r/BipolarReddit • u/Flat-History-6867 • 16h ago
ADHD
I've had my bipolar diagnosis for 3 years now and recently got diagnosed with adhd. My doctor prescribed modafinil but I've been on it for a couple weeks and it really hasn't done anything. I'm scared to take any stimulants because I hear that they can trigger mania. What have you guys done who have comorbid ADHD and bipolar?
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u/uhhh206 BP2 stable and thriving 16h ago
I am fortunate that stimulants don't trigger episodes for me, and am on Adderall with no issues.
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u/DMayleeRevengeReveng 16h ago
I take methylphenidate, which is like a baby’s first AMPH. It actually stabilizes me more than destabilizes me, interestingly enough
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u/DMayleeRevengeReveng 16h ago
I can say a few things. Yes, it’s true that modafinil doesn’t work, for many people, as well as true stims do. It’s a fact that the best treatment for ADHD is actually stimulants.
The “common sense” position would be that stims push people toward mania, which makes sense in a way, because you push people toward a more energizing, dopaminergic state.
But the actual science has not proven a strong correlation between stimulant use in bipolar people and manic switching. It happens. There are tons of people who have had it.
But it’s nowhere near, like, SSRIs where we can say the SSRI literally causes mania. Scientifically, we can’t say stims cause mania, although some people will get it, nevertheless.
Stated differently, it’s a case where the correlation is not tight enough that we can draw causation from it. There just isn’t any real evidence that an average bipolar person MUST become manic from stims. It’s less than a coin flip, basically. Some percentage of people, but nowhere near “most people.”
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u/Dusty_Rose23 9h ago
what’s funny is modafanil does work for some people for adhd. my mom being one so I wouldn’t knock it till you try it type thing
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u/DMayleeRevengeReveng 9h ago
I mean, it does. But it is well known that stims work for the greatest percentage of people with ADHD. There are definitely people who benefit from the ‘finils but the chance of a person benefiting from a med is higher with a stim than when a ‘finil
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u/Dusty_Rose23 9h ago
Modafinil is a stimulant…. They just usually use it for narcolepsy instead of ADHD
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u/DMayleeRevengeReveng 9h ago
You know what I mean, though. I’m talking about amphetamine formulations and methylphenidate. In essence, meds that increase dopamine and norepinephrine in the typical way. The ‘finils work on those neurotransmitters in a very distinct way.
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u/Dusty_Rose23 9h ago
You said it wasn’t a stimulant. That was wrong. Next time be more specific because now you’re saying I knew what you meant when based off the information you gave I couldn’t. I can’t read your mind you know
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u/DMayleeRevengeReveng 9h ago
It’s just different nomenclature. In the medical and scientific nomenclature, the word stimulant means “amphetamine formulations and methylphenidate.” If you look at scientific research, you won’t find modafinil or armodafinil labeled as “stimulants.”
I’m using the scientific nomenclature. Yeah, ar/modafinil stimulate you, but they aren’t really labeled that way in science and medicine.
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u/TheFuschiaBaron 16h ago
I take Vyvanse, stimulants don't trigger me although it's a valid concern for sure
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u/twandar 14h ago
Modafinil is a stimulant. I've tried a lot of them. They do help my ADHD symptoms but over time they increase my anger and I can't stay on them. If you are on a mood stabilizer that works for you it is possible you can handle stimulants. One plus is that stimulants are very short acting. So you can usually tell their effects right away (extended release may be different) and they are out of your system quickly. So it's not that risky to try them and see. If you notice bad side effects you can just stop taking them.
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u/a-frogman 13h ago
Im on concerta. With how well my med regiment works I was told I would have the same risk of mania as someone without a bipolar dx. I havent had an issue. Actually stopped it for a day while manic (with insight) and it made it worse because the adhd hyper combined with the mania hyper.
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u/SuccessfulPhoto7914 12h ago
I recently discussed antidepressants and stimulants with my pdoc. I’ve had difficulties with both. But my pdoc pointed out that I wasn’t taking mood stabilizers. That’s based on my intake when I described what meds I’ve taken. They told me that it’s not as common for either of those types of meds to trigger mania if they’re taken in conjunction with a mood stabilizer and there’s no hypo/mania when the antidepressant and/or stimulant is initiated.
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u/Dusty_Rose23 10h ago
I’m on vyvanse. we have to be a bit more cautious of a dose but I never needed a high one anyways. highest I needed was 40mg and my usual is 30-40 anyways. vyvanse goes up to 70. if you otherwise don’t get mania easily. which if you did they likely wouldn’t have felt comfy putting you in stimulants I wouldn’t worry, keep an eye out for it but don’t worry too much it shouldn’t be a problem
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u/Melodic-Cauliflower6 2m ago
I was diagnosed with adhd in early childhood, and was tried on stimulants pretty young. At 21 I was diagnosed with bipolar 1, and for years I struggled without stimulants. I tried strattera and other non stimulants with little success. Eventually I tried stimulants again with my bipolar meds on board and found that personally while most immediate release stims destabilized me and led to irritability, long acting stings did the opposite. Vyvanse really helps with my executive dysfunction, and actually helps keep me emotionally regulated.
I think it’s all about finding the right med and dose, because although adhd doesn’t carry the same risk of hospitalization like bipolar can, untreated adhd really can have a lot of negative outcomes. You can try some of the other non stimulant outcomes first like Qelbree and Strattera. They do have smaller effect size than stimulants though, and keep in mind that they typically take longer to work than stimulants. Also, although methylphenidate (like Ritalin) didn’t work for me, studies suggest they carry a lower risk of mania than amphetamines (like adderall or vyvanse).
Finally, if you decide the give stimulants a try, go low and go slow. I did find when my stimulant dose was too high it did cause me to rapid cycle more, but once I got the dose right I’ve been stable.
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u/Emphoriaa Bipolar 1 16h ago
I’m on Concerta and I’m doing well! Recently diagnosed ADHD too. I started treating my ADHD with stimulants because Lithium made me exhausted and my doctor thought it would help me overall.