HOW DO YOU TREAT ADHD WHEN I HAVE THE BPD? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
HOW DO YOU TREAT ADHD WHEN I HAVE THE BPD? 
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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