My son is 17 and under a psychiatrists  care.  He had been diagnosed with ADD with with Hyperactive tendancies about 2 years ago.  First he was put on Ritalin, then switched to Concerta (about 9 months ago).  As of late he has refused to take his medication and has been become quite angry and violent.  His doctor has now mentioned that he feels my son is bipolar.  How am I to be sure?  He says that lithium will be the drug of choice and I am apprehensive about starting this unless the diagnosis is concrete.  Please help.

Jody

Dear Jody -- 
I just talked to a friend of mine who's a child psychiatrist.  We were talking about your son -- or rather, we were talking about how much harder his job is than mine because of decisions like this.  We still don't have a good "concrete" method of diagnosis.  You will find this essay of interest though, because it makes the distinction (ADD or BPAD) look a lot clearer than it sometimes sounds. 

There are several alternatives to lithium.  Since I don't treat a lot of 17 yr. olds, I am not following any new news re: what is regarded as "1st choice" amongst these alternatives, but I can tell you that in adults, Depakote (the new ER version has less weight gain) and Trileptal (it basically replaces Tegretol because it doesn't cause the blood problem; and it doesn't seem to have the liver problems that often make child psychiatrists concerned when using these drugs in kids -- although again, I haven't followed the discussion re: whether Trileptal is known to have low liver risk in kids too) are used very frequently as first-line alternatives to lithium.  You'll find a basic run-down on these meds on my site. 

Dr. Phelps  


Published October, 2001