Q:  Could I Have ADD & Bipolar II

Dr. Phelps:

I have recently been diagnosed as Bipolar II disorder.  I was first diagnosed as a freshman in college with depression and treated with zoloft.  That diagnosis never made sense to me since I never struggled with what seemed like clinical depression.  I was then diagnosed as ADD and treated with Ritalin.  I used ritalin to treat ADD until recently when I wanted to seek alternatives to using ritalin.  My new Dr. asked questions that no one had ever asked, like does my mind not just get distracted but does it race?  And he asked about the anger fits, which had always just been an embarressment and I thought I just had a "hot temper" like many in my family .  I have never been in trouble with the law or acted out as much as it seems many with bipolar II usually do, however he began to treat me with 750mg of Depakote each night before bedtime, and we decided to work to taper me off ritalin.  

Until last thursday that was working fine.  I began to feel depressed and anxiouse and then had a break where I had what I described as a full out panic attack, accompanied by axiouse depression.  He promptly took me off the ritalin and after speaking with him and seeing him I was convinced that is what is best.  My problem is that was on thursday and friday and now here I am at work, completely unable to focus, concentrate or get any work done.  I am aggitated, and become short with anyone who talks to me, my mind isn't racing, I feel completely unable to work.  I am quite used to the ritalin and its effect so maybe that is the problem.  I just want to know if I there is a possibility I have both ADD and bipolar II?

Thanks

Emily

Dear Emily -- 
Many mood experts have written about "having both".  I still wonder whether they are two manifestations of the same thing, but that's really a moot point when it comes to deciding what to do about your symptoms.   As you can imagine, one has to wonder whether the stimulant could possibly make bipolar disorder worse (although your story also makes me wonder whether we should be asking, as I have on a few occasions, whether mood stabilizers can precipitate depression analogous to the way in which antidepressants can precipitate manic symptoms in people who've never had those before).  

Sounds like you have a good doctor who can help you work out the best balance between risks and benefits.  Good luck with that. 

Dr. Phelps