ADHD and Menopause

Many women with AD/HD report an increase in AD/HD symptoms when they enter perimenopause and menopause. Medications that were once effective for AD/HD may not work as well. Estrogen influences neurotransmitter systems and the levels of neurotransmitters (dopamine, norepinephrine, and serotonin) involved with AD/HD as well as depression and anxiety.

Someone with AD/HD already has dysfunction of neurotransmitter systems in the brain, which are only magnified when estrogen levels begin to fall in the perimenopausal period causing further dysfunction. Many women complain of memory problems, mood changes (sad, irritable, worried), hot flashes, sleep problems, memory problems, and problems with mental clarity during the years prior to the onset of menopause, which add to symptoms related to AD/HD.

Some women report increased symptoms of AD/HD during any low estrogen state: with increased hormonal fluctuations when girls enter puberty, in the premenstrual period, the postpartum period, and with the onset of menopause, and may report a decrease in AD/HD symptoms during pregnancy and while nursing, when estrogen levels are high. To make matters worse, some women with AD/HD entering perimenopause have a teenage daughter with AD/HD entering puberty!

Comprehensive treatments are often indicated for women with AD/HD whose symptoms are increasing during the perimenopausal period and during menopause.

Sometimes an increase in stimulant medications is effective, but sometimes it is not as some studies have found the response of stimulants to be related to estrogen levels (a better response with higher estrogen levels). Sometimes, estrogen replacement is beneficial, especially in women who not only have a worsening of AD/HD symptoms, but a significant worsening of mood.

However, risks versus benefits must be considered with estrogen replacement. Since falling estrogen levels influences the neurotransmitter serotonin, SSRI antidepressants that increase serotonin are often helpful for depression and anxiety (which can increase inattention and distractibility).

In summary, treatment of increased symptoms of AD/HD during the menopausal period often consists of some combination of a stimulant medication, an SSRI antidepressant, and sometimes short-term estrogen replacement. There are many other things to do about symptoms related to menopause which can be found on WebMD and on www.healthewomen.com.

It's extremely important for women with AD/HD to find a physician who is not only knowledgeable about AD/HD, but is knowledgeable about AD/HD in women.

Dr. Richard Sogn

Related Topics: WebMD Video: Menopause Myths, WebMD Video: Is it ADHD or Vision Problems?

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Bipolar Disorder in Children

Bipolar disorder in children is often confused with AD/HD. Because of overlapping symptoms, it's often extremely difficult to differentiate bipolar disorder from AD/HD, and it's not uncommon for someone to have both disorders.

The younger the child, the more difficult it is to diagnose something like bipolar disorder, as younger children tend not to have discreet cycles and other symptoms as do adults.

Bipolar disorder is both under diagnosed and over diagnosed. Most children with "rages" do not have bipolar disorder--the best description of these children is in the book, "The Explosive Child," by Ross W. Greene, Ph.D. This is the best book about children who are difficult, inflexible, and explosive.

The best description of bipolar children is in the book, "The Bipolar Child," by Demitri and Janice Papolos, although many children with severe AD/HD would be called bipolar following their classification. Another book that might help sort things out is, "It's Nobody's Fault," by Harold Koplewicz, M.D. Dr. Koplewicz describes common psychiatric problems in children, as well as their treatment.

Many children who are severely hyperactive and rageful as children, and are diagnosed as having bipolar disorder as children, often do not have the diagnosis as young adults. When there is doubt about diagnosis, a slow reduction in medications that potentially have significant side effects is a reasonable option.

When bipolar medications are suddenly stopped or decreased too quickly, bipolar symptoms often return very dramatically. Unfortunately, if a child is seen by ten different doctors, there might get ten different responses. The best thing to do is:

1. Read everything available to educate yourself as much as possible (you need to become the expert)
2. Talk to other parents who have experienced similar difficulties
3. Find the best therapists and psychiatrists you can find that are willing to work with you in a collaborative way to arrive at a diagnosis.

There are no easy answers, and these problems are something that require educating yourself and doing what you feel is in the best interest of your child throughout his/her childhood.

Related Topics: Is it ADHD or Bipolar Disorder?, A Ride on the Bipolar Rollercoaster

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Anger and ADHD

There are many potential reasons for anger. When related to ADHD, it's often related to a low frustration tolerance.

People with chronic anger often grew up in angry homes and may have experienced verbal or other abuse. Irritability can be a symptom of depression, anxiety, or some medical problems such as thyroid problems or sleep disorders.

Your ability to express yourself on paper better than verbally is because different parts of the brain are used for verbal versus written expression. You also have time to think things through when writing, while it's sometimes hard for people with ADHD to orgainze their thoughts quickly while speaking.

Sometimes a small dose of an SSRI antidepressant is added to an ADHD medication to treat a moody, irritable component to ADHD. You could also see a therapist who is experienced in treating ADHD to help sort out the source of your anger and to develop better coping skills.

Related Topics: ADHD Medications Chart, Combined ADHD Treatment Lowers Need for Drugs

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