Q:  Running Out of Options - Stimulants?

Although my 16 yr old has been dx with bipolar, we have had him on just about all the meds for this group to no avail.  We  as parents never really believed he  fit the dx that well. We do know he  fits ODD to a tee.  Are we out of line to ask about the amphedamine group of drugs because we are running out of options. Would one month be too much to ask for?

Thank You,
Outofmind
 

Dear Mr. O' -- 
There's an old maxim in medicine: when treatment fails, re-examine the diagnosis.  So what you're advocating here is definitely justified on that basis.  On the other hand, to my knowledge mood stabilizers have not been shown nor suspected to make ODD worse (probably the opposite is true to a degree).  By comparison, the stimulants have been discussed as capable of making bipolar disorder worse; not as clearly the case as it is for antidepressants, but it's been a concern.  So, on that basis, it would make sense (perhaps as his doc' has done) to lean away from the ODD hypothesis based on another famous medical maxim: primum non nocere, first do no harm.  Now you're probably in a position to say, okay, we've leaned one way, can we try leaning the other and see what happens, knowing you may be taking some risk of making something worse that hasn't been worsened, at least, so far (not better, perhaps, but not, hopefully, worse; that's an odd yardstick by which to measure our work, I'll grant you).  

Balancingly yours,
Dr. Phelps

Published July, 2002