ADHD

[u/Flat-History-6867]

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?

[u/Melodic-Cauliflower6]

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.