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Paradoxical Drug Reactions - Alcohol / Benzodiazepines

I recently took an online survey and believe that I have adult ADHD. The psychiatrist I spoke with said it was Bipolar II primarily on the basis that I didn’t have paradoxical drug reactions (a glass of wine relaxes me (doesn’t make me wild) and benzodiazepines work as prescribed (relax me).

He strongly believed that the lack of this effect completely ruled out ADHD. I saw nothing in the DSM criteria online that mention this effect. Is this a legitimate “determinative” factor in diagnosing adult ADHD?



There may be some anecdotal evidence to that diagnostic method, but I’m not aware of it. This article explains how to get an accurate ADHD diagnosis: As with any medical situation, if you are unsure of your physician or diagnosis, seek a second opinion.

ADDconnect Moderator, Author & Mom to Tween Boy with ADHD and LDs

Posted by adhdmomma on Aug 19, 2014 at 12:27pm

I’ll go one step further—what on earth is that idiot talking about and what cereal box did he find his medical degree in?

The “paradoxical reaction” is with STIMULANTS.

This so infuriates me—there is some pathological objection to making an ADHD diagnosis, and it gets mislabeled as everything else.

I firmly believe that at least a third of the young women in college labeled with “depression” actually have Inattentive ADHD—I’ve seen too many of them that don’t have the attention span to be depressed.

Dr. Ed’s quick test—if I can make them smile, even if for just an instant, it’s not depression.

Posted by Pirate on Sep 05, 2014 at 7:17am

You may or may not have ADHD, you need to see a specialist in ADHD, to help you find out.

Actually in my case, strong to large doses of alcohol or benzodiazepines do have paradoxical reactions to a degree- I become very hyped up and out of control.

It is important you get the correct diagnosis. Because such matters are subjective, they can always be wrong. Only time and perseverance will truly reveal to you the true nature of your difficulties.

Posted by Michael Freeman on Sep 04, 2015 at 10:47am

I counter your opinion regarding the paradoxical reaction is only for stimulants.  I’m diagnosed ADHD & I have a paradoxical reaction to most medications.

Alcohol is a stimulant for me, it’s like drinking cocaine.. I get totally wired & can’t sleep.  Modafinil (provigil) mellows me out & snaps me to attention.. and it’s a serious stimulant.

Benzodiazepienes are a major stimulant for me.  I take them & I get VERY wired, the reason I’m up at 2:36am instead of being lights out like I should be.

Posted by Bayberuth on Mar 30, 2017 at 9:39am

I also challenge the idea of paradox, especially as a diagnostic criteria, unless it is a small piece of the puzzle and there is more to it.

For example, if I am suspecting anxiety and not ADHD-Hyperactive, and I find out that stimulants make symptoms worse, it supports my suspicion, but I would not consider it conclusive on its own.

I have never seen anything in research that supports this.However,  psychopharmacology is not my scope of practice, nor is it something that I have done a deep dive in researching.

When most people talk about paradoxical effects, it has been on the superficial level of, “I take a stimulant, and it appears to mellow me out.”

When you look at the brain impact, “I take a stimulant; it activates my prefrontal cortex and my impulse control and executive functioning work better.” This is not a paradox.

Posted by Dr. Eric on Mar 30, 2017 at 1:45pm

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