Mental Health

Mental Health

Your mental health is just as important as your physical health when it comes to living a vital and fulfilling life. If you’re suffering from a mental health condition, get help understanding the facts, coping with symptoms and finding the right help.

What is it?

Overview

What Is It?
Bipolar disorder is characterized by intense episodes of elation or irritability and despair, with any combination of mood experiences in between, including periods of normal moods.

Bipolar disorder can be one of the most distinct and dramatic of mental illnesses. It is characterized by intense episodes of elation or irritability and despair, with any combination of mood experiences in between, including periods of normal moods. Mood changes are accompanied by changes in behavior, such as altered patterns of sleep and activity.

Traditionally, one percent of the population has been affected by bipolar disorder, but as the condition has expanded to include a spectrum of proposed bipolar conditions, this number has risen to an estimated 2.6 to 6.5 percent. According to the World Health Organization, bipolar disorder is the sixth leading cause of disability among people aged 15 to 44. It is less common than major depression, also called "unipolar" depression, or simply, "depression."

The classic form of bipolar disorder, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes, called hypomania, that alternate with depression; this form of the illness is called bipolar II disorder. In addition, there are two other forms of bipolar disorder: bipolar disorder not otherwise specified (BP-NOS) and cyclothymic disorder, or cyclothymia. BP-NOS is reserved for cases where people have symptoms of bipolar disorder that do not meet all the diagnostic criteria for bipolar I or II. Cyclothymia is a mild form of bipolar disorder where people have episodes of hypomania that shift back and forth with mild depression for at least two years. The symptoms of cyclothymia also do not fit into the diagnostic criteria for bipolar I or II.

Studies show that men and women are equally likely to develop bipolar disorder; however, there is some evidence that women may have more depressive and fewer manic episodes than men with the illness. Women seem to have "mixed states" (mania or hypomania occurring at the same time as depression) more often than men. Also, women are more likely to have the rapid cycling form of the disease, which is characterized by four or more episodes of depression, mania or hypomania a year, and may be more resistant to standard treatments. Women are also more likely to have bipolar II disorder.

The symptoms of bipolar disorder can be severe and debilitating. Bipolar disease is not curable. However, medication can help many people achieve remission of symptoms. Treatment and maintenance of this disorder is necessary throughout a person's life once bipolar disorder is diagnosed.

Like some other illnesses that require lifelong treatment, bipolar disorder poses unique medical challenges for women with the disorder who are pregnant or considering pregnancy. The notion that pregnancy itself is protective for women with bipolar disorder is not true. The risk of recurrence of either depression or mania during pregnancy and postpartum is high. A recurrence during the postpartum period often develops as postpartum psychosis. These risks are high for women who stop their mood-stabilizing medications and even higher for women who stop these medications abruptly.

So a woman with bipolar disorder who wants to become pregnant should discuss her treatment options with her health care team before conception, if possible, or as early in her pregnancy as possible. Concerns exist about the potential harmful effects mood-stabilizing medications used to treat bipolar disorder may have on the developing fetus and the nursing infant. However, these concerns need to be weighed against the potential serious risks that an episode of mania or depression may pose to the developing fetus, infant or mother.

Diagnosis

Diagnosis

Bipolar disorder, also known as manic depression, generally strikes in late adolescence or early adulthood, most often between the ages of 15 and 30, and usually continues throughout a person's life. However, some people develop their first symptoms in childhood and others don't develop them until later in life.

Researchers theorize that there are a number of contributing factors for why and how someone develops bipolar disorder, including a genetic predisposition, environmental influences and brain chemistry.

According to the National Institute of Mental Health (NIMH), close relatives of people suffering from bipolar illness are four to six times more likely to develop bipolar disorder than the general population. It is important to note, however, that not everybody with a family history develops the illness. No one gene has been identified for the disorder, but it appears likely that many genes act together and in combination with other factors in the person or the person's environment to cause bipolar disorder.

Studies of identical twins who share the same genes show that a person who has an identical twin with bipolar disorder is more likely to develop the disorder than someone who has a sibling with the illness, indicating that genes are definitely involved. However, an individual who has a twin with bipolar disorder will not always develop the illness, indicating that genes and other factors both play a role.

Studies suggest that stress, difficulty at work or interpersonal relationships may trigger episodes in those with bipolar disorder, particularly if the stress causes loss of sleep. The theory is that stress and/or loss of sleep precipitates changes in brain chemistry in susceptible people.

Behaviors and moods common to bipolar disorder may initially be attributed to other medical problems, or other mental illnesses, which can delay an accurate diagnosis and appropriate treatment. For example, many people with bipolar disorder are misdiagnosed with major depression. In addition, alcohol and drug abuse and/or difficulties with work and school performance may be identified, but their underlying cause—bipolar disorder—may not be diagnosed. However, the disorder is not difficult to diagnose by a well-trained clinician.

Bipolar disorder is diagnosed based on an evaluation of symptoms, the course of the illness and family history. To be diagnosed with bipolar disorder, a person must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), published by the American Psychological Association. In addition to a psychiatric evaluation, a complete medical exam should be completed. A physical exam and blood tests can rule out medical conditions that can mimic or worsen bipolar disorder.

Physical tests, such as a blood test or brain scan, cannot conclusively identify the illness, although progress is being made in these areas. For example, brain-imaging studies using magnetic resonance imaging (MRI), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) procedures allow researchers to take pictures of the brain to examine its structure and activity. These noninvasive techniques are beginning to help scientists learn what goes wrong in the brain to produce bipolar disorder as well as other mental illnesses.

Symptoms

The symptoms of bipolar disorder fall into several categories: depression, mania and mixed state type of episodes (in mixed episodes, symptoms of both depression and mania are present at the same time). In addition, people experiencing any of these types of mood episodes may experience psychosis, which is a serious inability to think and perceive clearly, or losing touch with reality. If you or a family member experiences any of these symptoms, you should discuss them with a health care professional and request a thorough evaluation, which should include a physical checkup and a family health history.

The symptoms of depression include:

  • constant or persistent sadness

  • loss of pleasure and interest in activities that were once fun, including sex

  • significant change in appetite or weight (either increase or decrease)

  • restlessness or agitation

  • irritability or excessive crying

  • change in sleep patterns, either oversleeping or insomnia

  • lack of energy, feeling slowed down mentally and physically

  • feelings of guilt, worthlessness, helplessness, hopelessness

  • persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain

  • difficulty thinking or concentrating

  • recurring thoughts of death or suicide

The symptoms of mania include:

  • persistent and abnormally elevated mood (euphoria)

  • irritability

  • overly inflated self-esteem or feelings of importance

  • a decreased need for sleep

  • increased talkativeness

  • racing thoughts

  • increased activity, including sexual activity

  • distractibility

  • increased energy and/or physical agitation

  • excessive involvement in risky behaviors, such as spending money irresponsibly

  • poor judgment

  • inappropriate social behavior

Significant disruption in your sleep-wake cycle is an early warning sign of an impending episode. Controlling your sleep-wake cycle and maintaining a regular pattern is critical to avoid making the illness worse. Decreased and disrupted sleep occurs frequently for new mothers. It is important for women with bipolar disorder who are pregnant or considering pregnancy to talk with their health care providers about ways to reduce their sleep disruptions after giving birth.

Other symptoms of manic depression include psychosis, which involves hallucinations and delusions (falsely believing in something with conviction, despite proof or evidence to the contrary).

Mixed state episodes include symptoms of both depression and mania, often including agitation, trouble sleeping, change in appetite, psychosis and thoughts of suicide.

Symptoms of mania, depression or mixed state are episodic and typically recur. Episodes may become more frequent with age if the condition isn't properly treated. These episodes, especially early in the course of the illness, are separated by periods of wellness, when someone suffers few or no symptoms.

Women with bipolar syndrome are more likely to experience psychosis and manic episodes during pregnancy and after giving birth. This risk is higher for women who stop their mood-stabilizing medications and even higher for women who stop these medications abruptly.

The combinations and severity of symptoms vary from person to person. Some people have severe manic episodes in which they feel out of control, have tremendous difficulty functioning and severe psychosis. Other people have milder "hypomanic" episodes that include increased energy, euphoria and irritability. Some suffer completely incapacitating periods of depression and are unable to function within their normal daily routine. Hospitalization is necessary to treat severe episodes of mania or depression.

If you have bipolar disorder, you may have difficulty acknowledging your mood swings even if family and friends tell you about these behaviors.

During a manic episode, you might abuse alcohol, schedule too many events or meetings for one day, drive recklessly, go on a spending spree, make unwise or risky business decisions or be unusually promiscuous sexually. Untreated, the manic phase can last from days to months. As it fades, a period of normal mood and behavior may occur. Sometimes the depressive phase of the illness then sets in, but another manic episode could also follow.

When you're experiencing a depressed episode, you might lose complete interest in everything you used to enjoy, not be able to stop crying, feel completely hopeless and contemplate suicide. In some people, depression occurs immediately after a manic episode or within the next few months. But with others, there is a long interval before the next manic or depressive episode. The depressive phase has the same symptoms as major depression (also called "unipolar" depression).

People with bipolar disorder may have abnormal thyroid gland function. Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that your health care professional closely monitor your thyroid levels. Additionally, if you're treated with lithium, that may cause low thyroid levels.

Treatment

Treatment

If you have bipolar disorder, you will need lifelong treatment. Regular monitoring and consultation with a health care professional is necessary to establish which medication or combination of drugs works best.

Medications called "mood stabilizers" are most often prescribed to help control bipolar disorder, and several types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for an extended time to manage their illness, usually for years. Other medications are sometimes combined with mood stabilizers when necessary to treat powerful episodes of mania or depression that may break through despite the mood stabilizer. These additional medications may include: an antipsychotic for psychosis or mania; an antidepressant for depression; and/or a benzodiazepine for agitation.

For nearly 40 years, the mood stabilizer lithium has been one of the main treatments for people with bipolar disorder.

Lithium evens out moods so you don't feel as high or as low, but it's unclear exactly how the medication works in the brain. Lithium is not used just for manic attacks, but rather as an ongoing treatment to prevent all types of episodes. It can take up to three weeks to start reducing severe manic symptoms. It might take a few months of medication before the illness is under control.

When taken regularly, lithium can effectively control depression and mania and reduce the chances of recurrence. However, while it is effective treatment for many people, it doesn't work for everybody.

Regular blood tests are a must if you're taking lithium. The level of lithium in your blood can be measured with a blood test. This level is used by your doctor, along with your symptoms, to determine the appropriate dose of lithium for you. Too small a dose might not be effective and too large might produce unwanted side effects, including weight gain, tremors, excessive thirst and urination, drowsiness, weakness, nausea, vomiting and fatigue.

Salt intake also affects the amount of lithium in your body. A dramatic reduction in salt intake, excessive exercise and sweating, fever, vomiting or diarrhea may cause lithium to build up in your body to toxic levels. An overdose of lithium can cause confusion, delirium, seizures, coma and may result, although rarely, in death.

In addition to lithium, other mood stabilizers used in the treatment of bipolar disorder include anticonvulsants. They may be combined with lithium or with each other for maximum effect. Specific ones used for bipolar syndrome include:

  • Anticonvulsants. Antiseizure medications (also called anticonvulsants) such as valproic acid (Depakene) and divalproex (Depakote) can have a mood-stabilizing effect in people with bipolar disorder. There is some evidence that valproic acid may result in hormonal changes in teenage girls and polycystic ovarian syndrome (PCOS) in women who began taking the medication before age 20. Young women should discuss this risk with their health care professionals, and those taking valproic acid should be monitored carefully for possible hormonal problems.

    The anticonvulsants carbamazepine (Tegretol) and oxcarbazepine (Trileptal) also have some effects as mood stabilizers, although they are not yet approved for bipolar disorder by the U.S. Food and Drug Administration (FDA). At this point, there is more evidence on the effectiveness of Tegretol than Trileptal.

    And the anticonvulsant lamotrigine (Lamictal) is FDA-approved for the long-term treatment of adults with bipolar disorder. It is specifically used to treat the depressive episodes involved with bipolar disorder.

    Some anticonvulsants can decrease the effectiveness of hormonal contraceptives, such as birth control pills. It is important to discuss your method of contraception with your health care provider to determine if there is an interaction.

Severely ill patients may require a combination treatment with mood stabilizers and other drugs, including:

  • Antidepressant medications. Several classes of antidepressant medications are sometimes used to treat the depressive symptoms of bipolar disorder, including fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin). However, the use of antidepressants in people with bipolar disorder is controversial, since antidepressants may not be any more effective than mood stabilizers at treating depressive episodes in people with bipolar disorder and can trigger manic episodes. Make sure you tell your health care professional about any prior symptoms of hypomania or mania (episodes that include increased energy, euphoria and irritability) before beginning antidepressants.

    Side effects and effectiveness differ for each class of antidepressant, as well as for the individual brands.

  • Antipsychotics. If you're experiencing psychotic or manic symptoms during an episode of bipolar disorder, health care practitioners will sometimes prescribe antipsychotic medicine alone or in combination with a traditional mood stabilizer to control symptoms.

    Olanzapine can also be used alone for the treatment of bipolar disorder.

    Examples of antipsychotics used include: olanzapine (Zyprexa), ziprasidone (Geodon), quetiapine (Seroquel), aripiprazole (Abilify) and risperidone (Risperdal), all FDA-approved for the treatment of bipolar disorder.

    In addition, antianxiety medications such as benzodiazepines may be used in some people with bipolar disorder with acute mania to help with sleep. There is a potential for abuse of or physical dependence on benzodiazepines. Therefore, these medications are often prescribed only for a limited time, such as during an acute episode.

Be patient. It may take up to three weeks of regular use of a new drug before your symptoms improve or subside. Stay in close communication with your health care professional and let him or her know if you don't feel like you are responding to treatment. In some cases, treatment plans need to be changed to effectively control symptoms.

Electroconvulsive therapy (ECT) is another treatment option for bipolar disorder and other types of major depression. It is usually only used to treat bipolar disorder when medication, psychosocial treatment or the combination of these treatments are ineffective or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide. ECT may also be considered when certain medical conditions, such as pregnancy, make the use of medication too risky.

Just prior to ECT treatment, you're given a muscle relaxant and sometimes general anesthesia. Electrodes are then attached to your scalp. An electric current causes a brief convulsion. Treatments usually last for 30 to 90 seconds. You won't remember the treatments and will probably awake slightly confused. You will most likely recover in five to 15 minutes and be able to go home the same day. Acute treatments usually occur three times per week for about a month. Maintenance treatments may be given after that at a reduced frequency.

ECT has been used for more than 70 years and has been refined since its early introduction as a treatment for depression. According to Mental Health America , ECT is administered to an estimated 100,000 people a year, primarily in general hospital psychiatric units and in psychiatric hospitals. Researchers don't understand exactly how it works to improve symptoms of depression and/or mania in some individuals, but the evidence is clear that it does work.

Although myths and negative perceptions continue to be perpetuated about ECT, it is a very effective treatment for many people with severe depressive, manic or mixed episodes who don't respond to or have bad effects from other treatments or can't take other treatments for some reason. Research has shown that patients who receive ECT followed by maintenance lithium therapy have better outcomes than patients who receive lithium alone. As with all other treatments, you should undergo a complete physical evaluation before beginning ECT therapy.

Side effects can include permanent memory loss and confusion. These side effects were more of a concern in the past, and modern ECT techniques have reduced them significantly. However, the benefits and risks of ECT should still be carefully weighed before an individual or his or her family and friends decide to go with the treatment.

Psychotherapy. As with all mental illnesses and other serious conditions, bipolar disorder can devastate a person's self-esteem and relationships, especially with spouses and family. Without treatment, people with the illness may jeopardize their finances, their careers, their families and their lives. Thus, in addition to treatment with medications, psychotherapy ("talk therapy") is also recommended for individuals with the disorder, as well as for their family members.

Bipolar Disorder and Pregnancy

Women with bipolar disorder who want to become pregnant need to consider several issues. Careful planning for pregnancy can help women with bipolar disease best manage their illness while avoiding risks to their babies. The goal is to maintain a stable mood during pregnancy and postpartum. It is extremely important to consider both the risks of the medications to the unborn baby, as well as the risks of untreated bipolar disorder to both the mother and unborn baby. These should be weighed carefully in a thorough discussion with your health care provider.

After discussing risks and benefits with your health care professional, if you prefer not to use medication during pregnancy, a trial off medications (following a gradual taper) prior to pregnancy, possibly only stopping medications after conception, might be an option. Most health care professionals suggest avoiding sudden changes in medication during pregnancy, which can increase the risk of relapse.

Overall, studies show that taking only one mood stabilizer during pregnancy poses less of a risk to the developing fetus than does taking multiple medications. Some anticonvulsants have been shown to be harmful to fetuses, possibly leading to birth defects. However, rates of problems vary widely based on the medication. Discuss possible medications and their risks with your health care professional and always weigh this against the risk of untreated bipolar disorder.

Some of these medications can be used while breastfeeding but all options should be discussed with your health care professional. Overall, if you are pregnant or planning to become pregnant and you have bipolar disorder, be sure to discuss safety of various treatment options during and after pregnancy with your health care professional.

ECT has also been used for decades (with appropriate adjustments) in pregnancy to treat severe mania or depression.

Prevention

Prevention

Patients and their families need to understand that bipolar disorder will not go away, and there is no way to prevent the disorder from developing. The only way to keep the disorder under control is through continued compliance with treatment.

Facts to Know

Facts to Know

  1. Bipolar disorder involves episodes of mania and depression.

  2. Traditionally, one percent of the population has been affected by bipolar disorder, but as the condition has expanded to include a spectrum of proposed bipolar conditions, this number has risen to an estimated 2.6 to 6.5 percent. According to the World Health Organization, bipolar disorder is the sixth leading cause of disability among people aged 15 to 44.

  3. Most people with bipolar disorder can expect that even their most severe mood swings will be relieved with treatment.

  4. Like other serious illnesses, bipolar disorder is not only difficult for the person who has it but also hard on family members, friends and employers. Family members of people with bipolar disorder often have to cope with serious behavioral problems (such as wild spending sprees) and the lasting consequences of these behaviors.

  5. Bipolar disorder generally strikes between the ages of 15 and 30.

  6. Bipolar disorder tends to run in families, and many researchers believe it is genetic. Researchers, however, have not associated a specific genetic defect with the disease.

  7. Not everybody with a family history of manic depression develops the illness.

  8. Studies suggest that stress, difficulty at work or with interpersonal relationships may trigger episodes in people with bipolar disorder, particularly if the stress causes loss of sleep.

  9. Lithium has been the treatment of choice for people with bipolar disorder but doesn't work for everyone with the disorder. Other effective treatment options are available.

  10. Bipolar disorder can get worse during and after pregnancy. Because of potential risk to the developing fetus due to both untreated illness as well as some medications, the disease must be carefully treated by a health care professional during this time.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about bipolar disorder so you're prepared to discuss this important health issue with your health care professional.

  1. Why did you diagnose me with bipolar disorder?

  2. What are the names and types of my medications and what are they supposed to do?

  3. How and when do I take these medications? Are there any side effects?

  4. Will they react with one another?

  5. What should I do if I notice side effects?

  6. How long do I have to take these medications?

  7. What if I want to become pregnant? How will my medications or my condition affect my pregnancy, my baby and the safety of my nursing my baby?

  8. Would I benefit from counseling?

  9. How can I keep my sleeping patterns regular?

  10. How can I keep my sleep patterns as regular as possible with a new baby?

  11. What should I do if I begin to have trouble sleeping or waking up?

  12. Other than medication, counseling, and attention to my sleep-wake cycle, what other things could I do to increase my chances of staying well?

Key Q&A

Key Q&A

  1. What is bipolar disorder?

    Also called manic depressive illness or manic depression, this mental illness is characterized by episodic mood swings that range from overly "high" and/or irritable to sadness and hopelessness, and then back again, with periods of normal mood in between.

  2. Who usually is affected by bipolar disorder?

    Men and women are equally likely to develop the condition, usually between the ages of 15 and 30. However, research has shown that women are more likely than men to develop the rapid cycling form of the condition—with episodes occurring four or more times within a 12-month period. Most often, symptoms begin between age 15 and 30. Research has shown that there is a genetic component to the disorder and that people with a close relative with bipolar disorder are four to six times more likely to develop it than people with no family history.

  3. Can the disorder be effectively treated?

    Yes. For nearly 40 years, lithium has been the treatment of choice for people with bipolar disorder. It levels out mood swings so that patients don't feel as high or as low and is used as an ongoing treatment. Symptoms may diminish after one to three weeks of treatment, but it might take a few months of medication to control the illness. Newer drugs developed for the disorder, used alone or in combination with lithium, are also prescribed.

  4. Can bipolar disorder be cured?

    No. Treatment for the illness in considered lifelong. Ongoing maintenance and periodic consultation with a knowledgeable health care professional is typical.

  5. What if I can't tolerate lithium?

    There are a number of other effective treatments. Your health care professional might prescribe several medications including both antidepressants and anticonvulsant medications. However, it may take several months to determine the proper medication, dosage and frequency.

Organizations and Support

Organizations and Support

For information and support on coping with Bipolar Disorder, please see the recommended organizations, books and Spanish-language resources listed below.

American Academy of Child and Adolescent Psychiatry (AACAP)
Website: http://www.aacap.org
Address: 3615 Wisconsin Ave., NW
Washington, DC 20016
Phone: 202-966-7300

American Psychological Association
Website: http://www.apa.org
Address: 750 First St., NE
Washington, DC 20002
Hotline: 1-800-374-2721
Phone: 202-336-5500

Association for Behavioral and Cognitive Therapies (ABCT)
Website: http://www.abct.org
Address: 305 7th Avenue, 16th Floor
New York, NY 10001
Phone: 212 647-1890

Bazelon Center
Website: http://www.bazelon.org
Address: The Bazelon Center for Mental Health Law
1101 15th Street NW Suite 1212
Washington, DC 20005
Phone: 202-467-5730
Email: info@bazelon.org

Child & Adolescent Bipolar Foundation
Website: http://www.bpkids.org
Address: 820 Davis St, Suite 520
Evanston, IL 60201-4448
Phone: 847-492-8519
Email: cabf@bpkids.org

Depression and Bipolar Support Alliance (DBSA)
Website: http://www.dbsalliance.org
Address: 730 N. Franklin Street, Suite 501
Chicago, IL 60610-7224
Hotline: 1-800-826-3632
Email: info@dbsalliance.org

Federation of Families for Children's Mental Health
Website: http://www.ffcmh.org
Address: 9605 Medical Center Drive, Suite 280
Rockville, MD 20850
Phone: 240-403-1901
Email: ffcmh@ffcmh.org

Geriatric Mental Health Foundation
Website: http://www.gmhfonline.org
Address: 7910 Woodmont Ave, Suite 1050
Bethesda, MD 20814
Phone: 301-654-7850
Email: web@GMHFonline.org

Mental Health America
Website: http://www.mentalhealthamerica.net
Address: 2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Hotline: 1-800-969-6642
Phone: 703-684-7722

National Alliance on Mental Illness (NAMI)
Website: http://www.nami.org
Address: Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201
Hotline: 1-800-950-NAMI (1-800-950-6264)
Phone: 703-524-7600

National Institute of Mental Health
Website: http://www.nimh.nih.gov
Address: Science Writing, Press and Dissemination Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892
Hotline: 1-866-615-6464
Phone: 301-443-4513
Email: nimhinfo@nih.gov

National Mental Health Consumers' Self-Help Clearinghouse
Website: http://www.mhselfhelp.org
Address: 1211 Chestnut St., Suite 1207
Philadelphia, PA 19107
Hotline: 1-800-553-4539
Phone: 215-751-1810
Email: info@mhselfhelp.org

SAMHSA's National Mental Health Information Center
Website: http://mentalhealth.samhsa.gov
Address: P.O. Box 2345
Rockville, MD 20847
Hotline: 1-800-789-2647
Phone: 240-221-4021

Screening for Mental Health (SMH)
Website: http://www.mentalhealthscreening.org
Address: One Washington Street, Suite 304
Wellesley Hills, MA 02481
Phone: 781-239-0071
Email: smhinfo@mentalhealthscreening.org

Why Am I Up, Why Am I Down? Understanding Bipolar Disorder
by Roger Granet, Elizabeth Ferber

50 Signs of Mental Illness: A Guide to Understanding Mental Health
by Dr. James Whitney Hicks

Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression--The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder
by Ronald R. Fieve

Bipolar Disorder
Website: http://www.nlm.nih.gov/medlineplus/spanish/bipolardisorder.html
Address: U.S. National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov

Factsheet: Bipoloar Disorder in Children
Website: http://www.mentalhealthamerica.net/go/en-espanol
Address: Mental Health America
2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Hotline: 1-800-969-6642
Phone: 703-684-7722
Email: sjones@mentalhealthamerica.net

Last date updated: 
Fri, 2009-12-11

What is it?

Overview

What Is It?
ADHD interferes with your ability to regulate activity (hyperactivity), control some behaviors (impulsivity) and focus on tasks (inattention).

Experts suggest that attention deficit hyperactivity disorder (ADHD) affects an estimated 8 percent of school-aged children, and about two-thirds of children diagnosed with ADHD continue to show signs of the disorder into adulthood.

ADHD interferes with your ability to regulate motor activity (hyperactivity), control key behaviors (impulsivity) and focus on tasks (inattention). When the hyperactivity is not present, the condition is sometimes called attention deficit disorder (ADD), although the more accurate term is ADHD-inattentive type.

By current estimates, more than two times as many boys as girls are affected by ADHD, but the ratio appears to become more even by adulthood.

Overall, women and girls may exhibit fewer of the typical symptoms associated with ADHD in boys. For example, girls with ADHD are more likely to be reserved than hyperactive. They tend to be less defiant and more compliant than boys and men with the condition. Like boys and men with ADHD, however, women with the condition may have difficulty completing tasks and remaining organized. Instead of being tested for ADHD, they're often dismissed as flighty or spacey.

Thus, because girls are less likely to disrupt class—the kind of behavior that often brings boys with the condition to medical professionals' attention—girls are less likely to get diagnosed with ADHD. Consequently, many girls and women do not get the help they need. Often, girls' self-esteem suffers as they encounter academic problems in school. They may have difficulty with interpersonal relationships as well as social challenges.

These secondary difficulties may result in depression, anxiety disorders, problems sleeping, self-harmful (cutting) behaviors and/or abuse of alcohol or other substances. Furthermore, girls with ADHD are at greater risk for early pregnancy, promiscuity and sexually transmitted diseases. A recent study following girls for 10 years showed significantly higher risk for suicide attempts and self-injury compared to a comparison group.

Once diagnosed, many women recall painful or difficult childhood experiences in school that were likely to have been linked to ADHD but attributed at the time to other causes, such as laziness or lack of ability. This misattribution can itself lead to significant damage to self-esteem and self-confidence, resulting in demoralization.

Causes of ADHD

Although no one knows for sure what causes ADHD, the condition does run in families, suggesting a strong genetic component. Children who have a parent with ADHD are at an increased risk for ADHD themselves. And twin and adoption studies confirm a high degree of genetic connection with this condition. For identical twins, there is a strong chance the other twin has it. Again, this "family resemblance" appears strongly related to genes rather than social factors. Many researchers around the world are now investigating various genes that may contribute to the development of ADHD in families. It is unlikely a single gene is responsible, but undoubtedly many genes, operating interactively with one another and with environmental risks.

A smaller percentage of cases of ADHD are due to environmental or nongenetic biological risk factors, including premature birth, low birth weight; prenatal use of alcohol, tobacco and/or cocaine; and exposure to lead, which can alter brain development in the fetus. Infections and complications during pregnancy can also increase the chances that a baby will eventually develop ADHD in childhood. Additionally, some postnatal problems, such as chronic low levels of lead, recurrent ear infections or severe head trauma, can result in ADHD.

For years, ADHD was thought to be a disruptive behavior disorder that most experts intuitively believed involved some brain abnormality. With the development of more sophisticated brain scanning techniques, it is now known that people with ADHD do have anatomical differences in their brains, as well as differences in the biochemical balance that controls everything from mood to impulses.

Brain imaging studies show differences in ADHD brains in several areas:

  • differences in dopamine receptors in specific areas of the brain
  • differences in total brain volume and brain volume of specific areas of the brain
  • differences in the brain networks that are used to solve specific tasks
  • differences in the rate of maturation of frontal/prefrontal areas of the brain

Children with ADHD show a pattern of delayed maturation of certain regions of the brain compared to their peers without the disorder. These regions of delayed development are involved with controlling motor behavior, impulse control and attention levels. The conclusion is that slower brain development is a characteristic of ADHD brains and may explain the delay in development of emotion/impulse control and organizational skills.

Another biological component of ADHD has to do with levels of certain neurotransmitters in the brain. Adults with ADHD who have never received any medication have lower amounts of receptors for the neurotransmitter dopamine in key subcortical regions linked to motivation and reward than do adults without the disorder. In fact, stimulant medications used in the treatment of ADHD help balance levels of dopamine, improving symptoms of inattention, hyperactivity and impulsivity.

ADHD is not caused by many environmental triggers commonly believed to be associated with the disorder, such as too much TV, food allergies, eating too much sugar, problematic home life, poor teaching or schools or permissive parenting. Still, it is essential to realize that the home environment and the school setting are extremely important in managing ADHD—and that ineffective parenting and educational settings can exacerbate the symptoms and lead to additional impairments.

Diagnosis

Diagnosis

Attention deficit hyperactivity disorder (ADHD) is the most prevalent chronic neurobiological disorder in children. Once thought to affect only children, it is now recognized as a disorder that most often continues into adulthood and presents unique issues for girls and women.

Common symptoms of ADHD can include:

  • failing to give close attention to details or making careless mistakes
  • difficulty sustaining attention to tasks
  • appearing not to listen when spoken to directly
  • failing to follow instructions carefully and completely
  • losing or forgetting important things
  • feeling restless or fidgeting
  • talking excessively or blurting out answers before hearing the whole question

ADHD is a serious diagnosis that can have a tremendous negative impact on your life, work and family. It may require long-term treatment with counseling and medication, so it's important that a health care professional carefully evaluate all symptoms to rule out other conditions that could cause similar symptoms or behaviors.

For instance, stress can cause symptoms similar to those seen in ADHD, such as forgetfulness or feeling overwhelmed and disorganized. However, reactions to stress are usually temporary, subside when the stressful events pass, and are not present in a chronic fashion since childhood. Symptoms caused by ADHD are persistent, chronic and unchanging since childhood or early adolescence.

The diagnosis itself, however, must be approached very carefully and shouldn't be done during a time-limited office visit with a pediatrician or other medical doctor. Improper treatment from misdiagnosis or failure to obtain treatment because of a missed ADHD diagnosis can both have significant, long-term consequences.

To reach an ADHD diagnosis in children, health care professionals use diagnostic criteria published by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) and consider information from other sources. For example, interviews with the patient, the patient's family and, in the case of children, information provided by caregivers and teachers who see the child regularly can provide a picture of the patient's behavior and learning styles.

Diagnosing and treating adults is challenging. The diagnostic criteria, with their emphasis on school behavior and performance, are designed to make the diagnosis in children, not adults. Hyperactivity, for instance, tends to diminish by adulthood, although other symptoms, such as inattention, may appear worse because of mounting adult responsibilities.

The following informal checklist further describes behaviors in adults that may be the result of ADHD. An individual having chronic problems since childhood with many of these symptoms may require further evaluation:

  • I am constantly trying to get organized, but can never seem to get or stay there.

  • I often feel that I talk too much or impulsively blurt things out.

  • I often feel overwhelmed.

  • I make impulsive purchases and decisions.

  • I frequently misplace personal items.

  • I start one thing but never finish it because I am distracted by something else.

  • I am frequently late.

  • I am a procrastinator.

  • I often make careless errors and oversights during the day.

  • I often pay bills late and have difficulty managing my money.

There are three primary subtypes of ADHD: predominantly hyperactive-impulsive, predominantly inattentive and combined hyperactive-impulsive and inattentive. The DSM-IV lists these other signs of ADHD, many of which apply to children in the classroom:

Inattention

Those who are inattentive find it difficult to keep their minds on any one thing and may get bored with a task after only a few minutes. They may, however, give effortless, automatic attention to activities and things that are highly engaging, like video games. But they may have difficulty with deliberate focus, conscious attention on organizing and completing tasks, responses to repetitive materials or mastery of challenging information.

Hyperactivity-impulsivity

  • Hyperactivity: Those who are hyperactive always seem to be in motion and have trouble sitting still. They squirm in their seats or roam around the room. Or they might wiggle their feet, touch everything or noisily tap their pencils. They may be fidgety or try to do several things at once, bouncing around from one activity to the next. They report an internal sense of restlessness and the need to continually move around.

  • Impulsivity: Those who are overly impulsive seem unable to curb or weigh their immediate reactions, thoughts and behaviors before acting. As a result, they may blurt out inappropriate comments or physically attempt something without thinking it through. This could apply to taking tests in school as well as participating in potentially dangerous behaviors. Their impulsivity also makes it hard for them to wait for things they want. This leads to poor frustration tolerance and temper outbursts.

Not everyone who is overly hyperactive, inattentive or impulsive has an attention disorder. Nor does everyone with ADHD exhibit all behaviors associated with the disorder. It's important to realize that during certain stages of development, it may be normal for children to be inattentive, hyperactive or impulsive, and that these behaviors at these stages don't fit an ADHD profile.

For example, preschoolers typically have lots of energy and run everywhere they go, but that doesn't mean they are hyperactive. And many teenagers go through a phase when they are messy, disorganized and reject authority. This phase doesn't necessarily persist as a lifelong problem with attention, organization and/or impulse control.

Because everyone exhibits some of these behaviors at times, the DSM-IV contains very specific guidelines for determining when the behaviors indicate ADHD. Specific symptoms must appear early in life, before age seven, and continue for at least six months. In children, they must be much more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work or social settings. However, it's important to know that the inattentive type of ADHD may not be diagnosed until age nine or 10, the age when symptoms of inattention become noticeable and problematic because school demands have increased.

So if your behavior or your child's doesn't impair work, friendships or other relationships, you probably won't be diagnosed with ADHD. Nor would a child who seems overly active at school but who functions well elsewhere.

Health care professionals also consider the following questions during an assessment for ADHD:

  • Are these behaviors excessive, long-term and pervasive? That is, do they occur more often in you or your child than in others the same age?

  • Are they a continuous problem rather than a response to a temporary situation?

  • Do the behaviors occur in several settings or only in one specific place?

The health care professional pieces together a profile of behaviors, based on all available information, and then considers:

  • Which ADHD-like behavior patterns listed in the DSM-IV are apparent?

  • How often and in what situations?

  • How long have they been going on?

  • How old was the child/adult when the problem(s) started?

  • Are the behaviors seriously interfering with school, friendships, activities or home life?

  • Are there any other related problems?

  • Is there a parent with ADHD symptoms?

The answers to these questions help identify whether the hyperactivity, impulsivity and inattention are significant and long-standing. If so, a diagnosis of ADHD may be made.

Other conditions may occur with ADHD, making it more difficult to arrive at a clear diagnosis. Women and girls with ADHD, for example, are more prone to depression than men and boys with ADHD. A serious but treatable mental disorder, depression can disrupt all areas of your life, including mood, sleep, appetite, relationships, and the ability to think clearly. If you think you're suffering from depression, it's critical that you get a diagnosis and proper treatment. Left untreated, depression can be life-threatening, given the risk of suicide that accompanies the disorder.

Anxiety is another common condition seen in those with ADHD. Some children with ADHD, for example, feel tremendous worry, tension or uneasiness, even when there's nothing to fear. Because the feelings are scarier, stronger and more frequent than normal fears, they can affect the child's thinking and behavior.

Children with ADHD are also more likely to have achievement problems than children without the disorder, even if they don't have a full-blown learning disability. ADHD is not in itself a learning disability but learning disabilities commonly occur with ADHD. But because it can interfere with concentration and attention, it can make it doubly hard for a child to do well in school, creating lifelong frustrations.

A very small number of people with ADHD have a rare disorder called Tourette syndrome. People with Tourette syndrome have tics and other involuntary movements like eye blinks or facial twitches they can't control. Some may grimace, shrug, sniff or bark out words. Fortunately, these behaviors can be controlled with medication.

The effects of ADHD extend far beyond the classroom, often wreaking havoc on everything from educational budgets to sibling relationships. In 2005, the CDC reported that the educational cost of ADHD was about $36 billion to $52 billion annually. Children with ADHD use more mental health services, have more frequent emergency department visits and have higher rates of pedestrian, bicycle and driving accidents than children without ADHD. All of which places extreme stress on their parents.

It doesn't matter if the child with ADHD is male or female; parenting either is equally stressful. Overall, mothers of children with ADHD report significantly higher levels of parenting stress than mothers of children with other chronic disorders, and they're more likely to become depressed.

Parents of children with ADHD are also more likely to experience increased absenteeism and decline in productivity in the workforce than parents of children without the disorder. The annual cost to the economy in terms of lack of productivity, unemployment and related issues linked to ADHD is measurable in many billions of dollars. Of course, ADHD also places tremendous strain on relationships and places marriages at higher risk for divorce. Learning how to manage children with ADHD effectively and consistently is a major component of most treatment plans.

Some research looks at the concept of executive function (EF). This involves the ability to organize, sequence a task, shift from task to task, prioritize, plan and anticipate, and hold information in your memory as you consider multiple factors when making a decision. Some researchers consider executive dysfunction inherent to ADHD, while others consider it a separate category as defined by neuropsychological test results. Children and adults with ADHD plus EF deficits show more academic and life impairments that those with ADHD without EF dysfunction. ADHD medication, although helpful for ADHD symptoms, has much less beneficial effect on EF symptoms. Skills-based therapies are more useful in these cases.

Getting a Diagnosis

Several types of health care professionals are qualified to diagnose and treat ADHD.

For children:

  • Child psychiatrists are physicians who specialize in diagnosing and treating childhood mental and behavioral disorders. A psychiatrist can provide therapy and prescribe any necessary medications.

  • Child psychologists are also qualified to diagnose and treat ADHD. They can provide therapy for the child and help the family develop ways to deal with the disorder. But psychologists are not medical doctors and must rely on physicians for medical exams and prescriptions.

  • Neurologists, physicians who work with disorders of the brain and nervous system, can also diagnose ADHD and prescribe medicines. They will likely be involved with any brain imaging tests. But unlike psychiatrists and psychologists, neurologists usually do not provide therapy for the emotional/organizational aspects of the disorder.

  • Family physicians receive training to provide continuing and comprehensive medical care, health maintenance and preventive services to patients of all ages. When it comes to ADHD, they can diagnose the condition, prescribe medications and, in some cases, provide counseling.

  • Pediatricians are physicians who have specialized training in treating children's illnesses. Like family practitioners, pediatricians may or may not have specialty training in or experience with ADHD. Because ADHD is most prevalent in children, it is likely that a pediatrician will have experience in the ADHD screening process and can help rule out (or identify) medical conditions similar to behavior or learning patterns of ADHD. Pediatricians can also provide referrals to local ADHD specialists.

  • Developmental and behavioral pediatricians specialize in behavior and development in children. Serving as a liaison with primary care physicians and other medical specialists, developmental and behavioral pediatricians serve as key members of a multidisciplinary team. They provide comprehensive developmental, medical and behavioral assessments; education for parents and professionals regarding various medical/developmental diagnoses; and medical management of ADHD and other neurobehavioral disorders.

For adults:

  • Psychologists, psychiatrists, neurologists and primary care physicians may also diagnose and treat ADHD in adults. But not all health care professionals are trained and skilled in identifying or treating ADHD in adults.

Within each specialty, individual health care professionals and mental health professionals differ in their knowledge of and experience with ADHD. So when selecting a health care professional, it's important to find someone with specific training and experience in diagnosing and treating the disorder and distinguishing coexisting psychiatric disorders.

Treatment

Treatment

An effective treatment plan will help you cope with ADHD, whether you or your child is the one with the diagnosis. For adults, the treatment plan may include medication along with practical and emotional support. For children and adolescents, it may include providing an appropriate classroom setting and accommodations, as well as medication and helping parents understand and manage the child's behavior.

Treatment for ADHD may involve medication, behavioral/psychological counseling, educational/workplace interventions or a combination.

Three medications in the class of medications known as psychostimulants, or stimulants, seem to be the most effective in treating ADHD in both children and adults. These are:

  • Methylphenidate (e.g., Ritalin, Concerta, Metadate, Methylin, Daytrana). Methylphenidate is available in brand name and generic tablets,capsules and liquid. Daytrana is a methylphenidate transdermal patch approved for treating ADHD in children aged six to 12.

  • Dexmethylphenidate (Focalin, Focalin XR)

  • Dextroamphetamine-amphetamine mix (Adderall, Adderall XR).

  • Dextroamphetamine(Dexedrine, Dextrostat, Concentra).

  • Lisdexamfetamine (Vyvanse)

Stimulant medications, when used with medical supervision, are usually considered safe. Stimulants seldom make children with ADHD "high" when taken as prescribed. Because these medications are stimulants, there is no sedating effect. However, restlessness and fidgetiness may decline leaving the person feeling "calmer." Ultimately, the stimulants help children control their hyperactivity, inattention and other ADHD-related behaviors.

Stimulant drugs are available in both short-, medium- and long-acting forms. The short-acting forms last for about four hours, medium-acting forms for about 6 hours and long-acting forms last 8 to 14 hours.

Stimulants do carry the risk of abuse and addiction. However, abuse and dependence with ADHD stimulant medication are more likely with short-acting forms. To reduce chances of substance abuse, make sure you or your child is getting the right dose of stimulant medication at the needed time of the day. Do not put your child or adolescent in charge of his or her own medication. Keep medication locked in a childproof container at home. If a school time dose is needed, don't send supplies of medication to school with your child; instead, deliver medication to the school nurse or health office yourself.

Although sudden deaths have occurred in children on stimulant medications, a recent extensive review of sudden death in children and adolescents on stimulant medication concluded that stimulant medication poses no increased risk for sudden death, cardiac arrest or stroke compared to children and adolescents not on these medication. Always review medication packaging information, and talk to your health care professional about this potential risk. Heart screening questions to assess any risk should be asked before starting any ADHD medication.

Additionally, stimulant medications have been associated with a slightly reduced growth rate in some children, although the extent of this appears to be a half inch on average.

Other potential side effects, such as weight loss, problems sleeping and tics, should be carefully weighed against the benefits before prescribing the medications. Preexisting tics may or may not worsen with stimulant medication. Most side effects can often be handled by reducing the dosage.

Atomoxetine (Strattera). The first non-stimulant medication approved to treat ADHD, Strattera is classified as a selective norepinephrine reuptake inhibitor. It works by blocking norepinephrine in the brain, thus leading to greater amounts in the synapse when the medication is used. Overall, Strattera has been shown to lead to significant improvements in individuals with ADHD, but the benefit may be less substantial than stimulants.

Strattera has been linked to rare side effects that include liver problems as well as the increased risk of suicide, according to the FDA. Call your health care professional right away if you or your child experiences yellowing of the skin or eyes (jaundice), unexplained flu-like symptoms or dark-colored urine, or if you or your child has thoughts of suicide or a sudden change in mood or behavior, especially at the beginning of treatment or after a change in dose.

Strattera is not classified as a controlled substance like the other ADHD medications (i.e., the stimulants), although it is a prescription drug. Unlike stimulants, refills can be provided on prescriptions. Side effects include: decreased appetite, upset stomach, nausea or vomiting, and fatigue. In addition, some of the most common side effects in adults are problems sleeping, dry mouth, dizziness, problems urinating (more so in males) and sexual side effects.

Other additional medications are sometimes used to treat the condition if stimulants don't work completely or if the ADHD occurs with another disorder. These medications are not approved for the treatment of ADHD, yet many have been shown effective in at least some studies.

For example, clonidine (Catapres) and guanfacine (Tenex), medications normally used to treat hypertension, may be helpful in people with ADHD who have tics and/or insomnia as a result of ADHD medications or who experience aggression as part of their condition. Clonidine can be administered either by pill or skin patch and has different side effects than stimulants, including rash (from the patch), constipation,nervousness and sedation.

Other medications not FDA-approved for ADHD but that may be prescribed include the antidepressants nortriptyline (Pamelor, Aventyl) and bupropion (Wellbutrin).

Antidepressants may temporarily increase risk of suicidal thoughts and behavior in people up to age 24, according to the FDA. Short-term studies in children and adolescents with major depressive disorder and other psychiatric disorders showed an increased risk of suicidal thoughts in those taking antidepressants, during the initial weeks of treatment. Although this effect is rare, anyone considering the use of an antidepressant in a child or adolescent must balance this risk with the need for the drug.

Also, health care professionals should observe their patients closely for any increased risk of suicide or unusual changes in behavior. Families and caregivers should also closely watch patients.

Medication won't cure ADHD; it will just control the symptoms while you're taking the medication. For instance, stimulants have only immediate benefits, so once a dose wears off that day, the symptoms return.

Also, although the medications may help you pay better attention to and complete your work, they can't increase your knowledge or improve your (or your child's) academic skills. As the expression goes, "Pills don't teach skills." The medications alone can't make you feel better about yourself or cope with problems. These issues require other kinds of treatment and support.

Psychosocial Treatment

Although ADHD primarily affects a person's behavior and cognition, the disorder has broad emotional repercussions. Scolding is the only attention some people with ADHD ever get while growing up. They may have few positive experiences to build their sense of worth and competence. Facing the daily frustrations that can come with having ADHD can make people fear that they are strange, abnormal, lazy or stupid.

Often the cycle of frustration, blame and anger has gone on so long it becomes incorporated into one's self-concept. In such cases, mental health professionals can help adolescents and adults with ADHD develop new skills, attitudes and ways of relating to other people. Often successful treatment will help a person separate the disorder (ADHD) and its symptoms/impairments from the individual and their innate strengths and potential.

In group counseling, people learn that they are not alone; other people with ADHD have similar experiences, and there are people who want to help. Support from group therapy can be complimented with individual therapy to address specific life issues. Very often, ADHD symptoms and inconsistent performance adversely affects personal relationships. Family and marital therapy with a professional aware of ADHD can be helpful in changing the communication pattern.

Several types of therapy are available, with different therapists preferring different approaches. Knowing something about the various types of interventions makes it easier to choose a therapist.

  • Psychotherapy works to help people with ADHD like and accept themselves despite their disorder. In psychotherapy, patients talk with the therapist about upsetting thoughts and feelings, explore self-defeating patterns of behavior and learn alternative ways to handle their emotions. As they talk, the therapist tries to help them understand how they can change. However, people dealing with ADHD usually want to gain control of their symptomatic behaviors more directly. The following interventions can provide that kind of help.
  • Behavior therapy, used with children and adolescents, involves providing parents with education about ADHD, teaching them to use regular and consistent rewards and punishments with their children and coordinating efforts with teachers at school. Indeed, for children and adolescents, behavior therapy and medication are the only two evidence-based interventions that consistently lead to improvement in symptoms and impairments.
  • Cognitive-behavioral therapy helps you work on immediate issues. Rather than helping you understand your feelings and actions, it supports you directly in changing your thoughts and behavior. The support might be practical assistance, like learning to think through tasks and organize work or changing a repetitive negative thought pattern. Cognitive therapies have not been found to be very helpful for children and adolescents, but for adults, results are promising.
  • Social skills training helps children and adults learn new behaviors, specifically social behaviors. Impulsive behavior can be intrusive and abrasive in interactions. In social skills training, the therapist discusses and models appropriate behaviors and helps the patient practice the new behavior. It is essential that clear limits are set in the social skills groups; otherwise, children may model maladaptive behaviors from one another.
  • Support groups connect people who have common concerns. Many adults with ADHD and parents of children with ADHD find it useful to join a local or national support group. Many groups deal with issues of children's disorders, and even ADHD specifically.

Ineffective or unproven alternative treatments

The following treatments have NOT been scientifically shown to be effective in treating people with ADHD:

  • restricted diets (although recent studies from the United Kingdom do show small effects of certain food additives on hyperactive behavior)

  • allergy treatments

  • medicines to correct problems in the inner ear

  • megavitamins

  • chiropractic adjustment and bone realignment

  • treatment for yeast infection

  • eye training

  • special colored glasses

  • herbal supplements

  • essential fatty acids

  • yoga and meditation

Neurofeedback, also known as biofeedback, is a promising intervention, not completely supported by definitive studies but with some recent investigations yielding support for improvements in attention and behavior.

Be cautious about pursuing complementary and alternative treatments that are not supported by scientific research and/or the U.S. Food and Drug Administration. Although single positive studies often receive media attention, it is important that such findings be replicated. Until sound, scientific testing shows a treatment to be effective, families risk spending time, money and hope on fads and false promises.

Managing Your Life as an Adult with ADHD

Here are some practical steps you can take to manage your life with ADHD from ADHD expert Kathleen Nadeau, PhD.

  1. Give yourself a break. High expectations are deeply ingrained in many women. Identify your strengths and perform those tasks. Identify your weakness and either find a compensatory skill or ask someone else to perform these tasks. Psychotherapy can help capitalize on strengths while limiting the impairments in areas of weakness.

  2. Educate your partner about ADHD and how it affects you. Your partner may be angry or resentful about a less-than-organized lifestyle. If your partner understands this as a disorder, he or she may be more understanding and accommodating. Reassign household responsibilities based on skill strength. Strategize how to make your life at home and work more accommodating.

  3. Try to create an "ADHD-friendly" environment in your home and work. If you can approach your ADHD with acceptance and good humor, tensions will decrease and you'll save more energy for the positive side of things.

  4. Simplify your life. Look for ways to reduce commitments so you're not always pressed for time. Learn how to better prioritize tasks to avoid overcommitment.

  5. Choose supportive friends. Many women describe friends or neighbors whose houses are immaculate, whose children are always clean, neat and well-behaved and who make them feel terrible by comparison. Try to avoid situations that lead you to impossible expectations and negative comparisons.

  6. Build a support group for yourself. For example, ask a friend who understands your condition to keep you company while completing a task that is always difficult for you.

  7. Build in daily breaks. This is essential when you have ADHD, especially if you're raising children. Make them routine so that you don't have to keep planning and juggling. For example, arrange for a regular babysitter several times a week.

  8. Eliminate and delegate. Look at things that you require of yourself at home or on the job. Can you eliminate some of these things? Can you hire someone to do some of them?

  9. Get help for premenstrual or menopausal symptoms. They may be severe in women with ADHD. Managing the destabilizing effects of your hormonal fluctuations is a critical part of managing your ADHD.

  10. Make lists and encourage other family members to list and record activities, responsibilities and events. Try to create a central family calendar with all activities for everyone to check. Online calendars may facilitate this. Avoid scattering information on multiple pieces of paper that can get lost.

  11. Create filing systems or organizational systems that work for you. Color coding folders is a fast visual way to identify what's in them. Set up autopay for bills, provided you have money and won't overdraw accounts. Don't let yourself be overwhelmed at home or at the office by mountains of paperwork: sort, file or discard.

Prevention

Prevention

According to current medical research, there is no known way to prevent most ADHD. There are some pre and post-natal risk factors that can be addressed: avoid alcohol and tobacco when pregnant, avoid a premature birth if possible and avoid lead exposure to the child.

Facts to Know

Facts to Know

  1. It is estimated that attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD) when present without hyperactivity, affects 8 percent of U.S. school-aged children, according to the Centers for Disease Control.

  2. Follow-up studies of children with ADHD find that the vast majority will continue to suffer impairments through adolescence, and 60 percent through adulthood. Many girls and women suffer the effects of ADHD and do not get the help they need.

  3. Once diagnosed, many women recall painful or difficult childhood experiences in school that were likely caused by ADHD, but at the time were attributed to laziness or lack of ability. Low self-esteem is the outcome of chronic criticism and is common among women with ADHD.

  4. ADHD, once called hyperkinesis or minimal brain dysfunction, is the most common psychiatric condition among children. More than two times as many boys as girls are affected in childhood; however, in adults it's almost equal proportions.

  5. ADHD can be mild, moderate or severe. An ADHD diagnosis is more difficult to identify in women and girls because they tend to be less hyperactive, less defiant and more compliant than boys (though this is not always the case). The absence of disruptive behavior can delay identification.

  6. ADHD has a very strong genetic component. Children who have a parent with ADHD or another mood or behavioral disorder are at an increased risk. Still, as with other conditions with a strong genetic liability, the quality of life and the provision of strong parenting and quality schooling can greatly influence any long-term outcomes.

  7. Like all chronic medical conditions, there are no cures for ADHD. Treatment for ADHD may involve medication, behavioral/psychological counseling, educational interventions or a combination.

  8. Medication can help to control the core symptoms: hyperactivity, impulsivity and inattention. But more often, there are other aspects of the problem that medication won't alleviate. Even though ADHD primarily affects a person's behavior and cognition, having the disorder has broad emotional repercussions.

  9. Currently, ADHD is a diagnosis made in people who demonstrate chronic and persistent symptoms across a number of settings. Although people identify with some of these symptoms at different times in their lives, ADHD is a disorder starting in childhood that usually persists into adulthood. Childhood onset (or early adolescence, in the case of the inattentive type) is the cornerstone of the diagnosis. There is no such disorder as "adult-onset ADHD," although some adults with this condition may not have been diagnosed as children.

Questions to Ask

Questions to Ask

Review the following Questions to Ask about attention deficit hyperactivity disorder (ADHD) so you're prepared to discuss this important health issue with your health care professional.

  1. Do you have experience in diagnosing/treating ADHD? How long have you been treating patients with ADHD?

  2. Do you have experience treating girls with ADHD?

  3. Do I or does my child have ADHD? How can you tell? Could something else be causing this behavior?

  4. What can I do about my child's behavior at home and school? How can I help my child?

  5. What can I do to function better at home and work? What tools can I use to organize my responsibilities and activities?

  6. Should I or my child be medicated for ADHD? What are the risks of medication for ADHD? What can I expect the benefits will be with medication?

  7. Do you offer counseling or behavior therapy as well as medication? Do you know of others in the community who can offer such treatment?

  8. When should I or my child be medicated, and when is it not necessary to take the medication?

  9. How should I approach the subject of ADHD with the people in my life, such as relatives, colleagues, other parents or teachers?

  10. Are there support groups for people with ADHD and their families?

  11. Can I expect my child to grow out of ADHD?

  12. Do you have experience working with adults and/or women with ADHD?

  13. As an adult with ADHD, should I tell my employer, boyfriend, husband, partner?

  14. What accommodations can I get at school or work in regards to my ADHD?

  15. As an adult on other medications, what concerns should I have when adding ADHD medication?

Key Q&A

Key Q&A

  1. I have trouble focusing on tasks and often feel overwhelmed during times of extreme stress. Does this mean I have attention deficit hyperactivity disorder (ADHD)?

    Not necessarily. Stress can cause symptoms similar to ADHD, such as forgetfulness or feeling overwhelmed and disorganized. Reactions to stress are usually temporary and subside when stress subsides. These symptoms should not be confused with ADHD symptoms or behaviors, which are long lasting and persistent.

  2. Are bad parenting skills to blame for ADHD?

    No. ADHD is a complex neurobiological disorder that affects learning and behavior. Too much TV, poor home life, poor schools or teachers, food allergies or excess sugar do not cause ADHD. International research demonstrates the presence of ADHD in children regardless of culture and parenting. Still, how a family responds to their child's ADHD may go a long way in shaping the child's ultimate outcome. Biology is not destiny.

  3. Does ADHD only affect children? I think I recognize some symptoms in myself.

    No. Until recent years, adults were not thought to have ADHD, so many adults with ongoing symptoms have never been diagnosed. There has been a recent increased awareness of adult ADHD, however. About half of children with ADHD continue to have impairments through adulthood. The recent awareness of adult ADHD means that many people can finally be correctly diagnosed and treated.

  4. What causes ADHD?

    Scientists are not sure what causes ADHD, although genetic and neurobiological factors are clearly involved. Health care professionals stress that because there is no known cause, it is far more important for a woman and her family to move forward with treatment and identify ways to manage her lifestyle in areas affected by ADHD than to search for a cause.

  5. Can stimulant medications be abused?

    Although stimulant medications are recognized as a safe and effective treatment for ADHD when taken as prescribed, these medications, like many others, nonetheless do have the potential for abuse. Stimulant medication has been misused by people without ADHD. They take these medications to increase alertness and focus but also to gain a "high." Substance abuse and dependence does not develop in people who take their medications as prescribed. You should discuss the risks and benefits of stimulant medication with your health care professional. If you have a history of substance or alcohol abuse, this should be discussed with your physician to choose the right course of treatment and medication.

  6. My relationship with my husband has suffered because of my ADHD. Is there anything I can do?

    Yes. Because adult women often suffer for many years without help for their ADHD, their personal relationships can become strained. Health care professionals usually recommend counseling for women and their families, along with medication treatments. A therapist can assist you and your family in finding better ways to deal with your ADHD and reduce the frustration of the non-ADHD spouse/family member.

  7. Is ADHD a learning disorder?

    No. ADHD is a specific psychiatric disorder that can occur with a coexisting learning disorder. Learning disorders do not, in general, improve with medication. Intelligence and ADHD are separate entities. People with ADHD can have a broad range of IQs. Regardless of IQ, most ADHD individuals feel frustrated at not living up to their potential because of the impairments.

Organizations and Support

Organizations and Support

For information and support on coping with Attention Deficit Hyperactivity Disorder, please see the recommended organizations, books and Spanish-language resources listed below.

Attention Deficit Disorder Association
Web Site: http://www.add.org
Address: 15000 Commerce Parkway, Suite C
Mount Laurel, NJ 08054
Phone: 856-439-9099
Email: adda@add.org

Attention Deficit Information Network (ADIN)
Address: 475 Hillside Avenue
Needham, MA 02194
Phone: 617-455-9895

CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder)
Web Site: http://www.chadd.org
Address: 8181 Professional Place, Suite 150
Landover, MD 20785
Hotline: 1-800-233-4050
Phone: 301-306-7070

Learning Disabilities Association of America
Web Site: http://www.ldaamerica.org
Address: 4156 Library Road
Pittsburgh, PA 15234
Phone: 412-341-1515

National Center for Girls and Women with AD/HD
Web Site: http://www.ncgiadd.org
Address: 3268 Arcadia Place NW
Washington, DC 20015
Hotline: 1-888-238-8588
Email: contact@ncgiadd.org

National Institute of Neurological Disorders and Stroke
Web Site: http://www.ninds.nih.gov
Address: NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Hotline: 1-800-352-9424
Phone: 301-496-5751

A.D.D. & Romance: Finding Fulfillment in Love, Sex, & Relationships
by Jonathan Halverstadt

ADHD: A Path to Success: A Revolutionary Theory and New Innovation in Drug-Free Therapy
by Lawrence Weathers

ADHD Handbook for Families: A Guide to Communicating with Professionals
by Paul Weingartner

The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child
by Michael Boyett

Put Yourself in Their Shoes: Understanding Teenagers with Attention Deficit Disorder
by Harvey C. Parker

Kids Health from Nemours Foundation
Website: http://kidshealth.org/parent/emotions/behavior/adhd.html
Email: PR@KidsHealth.org

Centers for Disease Control and Prevention
Website: http://www.cdc.gov/ncbddd/Spanish/adhd/whatisADHD.htm
Address: Centros para el Control y la Prevención de Enfermedades,
1600 Clifton Road
Atlanta, GA 30333
Hotline: 1-800-232-4636
Phone: 404-639-3311
Email: cdcinfo@cdc.gov

Last date updated: 
Wed, 2012-10-17

Stress Less in 7 Steps

woman laying on a hammock with a bookYou know the feeling: the more you do, the more it seems you have to do. As challenges mount in your work, relationships, finances and health—sometimes in several areas of your life at once—they can easily turn from trying to overwhelming.

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Natural Ways to Beat Depression

sad looking womanMisery doesn't love company. It also doesn't love sleeping well, or enjoying activities, or eating healthfully, or making hopeful plans. Misery is, well, miserable. And when sad, empty feelings continue for two weeks or more, you're not just feeling miserably—you may be depressed.

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Thursday, Jul 30th 2009

Is Divorce Bad for Your Health?

authored by Sheryl Kraft

Over the past few years, I've witnessed lots of people around me getting divorced. Most of the people I know suffer tremendous stress leading up to what is most times a very tough decision.

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Thursday, Apr 16th 2009

Midlife Transition? Here's Help.

authored by Sheryl Kraft

Amidst all the physical changes around at midlife, there's also that biggie - the emotional one: where do I go from here?

Perhaps your job has become tedious or un-rewarding...or the children you stayed home to raise have flown the coop (that's what happened to me before I made the decision to return to graduate school at 47 and carve out a whole new career).

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