Concerta and Bipolar Disorder

Concerta (methylphenidate HCI) is a long-acting stimulant medication approved to treat Attention Deficit Hyperactivity Disorder (ADHD) in adults and children. A growing body of research suggests that Concerta may also be helpful in bipolar disorder, a psychiatric condition marked by extreme high and low moods. According to the National Institute of Mental Health, bipolar disorder--once called "manic depression"--affects approximately 5.7 million American adults.

Description

• Unlike short-acting stimulants, Concerta is only taken once a day.

  Concerta is an extended-release preparation of methylphenidate, the same drug found in Ritalin. It is usually taken once a day, in the morning, and is available in 18-mg, 27-mg, 36-mg and 54-mg tablets. Typical doses range from 18 mg to 72 mg per day.

Indications

• Concerta may help with depression that hasn't responded to other treatments.

  If you have bipolar disorder, your doctor may suggest a stimulant such as Concerta for treatment-resistant depression or for sedation caused by other medications. If you have co-occurring ADHD and bipolar disorder, Concerta may also help with the distractibility and hyperactivity often found with ADHD.

Co-occurring ADHD and Bipolar

• Your doctor may recommend Concerta for bipolar disorder with ADHD.

  According to a review by Arnold L. Lieber, M.D., patients with co-occurring ADHD and bipolar disorder are usually first treated with a mood stabilizer (lithium or an anticonvulsant medication) and an antidepressant. If this is unsuccessful, physicians might try combining a mood stabilizer with a stimulant such as Concerta.

Bipolar Disorder

• Recent research on Concerta in bipolar disorder has been promising.

  Recent studies have shown promise for stimulant use in managing depression and medication-induced sedation in bipolar disorder. In a 2004 paper by Carlson and colleagues, methylphenidate as an adjunctive (additional) treatment provided "substantial improvement of overall bipolar illness," and the stimulants were well-tolerated. Several other studies have also found support for stimulant use in bipolar disorder.

Mania

• Mania can begin as a pleasant experience but can progress to psychosis.

  Stimulants can precipitate mania even in people with no history of bipolar illness. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), calls this a "Substance-Induced Mood Disorder"; it is also sometimes called "Bipolar IV," although this is not officially a clinical subtype. This type of mania usually abates when the medication is withdrawn.

Warning

• To help manage bipolar disorder, keep track of your moods each day.

  Because of the risk of mania, if you have bipolar disorder and take Concerta, you should keep close track of your moods and stay in close touch with your psychiatrist during treatment.