How do you treat patients with comorbid Bipolar Disorder and ADHD?

I usually start with non-stimulant medications, guanfacine (or clonidine) being my first choice. I'll move to bupropion or amantadine after that. I've had good results with amantadine and not much luck with atomoxetine (I find more problems with nausea and high blood pressure than benefits with that...

In child/adolescent psychiatry, the stats are that 2/3 of youth diagnosed with bipolar have comorbid ADHD. So, this is a common scenario. Implicit in Dr. @Dr. First Last's response is that the mood must be stabilized before addressing the ADHD. I think we have a consensus on that point.

In kids, I d...

I agree with the answer above concerning stabilizing the mood first and that stimulants will help ADHD more often than alpha 1 agonists or Strattera. However, I would not put aside Depakote as a mood stabilizer. It can be very helpful to patients of all ages. I've never had an instance of problems w...

I generally start by treating the bipolar disorder with a mood stabilizer. When the patient is at a full therapeutic dose and is reasonably stable, I then re-evaluate their difficulties concentrating, easy distractibility, and so on.

If appropriate, I'll start them on a trial of a low dose of generi...