. It wasn't until I came to realize the source of my cognitive problems that I understood how the two were different and the literature seemed to point more toward comorbidity.

For me, everything mood-related is bipolar disorder. I'm sure most ADDers have some mood problems, but since I've not only been emotionally stabilized by meds for 12 years and I've also developed a lot of coping mechanisms, I doubt any of my own mood issues are ADD-related.

Anything cognitive I attribute to ADD. There's a long list of "work-arounds" that I've developed over the years that I now realize are adaptations, but I obviously still have some ADD issues that can't be skirted.

Bipolar disorder can make it difficult to concentrate or make decisions, but it's "foggier" than the ADD version and forcing it does NOT make it worse. In fact, lots of people can actually manage minor mood disorders without meds through self-talk and various physiological "tricks".

I always say, "When in doubt, check it out". The disorders are so muddled together, it's hard to be certain any dx is correct.

It doesn't help that all psychoactive meds are a crap-shoot. I feel very fortunate that I was able to manage BiP so successfully. Adderall isn't quite as "perfect", but again I feel fortunate. I've known a number of people that have been on cocktails of unimaginable mixes and can't seem to get things under control.

I'd recommend any book by Kay Jamison, even though she's a classic (BiPI). She's also got a lot of experience.

Good luck!

mctavish23
03-02-06, 11:43 PM
Barb,

Those were some well thought out and articulated remarks.

I did my own lit search on Bipolar and my experience was similar to yours.

I didn't get to finish, however, the neurotransmitter that seemed to come up more often was GABA.

meadd823
03-04-06, 07:48 AM
Adapted from my post #73 from thread “What misinformation in Delivered from Distraction” a now closed thread in general ADD.

I found the discussion about bi-polar very interesting and was hoping I could copy a piece of a post I wrote and merge it with a couple of the post that strictly dealt with answering the below question about bi-polar.



I think the important thing to keep in mind is that Bipolar II comes in many, many variations that don't look much like classic BiP. Cycles can be short, long, severe, mild, more depression, more hypomania, rage or irritability instead of euphoria, etc. One way, I think, to tell it apart from ADHD is mood. First, BiP is faulty feeling while ADD is faulty thinking. Bipolar's perceptions about themselves and others are very faulty, especially when it comes to social interactions. Impulsivity in ADHD is more attention-driven while it's more confidence-driven in BiP.


My daughters social abilities are so affected that she is unable to function putting this off will decrease her chances of a productive adulthood.


My daughter is very sensitive and goes into extreme emotional reactions like the ADD but she has these period of "level" followed by period of extreme negative emotions which can be rage, accusing, or crying spells.

During the "negative phases" she sleeps a lot. During the more "level" periods she either sleeps normally or complains she can't sleep.

Although I do intend to check out the book mentioned in the first post. I was just wondering if there is any specific information I should be gathering between now and the time I can get her in to see the doc???

I guess it is had to tell from the out side which is ADD and which is bi-polar. It is like she has the ADD mood swings every ten seconds but with an added "kick of irrational" during certain periods of time.....

Some times I am just not sure what I am seeing....she has times where she is easier to get along with other times she is impossible. My other two daughters and my self have ADD we have the extreme emotional reactions but we tend to have a "base line" temperament that I fail to see in my “co-condition” daughter!!!!!

Times I describe as level in reality are often times when she makes poor decisions about behaviors……it is so hard to explain it is confusing to me and I am not even the one going through it !!!

How do people live with ADD and bi-polar and be able to function so well. This boggles my brain!!!

Andi
03-04-06, 09:56 AM
Well, for me it's called meds. That's the only thing that keeps the cycling in check. I never realized JUST how unstable and unpredictable my moods were until I found the right combination and people began to tell me that I was "different" now and how much easier it was to be around me. A bitter pill to swallow and it was difficult to embrace the “new” me initially but I learned to accept the stability as a blessing and realized that life didn’t have to have such turmoil.

Many of the things you are describing are most definitely the bipolar side of life and even though she may suffer from ADHD, the bipolar takes precedence. Unfortunately, I am currently not medicated for the ADHD component of my co morbid experiences and may never be do to my sensitivity to meds and manic episodes. This can be true for many bipolar patients but there are ways to cope just like any other ADDer. I do have my days where focus is limited, and I just do what I can and hope that tomorrow is a better day.

I hope she finds balance and with time, intervention, and maturity I'm sure she will. Unlike my experience, you are catching it early and she has the opportunity to learn and embrace her disorders. I've said it often but knowledge is power. The more you know about the disorders and learn about yourself and what is going on inside of you, the more you can succeed in life and with family that are willing to understand and support her, she's one very lucky girl. I hope she realizes that :)

Matt S.
03-04-06, 07:02 PM
Trial and error is key with meds when I was a kid i was dx'd bipolar and adhd hyperactive impulsive type and i have tried every cocktail in the book and it is key to find a combo where one doesn't precipitate the other... like myself i've been on every bipolar combo there was and the only meds for each disorder that I can tolerate without precipitating the other is an anticonvulsant-stimulant combination. I can only respond to dextroamphetamine in that class of drugs and for everyone else it is different some are strattera ppl some methylphenidate some adderall but u have to do trial and error...

barbyma
03-04-06, 09:08 PM
No problem on the thread split. That thread could have been split into 5!

Like Andi, I also strongly believe mood takes precidence.

Managing bipolar disorder, for me, is a lot easier than managing ADD. Even before I had a correct dx, I could manage my behavior even when my feelings were intense simply by reminding myself that my perceptions were far from reality. I learned to ask for reassurance when I needed it, and believe people when they made positive comments.

A lot of self-talk, but it got me through the meds coaster until I finally had the right dx and the right meds. Since then, I'm great.

ADD is a whole other story. It's really difficult. Adderall isn't the wonder drug it was before my body got used to it. I can work and read, but I have to time it right and put up with headaches coming on and off as well as occasional brief nausea. Its effects are a bit unpredictable; the more I need to work, the less effective it is. And sometimes it's too much.

But, I'm not having trouble with tolerance and as long as I can work for a reasonable amount of time each day, I'm still very thankful for it.

For your daughter's appointment, I'd try to take note of your observations as best you can. Some symptoms that overlap with ADHD are:



impulsivity - BiP's get stuck on an idea and won't let go until they've accomplished their goal.
hyperfocus - Bipolars also have a million unfinished projects, but they don't lose interest. What happens is they cycle down before they can complete the project, or they start too many and spread themselves too thin. It's really hard to tell which disorder is to blame.
poor judgement - Due less to self-control (as in ADD) and more to overconfidence.
physical symptoms like leg shaking
See if you can pinpoint what's behind the symptom. Is it emotional? or cognitive?

Your description of "level" moods is interesting. When I was first dxed, like most people, I spoke to family and friends that had known me a long time. They all said I never had an "in between". Very up or very down, but never just right. Makes for a pretty histrionic life.

I hate drama now!

meadd823
03-05-06, 04:33 AM
They all said I never had an "in between". Very up or very down, but never just right. Makes for a pretty histrionic life.


THAT IS IT EXACTLY....this is my Michelle to the letter.

When I first took her a seventh grader to be evaluated as a teen the doctor asked how long has she been moody?

My immediate response "Sense she was in diapers!"

That is the honest truth... she was moody in diapers. Either very pleasant or very trying.... she has never been "in between"

Right now she is living with ex-husband but I can tell where she is by her communications with me.... when she is down there is a dead silence. Those are the times I worry the most..... When she is on an "up swing" it is the opposite... constant e-mails and messages then when the up swing reaches a "zenith" it is dead silence again because she is "off and running" which is scary like the depression but a different scary.

When the "UP" begins to wane the e-mails begin except these are the no one loves me you don't want me ect.... I have saved down most of her stuff that would give me an intervals but I my calculation are about every six week to two months... the "exchange" doesn't take but a couple of days. Once the "mood" sets in it seems to begin mild and steadily climbs to a certain "degree" she will remain there for about two weeks then the mood begins to descend until a certain point then a few days later the cycle begin the same with the opposing mood. When the moods are at their zenith I quit hearing from Michelle and begin suddenly becoming popular with my ex-husband and Michelle’s twin sister who also told me David wasn’t “on top” of the medication thing and she was looking to move out ASAP!!!! Sad when a nine-teen year old knows what is coming but a 45 year old man thinks I am over reacting guess who has been dealing with these things in Michelle for 19 years!!!!!!! Me and Samantha as well as Michelle!!!

I thought for a while it was monthly cycle related but as a parent I used to "track" those things. Although PMSing (just what a bi-polar ADDer needs PMS AHHHHH) I noticed Samantha and my mood went exactly along with the female cycle but Michelle's didn't follow she seemed to lack a “set point” in her over all temperament .........

I just PMed her Dad.... apparently Michelle is in "terrorist " right now mode...It is a BAD sign she is “up” her opposing depression which she should be entering into an about two weeks will be just as bad. If the up swing is bad the down swing will be equally as bed. Her moods have been getting worse and worse over the last two or three years. She does tend to do better with the medications she is one presently although the mood swings are detectable still.

My responses to him was to “ Try Having her swallow the freaking pills, like Samantha said three weeks ago”... I pay for them so I know when she is taking them like she is supposed to.

She takes Depokote 1,000mg
Effexor XL 150mg

She is supposed to take concerta but she doesn't like it because it changes her personality too much as an out side observer it does!!!!! I insist on the bi-polar meds when she is with me. I remind her and stand there until they are “down the hatch” I told her dad he obviously didn't insist she take them (like I told him months ago) She is in terror mode well maybe NOW he will be getting a reminder as to what happens when bi-poplar people don't follow their medical regimes..... He is a silly man thinking I spend twice as much on her pills as I do mine own because I am board?????

She was diagnosis ADD at 9
Bi-polar which was called something along the lines of "mood disorder" at 12.

Until recently my ex-husband thought I was over reacting thus over medicating her!!!!! OUCH like the dawning has begun unfortunately Michelle must also be “reminded” why she needs to swallow those pills……..makes me want to scream!!!!! I have spent thousand literally because when we didn’t have health insurance I paid out of pocket still do!!!!!

I plan to let him simmer in his own juices while I figure out how to get her re-evaluated.... I talked to her last week and told her although having bi-polar wasn't her fault not treating the condition by staying on her meds was!!!!! I couldn’t help her if she didn’t help herself. If she wants to move back in with me she knows the main condition….take the pills. I buy YOU swallow!!!!

I popped over to get the name of the book Barb recommended.... needed it before going "shopping"!!!!

Michelle is a special person who I fear will be unable to function as an adult if I don't intervene now and get things rolling in a positive direction... she can't hold down a job at present never mind continue her education which she needs to do (in my opinion)!!!

I guess I will be using those crash coa rse skills I picked up in debates learning some of the things I should have learned long ago....... I do appreciate the in-put I didn’t realize how under educated I have been about bi-polar…. A “condition” I need to correct!!!!!

barbyma
03-05-06, 12:47 PM
Bipolars are notorious for not taking their meds. Part denial and part resistance to bring down the "ups".

If she's not taking her meds, it would certainly explain why she's getting worse. If you don't take them regularly, they can't help.

Depakote should be stabilizing her and that's a pretty hefty dose.

The consistency and duration of those swings, though, makes me think she might be type one. If that's the case, Lithium may be a better choice.

I'd also stay away from ADD meds until you know she's stabilized. We've seen some example on the boards here about how BiP's react to stimulants when they're not stable.

Good luck!!!

scuro
03-05-06, 01:53 PM
Interesting topic that has come up occasionally. Whats what, when it comes to ADHD and BiPolar? Throw in the possiblity of PTSD and BPD and your head is spinning. What some parents go through just to "get it right" for their kid with a proper diagnosis and then good treatment. :confused:

Andi did put up a great sticky in the BiP section and it looks to be good info. Here is a snippet.
http://www.addforums.com/forums/showthread.php?t=19800

"SYMPTOMS WHICH DISTINGUISH MANIA FROM ADHD:

Children are incapable of presenting many manifestations of bipolar symptoms described in adults. Studies have shown that five behavioral symptoms in children/early adolescents aid in correctly diagnosing childhood bipolar disorder. These manic symptoms which do not overlap with ADHD are elation, grandiosity, flight of ideas/racing thoughts, a decreased need for sleep, and hypersexuality (in the in absence of sexual abuse or overstimulation). These five symptoms provide the best discrimination of childhood/early onset bipolar patients from uncomplicated ADHD patients. Irritability, hyperactivity, accelerated speech and distractibility are frequent in both pediatric bipolar disorder and ADHD and are not useful in differentiating between the two disorders. Mixed mania (simultaneous mania and depression) is highly prevalent in childhood bipolar disorder".

By the way I have two daughters. One has been moody since birth and got worse at 13. She drives her mother crazy. She has a diagnosis of ADHD inattentive subtype. The other daughter has become very moody at 12, her diagnosis is ADHD Hyperactive subtype. Things are a real treat at my household. :D

Interestingly, my father was Bipolar.

meadd823
03-08-06, 04:30 AM
Things are a real treat at my household

Yea I bet never a dull moment.......YIKES!!!!

I orders some books from Amazon.com Sunday....they should be here by end of the week....

One is Kay Jamison "Unquiet Mind; A Memior of Moods and Madness"

Recommended author lots of "M"s in the name<----- ADDers way of selecting a book????

I was going to read it then pass it on to Michelle....

I got another one by David Miklowitz "The Bi-Polar Survival Guide; What you and your family need to know" Any one heard of him????….

I don’t mind kicking around theories or “abstracts” about ADD because I am pretty well versed but don’t want to begin a study of bi-polar with the “abstract” I would prefer to begin main stream…like I did my own disorder 13 years ago!!!!

Along with a book about meditation which I think I may be in need of after the bi-polar books I read portions on Amazon......looks scary!!!!!!

Funny I can diddle with a book for a month but I have also been known to go through a pretty good size book in a day or so.....if I go missing them I have been "absorbed"


One has been moody since birth and got worse at 13

Yep that is Michelle.....

My other two daughters as well as my self, and two siblings have various forms of ADD. .mostly combined I am the impulsive one of the bunch....like my oldest is emotionally immature but she is still able to make excellent adulthood decisions.....Samantha Michelle's twin also has ADD her emotional level is about right. Some times she is more social than others she has a "mood" base so to speak...like a natural temperament but Michelle has always had an addition mom called it a "libel" behavior!!!! To me the the difference in Michelle is easy to see when compaired to various other family members who have only the ADD.

The sister younger than me has like a depressive portion of her ADD. .she has said herself it is almost like she “almost” ended up with bi-polar but not quiet…she don’t have no “ups” only downs!!!! Okay Michelle has a roller coaster going. Plus the older she gets the worse. .see ADD changes some what but not the same way!!!!! Hard to explain!!!!

Depakote should be stabilizing her and that's a pretty hefty dose.


She is a pretty good size girl!!!!!


If she's not taking her meds, it would certainly explain why she's getting worse. If you don't take them regularly, they can't help.


Yea I know they must be taken every day as they aren't like my Adderall at all...Like I said I don't make a big deal out of her not taking the Concerta but when she is with me I insist she swallow her Depakote and effexor!!!! I hand them to her and want to see them go down the hatch!!!!!!

Her Dad thought I was over reacting and she wasn't really bi-polar so he the diabetic nurse no less didn't make sure she took her meds......I have been letting them simmer while I figure out what the heck the stupid pharmacy did with her medications (AHHHHH) I am pretty annoyed with her Dad he is a NURSE!!!!! She knows better toooooo!!!!

I will check out the hyperlink Scuro!!!!!

Well speaking of medication hide and go seek better see if the medications arrived at their proper destination in San Angelo, Texas!!!!!

Thanks guys!!!!

Scattered
03-08-06, 02:09 PM
If I understood John Ratey correctly in Shadow Syndromes, one of the risks of not taking medication for Bipolar II is that it can develop into Bipolar I. I'm sorry her dad's not supporting you in encouraging her to take her meds -- sounds incredibly frustrating. But you can only do what you can do -- she's a young adult now and has to also take responsibility for her own treatment (I know easier said than done -- especially when it's your kid). It really sounds like you've done everything in your power -- I hope your daughter and her dad decide to get on the band wagon before things go downhill further. I'll be sure and bring it up with a friend of ours for you!

Scattered

Crybaby1898
03-08-06, 06:10 PM
can I make a note here umm.. I have no idea what u are saying

barbyma
03-09-06, 02:22 AM
can I make a note here umm.. I have no idea what u are saying
:)

Well, sweetie, it seems your mom thinks you might not be getting/taking your meds. I'm hoping she's misinformed because the outlook for nonmedicated Bipolars isn't pretty....

Just a side note about Kay Jamison -- she also wrote a pretty good book with Patty Duke. Patty Duke's memoir is also excellent. It's a bit scary, though; she's a classic BiP I that even experienced manic psychosis (hallucinations) before discovering her disorder.

meadd823
03-09-06, 03:37 PM
I have no idea what u are saying

I buy YOU Swallow!!!!! the pills that is......

I want you to be the successful young lady you are capable of being.....I know it seems like I will never be where I can move you back up here but some things as more important and getting you where life isn't such a roller coaster is one of them!!!!

Michelle you are much smarter than you have ever given your self credit for, plus you are creative. I have spent to much of my time and energies focused on the ADD aspects (my fault) so I feel the issues of your mood swings have been neglected. I have saved enough to pay for evaluation but it may take more than one visit to get your meds where they need to be...their is the unreliable transportation factor there in San Angelo…..moving you here would decrease my ability to pay cash as you go...so it isn't avoidance as I am sure it appears it is called limited resources and being an ADDer prioritizing these two important things isn't easy I feel stuck between a rock and a hard place!!!!

I do not believe I am saying any thing Michelle you do NOT already know. I moved a portion of a thread started in general here to adult bi-polar to increase the chances of responses being made by people who [I]know what having bi-polar and ADD is like therefore will NOT be judgmental......toward you....you did NOT ask for this combination however I will need your help to get it under control!!!!

I want you to succeed and am trying to get my scattered feces in one sack my head "dislodged" and correct my own ignorance on the non-ADD portion of your problems. As Barb has already pointed out the bi-polar needs to get treated first then see about the ADD stuff!!!!! I have learned by being your parent how true this statement is!!!!!!!!!

I haven’t forgotten you are also a member here and finding this thread was a possibility but it isn’t saying any thing bad heck look at the responses made by others who themselves have to live with this roller coaster mood swing from Hades……I love you and am trying to help and find the right kind!!!!!!

I gotta go I am already late for work !!!!!!!!!!!!!!!!!!

meadd823
03-14-06, 11:12 PM
Trying to find a health care provider in San Angelo, is much like pulling teeth from a chicken.

My town is listed and it is half the size of the one Michelle lives in yet mine is listed hers isn't. I just don't want to take her to any body. I would like a professional that knows the difference between bipolar and a wet blanket!!!

She has so many things mes-mashed together I need some one who is real good.

I have started reading the books I ordered, which is why my presence here on ADDF has been decreased a bit lately.