Can you or can you not give stimulants like Adderall, Ritalin, Vyvanse Concerta to somebody with bipolar? This is something that psychiatrists are extremely split on and I want to share with you a little discussion in a private psychiatric group and see what other people thought.
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So it really does depend on the patient population because there are psychiatrist out there who work inpatient or with an addiction population and they see the worst case scenarios and think it shouldn't be done. There are other people who are more outpatient oriented and they've seen people who can be safely on stimulants, while diagnosed bipolar. And they feel like it's okay, but with a few caveats. A) Make sure that they have the right diagnosis. B) Uses stimulants as conservatively as possible and educate them on what hypomanic symptoms are. And then C) monitor them very closely and have a good open dialogue if they do notice any of those symptoms.
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I wanted to share a couple comments from other physicians, psychiatrists from this group. So one person said it is a disservice to undertreat ADHD and bipolar disorder patients because the ADHD can actually be much more debilitating between mood episodes.
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I found that in kids, at least, stimulants can help smooth out more subtle mood cycling, not the overt episodes. Lastly, sometimes stimulants are the only agent that helps with a deeply apathetic bipolar depression. I have patients suspend the stimulant if any hypomanic symptoms emerge during treatment.
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Another person said 40% of bipolar disorder patients have comorbid ADHD. As much as you don't treat bipolar mania with the same old dose of maintenance, ADHD treatment can and should be titrated in keeping with mood state. It's reckless to keep patients, keep manic patients on stimulants. It's also reckless to let them fail at work and school for fear alone.
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And so stimulants are okay as long as you monitor. So there you have it folks. Let me know what you think in the comments. Thanks a lot.
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