Is it safe to give a stimulant in bipolar as long as they are on a mood stabilizer?

Or is there a better way to treat ADHD in these cases?

Today, we show you how to treat the vexing overlap of ADHD and bipolar.

Welcome to the Carlet's Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Akin, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Cognitive problems are a common chief complaint in bipolar disorder. And last week we laid out a diagnostic plan for these symptoms, which may be caused by.

1. Untreated mood symptoms.

2. A distractible temperament such as cyclothymic disorder.

3. Cognitive deficits that build up with repeated mood episodes.

4. Or a genuine ADHD comorbidity.

Genuine ADHD begins before age 12.

Occurs independent of mood episodes and sometimes improves in adulthood.

The research on how to treat ADHD and bipolar disorder is scant.

So we're going to borrow from

clinical experience in sketching out a treatment approach today, starting with a look at

stimulants in bipolar.

Stimulants are first line for pure ADHD, but they carry several risks that we worry about

in bipolar disorder, mania, psychosis, insomnia, substance abuse, and neurotoxicity.

Stimulants raise the risk of mania seven-fold when taken without a mood stabilizer.

That risk falls to negligible levels when an anti-manic mood stabilizer is on board.

Lomotrogen would not count here, it's not anti-manic, but mood stabilizers do not protect against milder worsening of symptoms.

...