Question:
Dear Doctor,
I have BPD, GAD, and dysthymia. I have
always wondered however if I also had
ADD. I am 50. I am receiving
treatment at a VA facility. After nine
years, I got a psychiatrist who was willing
to try an ADD med. She prescribes 15 mg
twice a day of dextroamphetamine. She
didn't give it because she believes I
have ADD but because my inertia was so
great.
I now have just enough energy to get out of
bed. Still, I can't stay focused in
general. Though, as was stated in your book,
sometimes I have laser-like attention. I
have wanted to have the medication increased
but am afraid to ask because I'm afraid she'll
worry about dependence.
Is there any way to test if I have ADD as well
as BPD etc.?
Also, I was an incorrigible liar as a young
person and teenager. Any insight?
Thank you.
Dear Doctor,
Sorry I left out these facts in my other
email ot you. In that e-mail I wanted
to know if there was some test that could
be done to see if I have ADD as I for some
reason believe that very strongly. However,
I have been diagnosed with BPD, GAD, and
dysthymia.
I currently take citalopram 40 mg/day and
dextroamphetamine 15 mg 2 times per day. I
wanted to ask my doctor at the VA if she
would increase the dose of ADD meds to see
if it would help my inability to stay on
track with anything. Perhaps they are
right and this is just part of my BPD but
somehow deep in my gut I wonder if the ADD
was there when I was a child and people didn't
know about it then.
I wonder if the constant failures lead to the
depression. Sure wish there was some
biological test that could be done to
check. I want to know for peace of
mind and so the best treatment can be done
for me.
I am 50 and my life has been a mess for as
long as I can remember. I appreciate
your taking the time to answer me.
Thank you.
Dr. Heller's Answer:
BPD and ADHD are frequently
diagnosed in the same person. I strongly
suspect they co-exist as much as 50% of the
time. There are articles in the literature
that back up their frequent comorbid
coexistence, but no actual statistics are
available that I'm aware of.
I'm a firm believer that everything a patient
has wrong, makes everything else they have
wrong, worse. A classic symptom of
ADHD is impulsive aggressiveness (getting
angry too quickly). Since borderlines
can turn impulsive aggressiveness into a
rage, getting the ADHD under control seems
a wise course, as long as they're not abusing
the drug.
I generally prefer Vyvanse, which has a much
lower abuse potential. The dosing is
controversial. I greatly respect Dr.
Biederman's advice, and I agree that higher
doses are needed for most patients. For
Adderall XR he advises 0.5-1mg/kg (divide
your weight by 2.2 to get the maximum
dose, by 4.4 to get the lower dose). The
equivalent for Vyvanse would be to multiply
the Adderall XR dose by 2.34. Some
patients need less, some actually need
more. It's individualized and the dose
and type of ADHD medication is adjusted to
the person and their comorbid conditions.
Dr. Biederman, Professor of Psychiatry at
Harvard advises higher doses of stimulants
when needed for successful ADHD treatment
in adolescents and adults. In
"Today's Therapeutic Trends"
20(4):311-328, 2002 Dr. Biederman wrote:
"It should be reiterated that
stimulant medications are considered to
be very safe, and that dosage titration
should continue until an adequate dose
is reached, if tolerated. The
large therapeutic window associated with
these agents indicates that there is a
wide dosage range for their safe
use...under-dosing in older adolescents
and adults is a significant problem...."
- page 324.
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