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Old 07-09-03, 03:41 PM
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Studies clarify diagnosis, identify possible treatment for adults with ADHD and bipol

http://www.eurekalert.org/pub_releas...-scd070903.php


Studies clarify diagnosis, identify possible treatment for adults with ADHD and bipolar disorder

Two studies from researchers at Massachusetts General Hospital (MGH) address the challenges of diagnosing and treating individuals with both attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD). Published in the July, 2003, issue of Biological Psychiatry, one report clearly identifies symptoms of both disorders in study participants, supporting the theory that some individuals truly suffer from both disorders. The second study in the same issue finds that the antidepressant bupropion may be helpful in treating those with both ADHD and BPD.
"The question of whether ADHD and BPD can exist together has been controversial, with some believing that such diagnoses reflected particularly bad ADHD or that the manic symptoms of bipolarity were simple hyperactivity," says Timothy Wilens, MD, of the MGH Pediatric Psychopharmacology Unit, lead author of both papers. "The first study tells us these are distinct disorders that can occur and be identified in adults.

"Treating adults with ADHD and BPD has been difficult because the stimulants and many other medications used for ADHD may exacerbate manic symptoms," he continues. "However, not addressing both disorders in these individuals can make their lives more difficult."

In the first study, adult patients who had come to the MGH to participate in ADHD clinical trials went through an extensive clinical assessment of psychiatric symptoms. This included a complete medical history, psychiatric evaluation, a diagnostic interview with a section addressing ADHD, and tests of cognitive function. Data from the diagnostic interview were subsequently reviewed by a team of mental health professionals who were not informed of the patients' diagnoses, to confirm whether the symptoms reported made a significant difference in patients' functioning.

Of those evaluated for this study, 51 met full criteria for ADHD diagnosis, and 24 also met established criteria for BPD. Along with their BPD symptoms, participants with both disorders had a greater number of ADHD symptoms than those with ADHD alone, and 60 percent of those with both disorders reported having BPD symptoms starting at a young age. Both groups also had additional psychiatric disorders, but those with both conditions had a higher risk of additional disorders.

"Although the hyperactive/impulsive symptoms of ADHD tend to lessen as patients mature, it appears that those who also have BPD continue with those symptoms as adults. So if a youngster with ADHD continues to have prominent hyperactivity and impulsivity while growing up, it may indicate that accompanying BPD should be considered," Wilens says.

Bupropion an atypical antidepressant was chosen for the second study because it already is used to treat individuals with ADHD and to treat depressive symptoms in BPD. During the six-week study period, 30 participants diagnosed with both disorders began taking a daily 100 mg. dose of bupropion and increased their dosage to a maximum of 200 mg given twice daily. Any participant who felt that a particular dosage provided superior symptom relief could return to that dosage.

Most of the study participants showed significant improvement in their symptoms of both disorders, with 70 percent reporting that symptoms were 'much improved' or 'very much improved.' A majority of study participants continued taking the medication at the conclusion of the study.

"I have evaluated and followed a number of those participating in this study," Wilens says, "and they have noted major life changes associated with their improved functioning and well being. Many went from being incapacitated and unable to sustain relationships to being employed and reporting improved relationships and overall well being." Wilens is an associate professor of Psychiatry at Harvard Medical School.

He and his colleagues note, however, that because of this study's small size, along with the facts that there was no control group and all participants knew the dosages they were receiving, additional large-scale controlled trials are necessary.

Both studies were supported by grants from the National Institutes of Health. The bupropion study also received support from GlaxoSmithKline, Inc., manufacturer of the Wellbutrin brand of bupropion. However, the MGH researchers had complete control of the study design and reporting.

Wilens' coauthors for the first study are Joseph Biederman, MD, Janet Wozniak, MD, Samantha Gunawardene, Jocelyn Wong, and Michael Monuteaux. The second study was coauthored by Biederman, Jefferson Prince, MD, Thomas Spencer, MD, Stephaine Van Patten, Robert Doyle, MD, DDS, Kristine Girard, MD, Paul Hammerness, MD, Sarah Goldman, and Sarah Brown.


http://www.eurekalert.org/pub_releas...-scd070903.php


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Old 07-09-03, 06:49 PM
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Wow....thanks very much for sharing this Tara...very enlightening...and I relate to the findings with my own experience to a great extent....I don't know how it works....but I know Wellbutrin has made my life a whole lot better in the last few years...and I have been given both of these diagnoses....
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Old 08-07-03, 09:07 AM
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My experience has been the same. Bupropion is very helpfull to "even out" the effects of ADD and depression. I feel, however, that it alone is insufficient as a complete treatment. I would also like something stronger like Ritalin for those times when hard focus is neccessary. I don't mind the ADD, I just would like to be able to put it down once in a while.
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Old 08-07-03, 10:44 AM
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Agree Why but I haven't found the supplemental med to Wellbutrin that works for me that doesn't have hurrendous side effects. I was on Ritalin for a short time once and I just didn't respond...did nothing....and Stattera...well let's just not go there......Have you been on anything else besides Ritalin -- with the Wellbutrin -- that you feel really helped with the "hard focus". as you put it????
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Old 08-07-03, 11:03 AM
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I may have misspoke in my earlier post - Prozac, Wellbutrin and a few others (mostly anti-depressants and anti-psychotics) are all I've ever used. The idea of adding a ADD specific med to the Wellbutrin is something I've recently cooked up and have not yet attempted. Speaking of which, I'd love to hear everyones experiences with self-medicating (legal meds and otherwise) but perhaps that should be a whole new thread...
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Old 08-07-03, 11:08 AM
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Well another ADD med in combo with Wellbturin probably isn't a bad idea, if you can find the right combination without feeling overmedicated or like a zombie......if you ever try it, let me know how it goes......
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Old 08-09-03, 08:55 PM
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In response to whys statement about wellbutrin with something like ritalin, I need to say stimulants are strictly out for bipolar people. Many times those of us with BP II and hypomania dont feel our mania is mania. We feel it is "drive" or "energy" It usually takes somethingbad happening before we decide the mania may not be as harmless as we think. Stimulants trigger mania. Period. Now, the issue is finding the balancxe between being ok with NOT being hypomanic and being balanced. Its a tough call to make.
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