For my dd the concerta for her ADHD is good.  I'm not saying something else might be better, but for now she (not me) explains it this way:

Her head is full of a wall of tv's all on different channel, all with the channels switching constantly.  When she takes the conerta, she can get them all to stay on the same channel.

My goal of course is to turn the tv's off.  But in the meantime, I think the stims do more good than harm.

And I ned to update my signature.  She is also now on 100 mg Equetro at night along with the abilify.

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Karenj

Self: as sane as I can be everyday
A - DD (17yo) well adjusted, high functioning, motivated, successful, waiting patiently to go away to college
M - DD (13yo) Mood Disorder NOS (dx 4/2011) ADHD (dx 2nd grade), dumb high IQ, mainstream education with 504 only but failing miserably, Abilify 7mg evenings, Concerta 36mg before school
BF - Live in boyfriend of 5 years, supportive and learning more every day
EX - Ex-husband, divorced since 2002, family history of bipolar, unpredictable and sometimes raging

 We had better luck with the focalin than using concerta, but it may have been that we did more tweaking with lithium and seroquel, and then used a lower dose compared to the concerta..

In referring to the treatment guidelines, it's generally best to treat the bp first, then the adhd.  In comparing the meds your dd is on to the treatment guideline protocol, seroquel is the only one that is a first or second line med, though generally, a normal psychotropic dose would be more in the 300-600mg range. Frequently, at doses your daughter takes, under 200mg, seroquel can make one sleepy. Often, the adhd symptoms will diminish when the bipolar is stable (unsure if it is or not by post).  Also, there's potential that stims or antidepressants can bring on cycling. I used them with my son, but even doing  a pretty careful juggling act with his combo to keep things working, still got caught with the luvox until we got the dosing and timing right.  It might be something to discuss with pdoc as well. 

There is some info on our CAM forum about food intolerances, micronutrients and adhd to consider also.

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Darryl - parent volunteer, dad to
Levi, 12, stable using supps and diet exclusively since June 07. Previously treated and stable with med combo inc. lithium, 900mg seroquel, and small amounts of risperdal, luvox and focalin after being dx'd at age 3 1/2.

My daughter is currently on Focalin XR and Intuniv.  Over time I'm finding that the Focalin is making her more manic and the Intuniv is making her depressed.  I am having lots of mixed episodes with my daughter lately.  I want to get her off of both of these but she can't focus without them and acts out and hurts other children.  My daughter is also on Abilify, but we're still working on the right dose for that.  I want to focus more on the bp, but since her psychiatrist believes she is only ADHD he has focused more on the inattention, even with all of the mood problems.  If your child's bp is stable this may not be the case.  If your child's bp is stable then I would suggest both if it is possible.  Intuniv really makes my daughter tired and that is why the Focalin XR was added.  The combo does wonders for her inattention, but it wreaks havoc on her mood. Good luck to you!

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Jessica Acevedo

Jessica,

The longterm effects of taking meds that cause instability in BP can be quite serious.  Have you considered taking her to another pdoc for a second opinion? 

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Brenda,51, TBMF Parent to Parent Volunteer
Mom to A, 17 1/2, BP, Tourette's, OCD, ADHD: Eskalith CR, Lamictal, Cytomel, Allegra
E, 16, BP,AS: Seroquel, Eskalith CR, inositol, Buspar
B, 14 1/2 & H, 11 1/2
Married 18 years to DH, 51

FROM TBMF: Do not start, stop, or change medications or other treatments for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.

Brenda,  I have just recently switched our pdoc to a nurse practitioner.  She is willing to work with us and is looking at the possibility of BP.  This is great news for us.  She still feels that the stimulant is good for her at school, but has taken her off of the Intuniv.  She says we'll need to increase the Abilify drastically to counteract the negative effects of the stimulant and to regulate her mood.  Maybe when she becomes more stable she won't need the stimulant at all.  Thanks for your concern.

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Jessica - BP2, Pristiq, Abilify, Lamictal, Xanax - Vegan diet
DD - Lilli ADHD w/ ODD (close to EOBP DX) (5) Abilify, Focalin XR
Delayed Development
Regular Kindergarten with IEP
Maryland