![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 46. This is the beginning of the thread.
Posted by JonW on July 1, 2002, at 8:47:41
Hi,
I can appreciate the similarities between GAD, ADD w/ agitation, and Bipolar II. My agitation, irritability, and some sense of internally driven moods have led myself and my pdocs to believe I have some form of bipolar disorder, but I really think questioning this and diagnosing me with ADD (hell, why not? I've got 'em all!<g>) should be entertained. I've recently read parts of 'Driven to Distraction' and identify well with this diagnosis. However, I think ADD is one of those things that nearly everyone could identify with at least some symptoms. My most indicative symptoms are these:
* Aversion to reading. I drift off while reading and nearly always have to reread this or that paragraph several times. I drift off during conversations with other peole as well. I often have to ask, "what did you say?" right after they say something. The greatest problem and difference between myself and others my age is that I cannot read without superhuman amounts of discipline.
* I have a history of being described as an underachiever as a child. I was always going on 'flights of thought' in the classroom. One of my teachers remarked that I wouldn't wake up until 10:00am. I was diagnosed with ADD when I was like 14, but my diagnosis has changed or at least changed focus since then.
* Difficulty getting to sleep. Difficulty waking.
* Impulsivity. I answer questions before they are done being asked or finish other peoples sentences. I talk over the person asking the question, assuming I know what they are asking because I want to talk. I've learned to cope somewhat and wait when I feel this urge so I'm not sure if this is a symptom.
* Mood lability. Also can have an entire day or two of a *really* bad mood.
* Sensitive to external stimuli. A lot of sounds give me cold blood, and certain sounds like someone chewing make me want to kill them! Sensitive to other's idiosyncracies. At the same time, I love certain things -- like the smell of a new book (too bad I can't read it!<g>)
* There are other little things... like being left-handed, seeking high-stimulation (yet I don't think I'm hyperactive), always getting lost (once it took me 3 hours to find a place that was 20 minutes away), and when I was working I would often make 3 or 4 trips in the morning from my car to the house before I left because forgot some things (sometimes the same thing<g>)
I've taken Ritalin, Adderall, and Dexedrine at different times during my life. I don't recall my experience on Ritalin. I've taken Dexedrine recently and it was notable for one thing in particular -- it seemed somewhat calming and to completely extinguish my irritability and sensitivity to other's idiosyncracies. Other people were more pleasant to be around and I was more pleasant to be around. It was somewhat euphoric (by my standards, at least) so maybe that's all that explains it. Unfortunately, it gave me insomnia and horrible depression when comming out of the system. Adderall was less of a problem for causing depression but it may not have been quite as effective. When on the Dexedrine I seem to have less trouble with reading -- and my parents even say I read a lot more when I took it. Anyway, what do you think? Does this sound like ADD? I know it's a horrible idea to diagnose yourself and easy to find something when you are looking for it... I know GAD can cause restlessness, agitation, fatigue, irritability, and trouble with concentration and sleep. Could this explain the symptoms I'm having? I definitely have atypical depression + social phobia. Could this or possibly bipolar disorder explain these symptoms? Your thoughts are much appreciated!
Thanks,
Jon
Posted by mist on July 1, 2002, at 10:00:34
In reply to ADD, differential diagnosis help ???, posted by JonW on July 1, 2002, at 8:47:41
As far as I know there is no way to differentiate until you try medical and other treatments for whatever disorders you think you have, and see how you respond to them.
Most people who have ADD can recognize themselves in the symptoms. Supposedly you can tell for certain by how you respond to stimulants, but other factors may come into play with that.
I have unipolar depression and social anxiety (at least) but I know I have ADD because I have so many of the symptoms and have had them since childhood. (Mine are different than yours though. For example, I usually don't have a problem reading, if anything I sometimes go into an almost trancelike state when I read—which I suppose is hyperfocusing—but it's often hard for me to sit through movies and follow the plot. I get restless and uncomfortable and I start to space out and lose track of what's happening. Sometimes I just want to jump up and leave, even in movies that others are enjoying. I also feel this way with desk work. I have get up and walk around much more frequently than others do. I have restless energy.)
When I first started looking more deeply into what ADD was, many things about my life began to make sense and I felt much better. At the same time, I'm not exactly sure where the depression stops and ADD begins (especially since I have symptoms of Limbic ADD among other subtypes).
The way I've decided to approach it is to try meds for it (when I get around to it, he-he I do have ADD after all), and try to manage the symptoms that interfere with my functioning. The symptoms can get better or worse depending on what you do. For example, I want to find activities that will help me concentrate, even mindless ones, just so I can improve my concentration.
(I'm also pretty sure meds would do something for me since L-tyrosine did.)
By the way, I don't think ADD is really a disorder. It's just that people with it aren't best suited to the type of society most of us posting here live in, and if the "symptoms" are really bad it can interfere too much with your life.
Posted by Fuscia on July 1, 2002, at 12:37:21
In reply to ADD, differential diagnosis help ???, posted by JonW on July 1, 2002, at 8:47:41
Hi Jon the poet,
I have all my old report cards. I seem to have problems in school that started in the 2nd grade. My teacher wrote "is very disruptive in class, talks out of turn, doesn't understand concepts". Anyway, I read this and am so surprised that this is me that I am reading about. I always thought I was the scared shy kid. I also began to masterbate at this time, which seems awful early. Usually girls start to experiment when they are about 10-11 years old. I have six older brothers, one of which has schizophrenia - lots of turmoil through growing up years. I can still see my dad chasing one of my brothers down the road yelling "I'm going to kill you". My dad used to tell us to our face that he wish we were never born. Ah, so is life.
It is good to see you question your diagnosis. It can take years to properly diagnose bi-polar depression, and there are so many grey areas which can come about as our life experiences. I have a friend that is a rapid cylcer bi-polar - days start out very depressing, don't want to get out of bed, and then are pretty high by late afternoon. SSRI's worked pretty well the first month, then not at all afterward. He also has road rage. Another friend was diagnosed with bi-polar and it turned out to be underactive thyroid and estrogen dominance.
Anyway, I was curious, are the above listed symptoms prior to the meds you are currently taking? Do you have any impulses? Shopping? Sex? Aversion to sex? Substance abuse? How does caffeine effect you? How about sugar or bready sugar foods, like doughnuts, waffles, and other simple carbs? How do you do when you're all by yourself? There's lots more questions I could ask, but I don't want to be too nosey ; )
Fuscia
Posted by katekite on July 1, 2002, at 15:13:00
In reply to ADD, differential diagnosis help ???, posted by JonW on July 1, 2002, at 8:47:41
Hi Jon,
There is something called a "continuous performance test" that would be administered by a psychologist. See if you can get evaluated with it. That was what initially led to me trying stimulants (it said I most likely had ADD).
That test discriminates pretty effectively people who have ADD from those who do not. The test is basically some numbers or letters flashing on a computer-like screen. For example, one at a time: A B A C D A D etc. The task is to press a button every time an A follows a B, but not when you see an A the rest of the time. Various versions of the test are out there. In some it gets faster as it goes along, or harder with distracting colors or shapes flashing around. Most people with ADD make many mistakes: hitting the button for too many As (which is showing you are impulsive) or not hitting the button in time when an A comes on (shows you weren't paying attention). Since the two major facets of ADD are being impulsive and not paying attention the test works quite well.
The downside of the test is expense: its just a silly computer which (in my case) looked like it was made in 1960, but apparently it takes a skilled person to interpret it and they can charge. My insurance actually paid, which is rare. It might be worth it out of pocket to rule it out if it can be ruled out.
kate
Posted by IsoM on July 1, 2002, at 18:51:38
In reply to continuous performance test (cpt)., posted by katekite on July 1, 2002, at 15:13:00
This is one of the tests that were administered to me for ADD. It was amusing that when things were boring, I made far more mistakes. I actually thought I was paying attention but apparently not - my mind & attention was wandering. When it was sped up I did quite well. It shows how much better I respond to fast paced jobs or when I DO pay attention, even if I had thought I had before. :-)
It is a silly, long, boring test seemingly pointless but it's often used by trained psychologists in diagnosing ADD.
Posted by katekite on July 2, 2002, at 10:38:37
In reply to Re: continuous performance test (cpt). » katekite, posted by IsoM on July 1, 2002, at 18:51:38
I couldn't tell from you message if you thought the test helped the psychologist to decide yes or no on whether they thought you had ADD, or not. I'm sorry I don't recall whether you take stimulant meds or not -- do they help you? Thanks, kate
Posted by JonW on July 2, 2002, at 10:52:09
In reply to Re: ADD, differential diagnosis help ??? » JonW, posted by mist on July 1, 2002, at 10:00:34
> Most people who have ADD can recognize themselves in the symptoms. Supposedly you can tell for certain by how you respond to stimulants, but other factors may come into play with that.
Hi mist,
Thanks for the reply! How are you supposed to respond to stimulants? Doesn't everyone get more focused on them? Dexedrine is relaxing for me as well but not like when people here describe stims putting them to sleep. It also improved my mood at first. At the end of the day isn't an improvement in your quality of life all that matters?
>an almost trancelike state when I read—which I suppose is hyperfocusing—but it's often hard for me to sit through movies and follow the plot. I get restless and uncomfortable and I start to space out and lose track of what's happening.
I've "hyperfocused" on occassion but it must be something I'm interested in. I have a hard time sitting through a movie unless I'm interested, and even if I'm interested, it's gets difficult after about an hour or so. Maybe that's typical, though...
>Sometimes I just want to jump up and leave, even in movies that others are enjoying. I also feel this way with desk work. I have get up and walk around much more frequently than others do. I have restless energy.)
I *definitely* feel this way! Unless I'm solving some tricky problem that my co-workers couldn't solve or something like that -- I'm a computer technician. When I was working I would take on average about 20 to 25 useless walks away from my desk a day, but my work never suffered and my boss loved me.
Thanks again for the reply!
Jon
Posted by mist on July 2, 2002, at 10:59:46
In reply to ADD, differential diagnosis help ???, posted by JonW on July 1, 2002, at 8:47:41
When I called some psychologists and a psychiatrist several weeks ago about getting an ADD diagnosis this is what they told me:
The psychiatrist I talked to diagnoses it without any tests. Just talks to the patient in a session and if it sounds like they have it, prescribes something. (This sounded preferable to me as the tests are expensive.) It's my understanding that this is generally how psychiatrists diagnose ADD.
One psychologist specializes in ADD clients, runs groups for them, etc. but does not diagnose. If someone wants an official diagnosis he sends them to someone who does the testing (another psychologist, I believe).
The one who does the ADD testing specializes mainly in tests of various kinds (learning disabilities, etc.).
I also went to an ADD support group. Some of those present had a formal diagnosis, others not.
By the way, there are also on-line tests. (When I took one, the results said it was "highly probable" that I have ADD.)
That was my experience in exploring how to get formally diagnosed. (Which might be useful for insurance purposes?) (Since I don't have health insurance at the moment, in my case I wasn't worried about it.)
Posted by JonW on July 2, 2002, at 11:04:36
In reply to continuous performance test (cpt)., posted by katekite on July 1, 2002, at 15:13:00
Hi Kate,
I took a test like this when I was younger where an 'X' would flash on the screen at random and at random locations and you were supposed to press the space bar every time you saw an 'X'. Anyway, that test showed that I had ADD, but my pdoc at the time wasn't sure if I had ADD or not. My suspician is that since I suffer from several conditions and since at the time this wasn't known, he was left a little baffled -- plus he was an idiot and easily baffled! ;) At the same time, perhaps these other conditions caused me to score on the test in a way that indicated ADD. I don't know... my inclination is to see if my pdoc will prescribe a stim and see what it does before taking an expensive test but it would be nice to know for sure. However, is there really such a thing as for sure? Thanks for the suggestion!
Jon
Posted by mist on July 2, 2002, at 11:14:03
In reply to Getting diagnosed, posted by mist on July 2, 2002, at 10:59:46
I don't know anything about them, though and doubt they are necessary when there are other ways of determining if you have it.
Posted by mist on July 2, 2002, at 11:24:24
In reply to Re: ADD, differential diagnosis help ??? » mist, posted by JonW on July 2, 2002, at 10:52:09
>How are you supposed to respond to stimulants? Doesn't everyone get more focused on them? ... At the end of the day isn't an improvement in your quality of life all that matters?
The way I look at it, if they help you they help you--whether they make you more relaxed, focused, or whatever. I would probably try them just for depression even if I didn't have ADD symptoms, but if you think you have ADD it makes even more sense to try them (if you want to go the medical route).
I was less restless when I took L-tyrosine (which had the effect of a stimulant on me) not because it made me relaxed but because it helped me to focus.
Posted by JonW on July 2, 2002, at 12:34:41
In reply to Re: ADD, differential diagnosis help ???, posted by Fuscia on July 1, 2002, at 12:37:21
> Hi Jon the poet,
Hey, your nickname alone is far more poetic than I'll ever be! :-)
> It is good to see you question your diagnosis. It can take years to properly diagnose bi-polar
I understand it takes like an average of 8 years from the first report of symptoms and 2 to 3 pdocs to get a correct diagnosis of bipolar disorder. Sometimes I think my symptoms are the result of bipolar disorder and sometimes of ADD. It seems more like ADD, but I don't know a lot about differential diagnosis. I'm not sure how much it matters at this stage of the game.
>have a friend that is a rapid cylcer bi-polar - days start out very depressing, don't want to get out of bed, and then are pretty high by late afternoon. SSRI's worked pretty well the first
I'm dead in the morning (slow, depressed, low energy), and I'm a noticeably better by say 10:00am. I have trouble falling asleep (Nardil has made this worse) and trougle waking. I wouldn't describe anything I experience as "high". I feel like I suffer more from mood lability and less from mood cycling. Any so-called cycle certainly wasn't and isn't too profound in terms of "high" and "low" -- but I've definitely always had sleep problems, trouble getting to sleep, trouble waking. By the way, my mood is very sensitive to sunlight. Agitation and irritability have definitely been a *big* problem and are usually aggrevated by anti-depressants. Should I be called bipolar simply because of this reaction to anti-depressants? What do you think? Please ask any questions you want...
> Anyway, I was curious, are the above listed symptoms prior to the meds you are currently taking? Do you have any impulses? Shopping? Sex? Aversion to sex? Substance abuse? How does caffeine effect you? How about sugar or bready sugar foods, like doughnuts, waffles, and other simple carbs? How do you do when you're all by yourself? There's lots more questions I could ask, but I don't want to be too nosey ; )
Please, be as nosey as you want and ask as many questions as you like! I'm open to anything that could ultimately lead to insight. As for the questions you asked... Yes, the symptoms I described precede being on medication. If anything, I would describe myself as hyper-sexual -- but I have severe social phobia, so you do the math! ;) I *love* carbs! French toast is one of my favorites! When I was a kid I used to eat sugar from the packets at restaurants, my parents would have to stop me. I hate being alone and I hate being bored. If I'm alone or bored I'll often go out in my car for a drive.
Thanks for the reply! You've been very helpful.
Jon
Posted by MomO3 on July 2, 2002, at 13:02:49
In reply to Bipolar or ADD??? » Fuscia, posted by JonW on July 2, 2002, at 12:34:41
Hi Jon,
I have been struggling with the Bipolar vs. ADD question recently too... It sounds like you and I are much the same page right now.
I took prozac for the better part of 9 years but rarely for more than 2-3 months at a time. Several months ago I got pdoc to diagnose ADD and I have gone thru the standard pstims - I liked them ok, but the resulting irritability and anxiety were unbearable.
For 2 months I was taking neurontin, dexadrine & paxil in the morning, and neurontin & xanax at bed. I was also mood charting (not at Dr req, but just for personal discovery). About a month into this combo, I felt *great*, I was happy, active, motivated, peaceful... then things started to come apart, and the mood chart showed it.
I would grog in the a.m. as always - after 1st cup of coffee I would feel ok, then I got very overactive, over-focused, irritable, and didn't accomplish much. By 2pm I would sometimes have an anxiety attack followed by a crash, or just a plain crash. I was so depressed I couldn't move... couldn't cook, clean, I would literally crawl back to the babies room to change diapers, and then lay on the floor when I was done. I would go to bed and repeat the same the next day... this went on for atleast a week... I felt like I was about to come un-glued. (Does this sound like mixed-states bipolar?)
In desperation I switched all of my meds... I switched from a low dose of dexadrine to a higher dose of concerta (leftover in the cabinet) - I switched from paxil to celexa - and basically caused a "switch" to a hypomanic state, with restlessness and insomnia.
I told Pdoc about all of this and he upped the neurontin dosage, and has made me swear off the SSRIs completely... My new cocktail is neurontin + ritalin in the am - sometimes ritalin at noon, and neurontin + klonopin at night. I am now usually overfocused, and battling a lurking depression. Yesterday I forgot the ritalin and was on the floor at noon... so I guess the ritalin is my anti-depressant now? I just don't know anymore....
Although I am leaning towards bipolar, I am really afraid to get that diagnosis because I don't want to take lithium or anything that will make me any fatter than I already am...
What meds are you taking (sorry if you already posted that I am just back after a psycho-babble sabatical).
Thanks!
Mom
Posted by JonW on July 2, 2002, at 13:04:45
In reply to Re: ADD, differential diagnosis help ???, posted by Fuscia on July 1, 2002, at 12:37:21
Hi Fuscia,
I forgot to answer a couple of your questions... must be the ADD ;)
I have a craving for alcohol. I gave it up because it makes my depressed a couple of days after I get drunk (mood elevated the morning after, though), but I used to binge drink every weekend. To this day, I crave beer when I think about it. I don't think I'm an alcoholic or anything but alcohol and I definitely have a special relationship. I avoid caffeine, too. But as I remember, drinking coffee always used to result in me cleaning or organizing. Not really in a hypomanic way but maybe in a good way. However, my impression was always that it was a very extreme reaction and that I was very sensitive to caffeine.
Jon
Posted by Noelle on July 2, 2002, at 22:15:17
In reply to Re: continuous performance test (cpt). » IsoM, posted by katekite on July 2, 2002, at 10:38:37
How do you find this continuous performance test
Posted by IsoM on July 3, 2002, at 0:11:36
In reply to Re: continuous performance test (cpt). » IsoM, posted by katekite on July 2, 2002, at 10:38:37
Kate, the psychologist did decide that I had ADHD but he said even more extensive tests were necessary to gain a "full" diagnosis even though the forms filled out, family history, & the cpt showed very strong indication of ADHD. But I wasn't willing to shell out $300-$400 for the full thing. I figured it was a good enough indication for me.
Yes, I take adrafinil (but it also helps greatly with my narcolepsy) & occasionally I'll take Dexedrine too but I don't need it that often since I've being on adrafinil. SSRIs have served to curb the impulsive side of me. I've never been impulsive about shopping (not enough money perhaps?) or some of the other things that affects others, but with me, speech & ideas were the part I had trouble controlling. I'd often talk out of turn, answer questions before they were finished, finish other's sentences, & just blurt out silly comments before I'd always think of other's reactions.
Now, I'm very well behaved :-) & have learned a great deal of self-control that I think would carry over into normal life even without any meds. But then I'd end up VERY down again & I've gone through that too many times to try again without.
Posted by IsoM on July 3, 2002, at 0:16:52
In reply to Re: continuous performance test (cpt)., posted by Noelle on July 2, 2002, at 22:15:17
Noell, it's a simple software program that a psychologist buys & administers to his clients when asked for an ADD diagnosis. The test is simple but a person needs to be trained to interpret it & so a psychologist who's familiar with ADD is the one who'd have it. You'd need to make an appointment with such a psychologist to be able to take it & get the proper results read from it.
Posted by JonW on July 3, 2002, at 9:52:52
In reply to Re: Bipolar or ADD???, posted by MomO3 on July 2, 2002, at 13:02:49
> Although I am leaning towards bipolar, I am really afraid to get that diagnosis because I don't want to take lithium or anything that will make me any fatter than I already am...
Hi Mom,
I'm a guy and I don't like weight gain so I can only imagine how frustrating that must be for a woman. But at the end of the day, wouldn't you rather be fat and happy? ;-) The truth is not all meds for bipolar cause weight gain. For instance, this is rarely a side-effect for trileptal, lamictal, seroquel, and geodon.
> What meds are you taking (sorry if you already posted that I am just back after a psycho-babble sabatical).
I'm currently taking nardil + risperdal + depakote + neurontin. *All* of these cause weight gain and I've gained about 15 pounds. However, I started riding my bike 3 days ago and am starting to whip myself into shape and have lost 3 pounds already. I'm thin to begin with so it's not a major problem, but anyway...
I've been reading both 'Driven to Distraction' and 'The Bipolar Child' to try to help me answer the question "Is it bipolar or is it adhd?" I would suspect that you have bipolar disorder rather than adhd. Bipolar has nearly all of the symptoms of adhd. Have you been this way since childhood? Here's a list of the 'very common' symptoms seen in childhood onset bipolar disorder according to 'The Bipolar Child':
Separation anxiety, rages and explosive temper tantrums lasting up to several hours, marked irritability, oppositional behavior, rapid cycling(frequent mood swings, occurring within an hour, a day, or several days) or mood lability, distractibility, hyperactivity, impulsivity, restlessness/fidgetiness, silliness, giddiness, goofiness, racing thoughts, aggressive behavior, grandiosity, carbohydrate cravings, risk-taking behaviors, depressed mood, lethargy, low self-esteem, difficulty getting up in the morning, social anxiety, oversensitivity to emotional or environmental triggers.
Jon
Posted by katekite on July 3, 2002, at 10:49:18
In reply to Re: continuous performance test (cpt)., posted by Noelle on July 2, 2002, at 22:15:17
Ask a doctor or pdoc for the name of a psychologist that diagnoses ADD and ADHD.
Or, try the website www.chadd.org which will have some direction towards specialists in your area, I think you would contact the closest regional chapter.
Posted by Fuscia on July 3, 2002, at 11:25:17
In reply to Ooops! Bipolar or ADD? » Fuscia, posted by JonW on July 2, 2002, at 13:04:45
Hi Jon,
I appreciate you answering the questions! I'm still wondering, though, if the symptoms you mentioned occured simultaneously prior to starting any of the meds you are on? I am also curious as to how the current med combo you are taking was initiated. (Excuse me if you mentioned this before, but I didn't catch it). Were you prescribed all at the same time, or start out on one drug, then another drug added? Fact is, that these meds can cause the very symptoms you mentioned, and it's even more of a probability when one is taking a combination of drugs for who can truly say as to the combination effect on the body.
All I know is that you do have a lot of common sense, for you said that it isn't good to self-diagnose and that it's easy to find something when you are looking for it....you and I are much alike in that respect. I am always curious and always trying to figure out the "why" of everything, for I believe that there is a cause for everything. I'm driven to find out what it is. I even do this with everyday stuff - always analysing. There's nothing wrong with that. Just be careful with labels, though, for there are so many grey areas and a person can have more than one disorder that can add to the complication of diagnosing. I have been going through this myself. But, I have to be careful with labels, for I know how easy it would be to wear it like a flag and use it as an excuse for my actions, or that there is no hope for me, just the hope of finding the "right med". It can be a letdown going this route. So, as you told Scott, part science - part oneself as to getting to feeling and acting happy and content. You might consider the Adderall as a starting point since it didn't cause the depression as the dexedrine did (I assumed this depression occured when you discontinued the dexedrine?) And, you might be able to discontinue one of the other drugs you are taking if the Adderal helps.
Okay, so you are sensitive to hearing someone else chew their food. Are you sensitive to bright lights, loud music, annoyed at flashing commercials? I am. I have to turn away when I turn on a flourescent light over our kitchen counter, same for flashy commercials when mute is on. A friend sent me an article about Highly Sensitive People. In a nutshell it states that individuals with HSP are sensitive to external stimuli, caffeine, and medicines. I can take an antihistamine (dyphenhydramine,Benadryl) that only lasts four hours, but feel its effects well into the next day. I'll have to find that article and post it - it's interesting.
I too finish peoples sentences and interrupt them. It is like I am carrying on the conversation 5 seconds ahead of time in my head, and so I don't lose the thought I spew it out - otherwise I can't remember what I was going to say if I let the other person finish. This was prior to start of any meds. I felt like I had early signs of dimentia or Alzheimer's disease, or that I take after my mother who has the same problem. You should hear us on the telephone. She seems to not hear what I am saying, and I talk over her to finish my thought. I also get irritable when my husband and I are having a meal together and he starts to talk about something. I just can't concentrate on what he is saying and wish he would stop talking. Well, maybe other couples that have been married for 16 years go through this, too ; ) This has started after being on SSRI's.
I'm also left handed. I also have a difficult time reading, but more so at the start of a book, say, then once I get into the story - I just want to keep reading it through until the end. I can't read magasine articles. My mind drifts off. I am self-absorbed most of the time, thinking of how I feel, or ruminating over something I said to someone. If I am doing something physical like digging a hole to plant a tree, that is usually when I feel fine for my mind is not on myself. If it is a repetitious task, then I ruminate.
Now, getting lost is a good sign of ADD and not of Bi-polar disorder. But, I've heard this occuring to one that was taking one of the benzodiazepines for anxiety, and also an older person that was taking a beta-blocker for high blood pressure. Also, anxiety can certainly cause forgetting something that one normally wouldn't. I am taking Prozac 20mg weekly now, and I have noticed that since starting on SSRI's two years ago that my short-term and long term memory is terrible. It was bad before, but much worse now. I forget all sorts of stuff now that I used to not forget. It's frustrating.
Just be aware if you do take a test for ADD that the current drugs you are taking could effect the outcome.
Well, I hope I didn't come across too strong in my first post to you. I can lack tact.
Take care, and hope that all works well and we hope you keep us posted on how things go for you.
Fuscia
Posted by Fuscia on July 3, 2002, at 11:34:05
In reply to Re: Ooops! Bipolar or ADD?, posted by Fuscia on July 3, 2002, at 11:25:17
After all is typed and done, I read the first of two posts you wrote to me. "Erneener" as me and my friend used to say when we felt stupid.
So, this was before meds. Thanks for letting me know.
I'd say, go for the Adderall, but I also wonder if you do try something like Ritalin or Adderall that if you can drop one of the other meds. then by all means, do so. One less med is one less substance that your liver has to clear.
Take care Jon!
Fuscia
Posted by cybercafe on July 3, 2002, at 14:28:41
In reply to Re: Bipolar or ADD??? » MomO3, posted by JonW on July 3, 2002, at 9:52:52
> I'm a guy and I don't like weight gain so I can >only imagine how frustrating that must be for a >woman. But at the end of the day, wouldn't you >rather be fat and happy? ;-) The truth is not
good point dude :) ... yeah when you're anxious and irritable you tend to have irrational expectations of how horrible side effects will be... but when you're happy, you could care less! ...
look if you are taking an antidepressant and are totally depressed about the side effects, that antidepressant probably isn't exactly working 100%, am i right?
hmmm... if you are in a position where you can actually survive without medication... or wonder if you have the disorder or not.... you probably aren't going to need to large dose no? ....
> I'm currently taking nardil + risperdal + >depakote + neurontin. *All* of these cause >weight gain and I've gained about 15 pounds.
not for me dude :)
depakote didn't give me any weight gain...
gabapentin 0 weight gain...i'm taking gabapentin and i'm 6'1" and 155 pounds....
i used to be 160, but with Parnate i have trouble keeping the weight on.. :)
i'm afraid i am going to die of starvation and not even know it :) :).. i suppose i could also add that a mood stabilizer might not be necessary, just an antidepressant (if your doctor returns his phone calls in the event of mania) -- assuming you're type II ... i assume if you were type I you'd know it :)
>However, I started riding my bike 3 days ago and >am starting to whip myself into shape and have >lost 3 pounds already. I'm thin to begin with >so it's not a major problem, but anyway...
yeah i'm totally in better shape on meds...
i hit the weight room after taking Parnate, and laughed at my old max weights ...good luck mom :)
oh and btw... contrary to popular belief, bipolar disorder is not caused by a doctor's diagnosis :)
in other words -- you have no reason to fear seeing a doctor -- either you have it, or you don't... seeing a doctor ain't gonna change that fact :)
Posted by MomO3 on July 3, 2002, at 16:45:50
In reply to Re: Bipolar or ADD??? » MomO3, posted by JonW on July 3, 2002, at 9:52:52
Jon,
Thanks for responding... I really needed a response... my self-esteem is sinking by the day, and I am having dreams about chocolate and cocaine (all on the same table)... I called the pdoc today because unless something changes quickly a binge of some sort is inevitable. I have been wringing my hands for 3 days trying to ignore this "i need SOMETHING" feeling.
> I'm a guy and I don't like weight gain so I can only imagine how frustrating that must be for a woman. But at the end of the day, wouldn't you rather be fat and happy? ;-)
My weight issue is that I have spent the last 5 months working very hard to lose some post-baby weight. I am 5'8" and at the 1st of the year was 190, today I am 162. I bought cigarrettes and 2 bags of chocolate chips yesterday. I was very hesitant to give up the dexadrine in favor of ritalin because the dex curbs my appetite - ritalin does not.
> I've been reading both 'Driven to Distraction' and 'The Bipolar Child' to try to help me answer the question "Is it bipolar or is it adhd?" I would suspect that you have bipolar disorder rather than adhd. Bipolar has nearly all of the symptoms of adhd. Have you been this way since childhood?
Yes, I think so... also, my dad is very clearly an un-diagnosed BP I - but he is fortunate to make enough money to cover the credit card payments on his shopping sprees.Here's a list of the 'very common' symptoms seen in childhood onset bipolar disorder according to 'The Bipolar Child':
>
> Separation anxiety, rages and explosive temper tantrums lasting up to several hours, marked irritability, oppositional behavior, rapid cycling(frequent mood swings, occurring within an hour, a day, or several days) or mood lability, distractibility, hyperactivity, impulsivity, restlessness/fidgetiness, silliness, giddiness, goofiness, racing thoughts, aggressive behavior, grandiosity, carbohydrate cravings, risk-taking behaviors, depressed mood, lethargy, low self-esteem, difficulty getting up in the morning, social anxiety, oversensitivity to emotional or environmental triggers.Pretty good descriptors there.
Questions: What is the difference between mixed-states and rapid cycling?
What to do about depression at this point? My friend said that mood stabilizer (and is neurontin really a mood stabilizer??) without AD causes depression... I read BP shouldn't take ADs.
And what about klonopin? Does it cause depression?Thanks for any advice,
Mom
Posted by BarbaraCat on July 6, 2002, at 0:10:11
In reply to Re: Bipolar or ADD??? Now what?, posted by MomO3 on July 3, 2002, at 16:45:50
Hi Mom o'
I've also struggled with the BP-II vs. ADD question and asked my pdoc. He said that a good test is how consistent your chaotic, disorganized thinking and behaviors are. If it's an all the time thing, it's probably ADD. If it's cyclical, it's probably BP-II. I've used that criteria and looking back over my life I've seen that the frantic overwhelmed life is falling apart feeling has been cyclic and is always followed or accompanied by a huge black engulfing depression. This despairing wailing black hole kind of agitated depression accompanying it is called bipolar mixed states and is presumably the most dangerous suicide prone kind of depression. I can vouch for that. It's hideous in the extreme. However, there are long periods of blessed calmness and relative normalcy. My concentration is generally excellent, except for periodic plunges into madness. This is not indicative of ADD.Have SSRI's alone exacerbated your anxiety or symptoms? For me all SSRI's and their analogs righteously pooped out and any increase in dosage would drive me into panic attacks, until I started adding lithium. This is pretty classic and sure wish I had known about it years ago - would've saved some singed nerves from all those panic attacks. So, SSRI non-response and/or agitation is a BP-II thing, but not an ADD thing.
The extreme weariness you describe is what raises a red flag, however. You've probably gotten your thyroid tested but has it been recently? As someone who suffers from hypothryoidism, fibromyalgia as well as BPII mixed states (yikes! that sounds serious) I can relate to crawling on all fours as you describe, and a bone crunching fatigue. Hypothyroidism is rampant among women, you could say a true epidemic. It's a tricky thing also because many, many doctors will let a subclinical case slide 'oh, it's borderline low'. Crapola! TSH levels need to be 2.0 and lower, period. Also, the kind of thyroid you take is important, with the natural hormone generally better for those of us with mood disorders. Anyhow, long story short, I just raised my dose recently hoping to kick start my weight loss efforts and lo and behold, even my fibro symptoms are improving. Your tiredness truly sounds like it has a physical basis and perhaps a small dose of thryoid just to see is in order. It's worth a try, Mommy. - BarbaraCat
Posted by Fuscia on July 7, 2002, at 11:25:03
In reply to Bipolar or ADD??? » Fuscia, posted by JonW on July 2, 2002, at 12:34:41
> > Hi Jon the poet,
>
> Hey, your nickname alone is far more poetic than I'll ever be! :-)
>
> > It is good to see you question your diagnosis. It can take years to properly diagnose bi-polar
>
> I understand it takes like an average of 8 years from the first report of symptoms and 2 to 3 pdocs to get a correct diagnosis of bipolar disorder. Sometimes I think my symptoms are the result of bipolar disorder and sometimes of ADD. It seems more like ADD, but I don't know a lot about differential diagnosis. I'm not sure how much it matters at this stage of the game.
>
> >have a friend that is a rapid cylcer bi-polar - days start out very depressing, don't want to get out of bed, and then are pretty high by late afternoon. SSRI's worked pretty well the first
>
> I'm dead in the morning (slow, depressed, low energy), and I'm a noticeably better by say 10:00am. I have trouble falling asleep (Nardil has made this worse) and trougle waking. I wouldn't describe anything I experience as "high". I feel like I suffer more from mood lability and less from mood cycling. Any so-called cycle certainly wasn't and isn't too profound in terms of "high" and "low" -- but I've definitely always had sleep problems, trouble getting to sleep, trouble waking. By the way, my mood is very sensitive to sunlight. Agitation and irritability have definitely been a *big* problem and are usually aggrevated by anti-depressants. Should I be called bipolar simply because of this reaction to anti-depressants? What do you think? Please ask any questions you want...
>
> > Anyway, I was curious, are the above listed symptoms prior to the meds you are currently taking? Do you have any impulses? Shopping? Sex? Aversion to sex? Substance abuse? How does caffeine effect you? How about sugar or bready sugar foods, like doughnuts, waffles, and other simple carbs? How do you do when you're all by yourself? There's lots more questions I could ask, but I don't want to be too nosey ; )
>
> Please, be as nosey as you want and ask as many questions as you like! I'm open to anything that could ultimately lead to insight. As for the questions you asked... Yes, the symptoms I described precede being on medication. If anything, I would describe myself as hyper-sexual -- but I have severe social phobia, so you do the math! ;) I *love* carbs! French toast is one of my favorites! When I was a kid I used to eat sugar from the packets at restaurants, my parents would have to stop me. I hate being alone and I hate being bored. If I'm alone or bored I'll often go out in my car for a drive.
>
> Thanks for the reply! You've been very helpful.
>
> JonHi Jon,
I didn't have time to really think over and answer your post, but now I do (hubby is still in bed - he's an at home engineer (mechanical/design) and usually gives me the elbow to "MOVE OVER" when he needs to use this computer).
Anyway, I was thinking about what you said concerning craving beer, that you love sweets, and how you used to down packets of sugar when you were a child. Well, I started thinking about hypoglycemia. You've probably heard about this low blood sugar problem. It can cause a variety of symptoms that can be mistaken for other health disorders. So, I thought I'd post you the following, just in case you don't need to start taking Adderall or Ritalin. It could just be a diet thing.
I mentioned to my rapid cycling friend that he might try taking a spirulina supplement in the middle of the night in case his morning lows were due to low blood sugar. He never tried it and so I don't know if this was what was causing his morning blues - it was so bad that he didn't even want to get out of bed most mornings.
I have had problems with simple carbohydrate cravings most of my life that started when I was in my early teens. I began to upchuck food after binging in order to stay thin - didn't work. I blimped out anyway, this when I was 16 or 17. I had bulimia. Anyway, throughout my life I've been at a fairly normal weight, though my low-self esteem told me I was fat and ugly. I binged and purged for years until my husband was laid of from the aerospace industry during the early Clinton days. Aerospace was then a dead dog, it still is. We moved out to the country and I think this made me not be self-conscious of myself for what did I care what our hillybilly neighbour thought of me. I began to relax more and care less about my appearance, and stopped the purging, but still had problems with the binging on cookies, cake, white flour stuff like homemade bread, etc. Then, when I was started on Zoloft over two years ago, (25mg) the cravings instantly ceased. I had no appetite, and I began to lose a pound or two. It is still this way for me. SSRI's have completely changed my appetite and I no longer have food cravings - in fact, many times I could easily skip a meal, but I force myself to prepare something for my husband's stomach. This was one appreciated effect from the SSRI's, for it was THAT BAD. Anyway, I used to get very lethargic in the daytime from these food binges, especially mid to late afternoon. Now my energy seems to start at that time of day - quite the opposite. I can't say I was this way on Celexa for it made me lazy - too sedating. It has been shown that bulimia folks have low serotonin levels, so this may be why I no longer see food in the same light. I've been on SSRI's for 2 years and I've not become overweight like so many others complain of. I'm of average weight for my bone size and height, which I am pleased with, especially living in Arkansas where folks tend to be extremely overweight. Anyway, I thought I'd share that with you.
I wouldn't call you bi-polar just from aggravation from SSRI's. That is just an indicator. I must be bi-polar as well for they say a rapid response from SSRI's is a good indicator of bi-polar disorder, and I had one rapid response - two days.
The aggravation could have simply been from too high a start up dose of the SSRI. Like I said, there are some folks that are super sensitive to the effects of drugs. This is very true for high adrenaline Panic Disorder folks. These people are running on fight or flight hormones and this would make any medicine's effects very pronounced.
Here is the information you might find interesting: I'll probably post some more for you on this subject. Maybe you can try reducing the simple carbs from your diet (yes, you'll go through withdrawals for the first few days - I did when I tried it, but I felt so much better by the 5th day of no sugar and no butter sauted flour tortillas that I was truly amazed!) I think you gave me an idea for tomorrows breakfast - French toast. That has eggs in it, so can't be too bad for you ; )
From the book, The Antidepressant Survival Guide by Rober J. Hedaya, M.D.
Hypoglycemia Self-Evaluation
1. If you miss a meal or go more than three or four hours without eating, do you experience any of the following symptoms: irritable, restless, jittery, dizzy, nauseous, lightheaded, sweaty, trouble concentrating, headache?
If so, are these symptoms alleviated by food?
2. Do you frequently crave sugar, cakes, cookies, sweets, or alcohol?
3. Have you gained ten pounds or more since beginning antidepressants?
These are all signs that you may have a condition known as hypoglycemia, or low blood sugar.The control of blood sugar within a normal range is a very complex process, which involves multiple chemicals (epinephrine, insulin, glucagon, cortisol) and minerals (chromium, selenium, manganese, and vanadium). With careful questioning I have found that about 50 % of my patients experience symptoms of hypoglycemia. Hypoglycemia contributes to the weight gain caused by antidepressants.
What exactly is hypoglycemia? It is an intermittent but usually long-term condition that causes blood-sugar levels to fall below the normal range necessary for optimal functioning of the brain and body. Your body can respond to the early stages of hypoglycemia by causing intense cravings for sweets and starches. This is your body signaling your brain that you need more glucose in your bloodstream-NOW! Once your body is in this state, you may either feed these cravings with carbohydrates or drink something with caffeine-which temporarily causes a release of adrenaline, which raises your blood sugar. If you don't respond, you will feel woozy, irritable, and nervous. Most people take a quick sugar fix. This causes temporary relief by increasing blood sugar, but it also increases the output of insulin and cortisol, both of which lead to weight gain and further blood-sugar problems. It's a vicious cycle that quickly spins out of control.
If you're hypoglycemic, your pancreas gradually becomes ill-equipped to handle foods high in sugar or other simple carbohydrates. These are foods that have a high glycemic index, which means your body rapidly breaks them down into glucose and shuttles this glucose into your bloodstream to give you instant energy. Eventually, your pancreas responds too forcefully, by releasing too much insulin to help your cells use the glucose in your blood. So instead of giving you a sustained amount of energy, your blood-sugar levels spike temporarily before plunging again. Any excess sugar not used by your cells gets carted away to be stored as fat-which is why you gain weight. The more you feed your sugar cravings, the less efficient your body becomes at using the sugar. As a result, you feel more intense hunger, which makes you eat more sugar, which causes you to gain weight. Starting to get the picture?
When you bring antidepressants to the mix (with the exception of Serzone and Wellbutrin), you frequently add at least one or two other mechanisms to the weight gain dilemma. All antidepressants that affect serotonin initially cause an increase in serotonin availability. This reduces appetite and contributes to weight loss (which is why the makers of Prozac, Eli Lilly, initially considered marketing it to help with weight reduction). Eventually, however, for most people, the nerve cells adjust to this state, and the net effect can be less (but more efficient) serotonin activity, resulting in increased appetite. In addition to this mechanism, many antidepressants can have an antihistamine effect, which in and of itself may cause weight gain.
The bottom line is that when you add the hypoglycemic drive to eat simply carbohydrates to the serotonin and antihistamine mechanisms, you have a prescription for serious weight gain-and serious loss of self-esteem. Not only have you gained twenty pounds but you can't seem to get a handle on your sugar cravings!
Diagnosis of and Treatment for Hypoglycemia
If you have any of the signs of hypoglycemia, you need to discuss your symptoms with your doctor. Before your appointment, keep a food diary for a week. Write down everything you ate, how you felt right after eating, and whether you experienced any symptoms (fatigue, wooziness, irritability, and so on) one to three hours later. Keep a record of your food cravings and how you dealt with them.
Take this food diary to your doctor. It will be a basis of your diagnosis. Unfortunately, there is no reliable test to confirm whether you have hypoglycemia. (Many doctors perform a glucose tolerance test, in which peaks and valleys of your blood-sugar levels are measured for several hours after drinking a high-sugar beverage. I've found that this test frequently enough misses clinically confirmed cases of hypoglycemia. For this reason, I don't perform it on my patients.)
If you do have signs of hypoglycemia, following the nutrition plan will help get the condition under control. Forgoing sugar, alcohol, caffeine, and refined carbohydrates will help stabilize your blood-sugar levels very rapidly. Eating an increased amount of protein will give you sustained energy. Replenishing your minerals will be critical.
Realize, though, that when you begin the nutrition plan you may not feel well as your body adjusts to less sugar. The first three or four days are the hardest: Many of my patients report feeling weak, dizzy, tired, and moody. After this initial stage, though, your energy will rebound, your depression will lift, and you'll be free from your cravings. By six weeks your taste buds and preferences will have changed so much that you will be surprised you once thought those sweet foods tasted so good. You'll probably also notice that your clothes are looser as you begin to lose weight and retain less fluid. On the flip side, if you cheat a little and sneak some cookies or ice cream, you'll see that your hypoglycemic symptoms will quickly return, and your taste buds and preferences will not change.You also need to make four additional modifications to your eating habits to keep hypoglycemia at bay:
1. Eat five or six small balanced meals a day. More frequent meals will keep your blood-sugar levels stable and should prevent hypoglycemic symptoms.
2. Be sure these meals or snacks contain the right carbohydrate-to-protein ratio. Snacks should have at least 7 grams of protein for every 10 grams of carbohydrates. Read the food labels. Or, if there is no label to read, eyeball the food. The protein (meat, fish, turkey, and so one) portion should be slightly more than one-third the volume of the meal, with the other two-thirds being carbohydrate. Snacks that are balanced will help reduce sugar cravings and keep your appetite under control. Some great balanced snacks include a handful of nuts with some fresh fruit, a cup of plain yogurt sprinkled with wheat germ, cottage cheese on a rye cracker.
3. Avoid artificial sweeteners. No, they aren't sugar, but they can contribute to sugar cravings. If your body is used to getting something sweet, it will continue to crave sugar.
4. Learn to recognize the difference between fatigue and hunger. We often gravitate toward sweet foods thinking they will give us an energy boost when the real problem is fatigue and stress. This depletion usually is associated with cravings toward the end of the day (when you are most tired) or after a night or more of inadequate sleep. Five minutes of simple relaxation will usually alleviate the problem for a while. Catching up on your nighttime sleep will also help a lot.Note To Your Doctor
In my experience, antidepressants can cause or worsen hypoglycemia in many patients. Antidepressants may increase appetite via histamine or serotonergic mechanisms (possibly via the 5-HT2c receptor). Initially, with the serotonergic reuptake inhibition caused by the antidepressant, you will note decreased appetite in your patients. As the postsynaptic serotonergic receptors downregulate in response to the increased serotonin output, the net effect is often a decrease in serotonergic activity, probably in the serotonergic neurons that run from the raphe (mid-brain) to the hypothalamus. Decreased serotonergic activity in this pathway is associated with increased eating. Serzone is unique in that is increases serotonergic output from the presynaptic neuron but blocks the 5-HT2c receptors, so there is no increased serotonergic activity at these receptors and perhaps then no alteration in the raphe-hypothalamic serotonin pathway.
Patients who are clinically hypoglycemic already have a tendency to overeat (independent of the serotonergic and antihistamine drives), particularly carbohydrates. Intervening in this mechanism will help reduce this contribution to weight gain, which occurs at least in part via elevated glucose levels, with gradual insulin resistance, increased insulin output, consequent increased levels of cortisol, and sequestration of glucose in adipose tissue.
I don't put much stock in the glucose tolerance test because of its high rate of false negatives. A far more reliable method is to have your patients keep a written record of what they've eaten and when they experience the onset of symptoms. They should note the effect of a high-carbohydrate snack on their symptoms. I keep a box of fruit cookies in my office and offer a few to fasting patients whom I suspect are experiencing low-blood-sugar levels at the time of their appointments. I then see if they feel any better.
If you suspect hypoglycemia based on history, you can try putting the patient on the Five-Day Jump Start to confirm whether dietary intervention will help improve symptoms. If the patient closely follows the plan and notes significant improvement, you should consider the diagnosis of hypoglycemia reasonably likely. Treating the hypoglycemia with frequent meals balanced with low glycemic index carbohydrates as well as high-quality protein generally has a very beneficial impact on the patient's energy, weight, and mood.
In addition, you should perform a mineral profile, since low chromium, vanadium, and possible manganese and selenium levels are clearly associated with glucose tolerance. If the patient's mineral profile comes back with low or borderline low levels of these minerals, I recommend supplementing fairly aggressively, rechecking the levels in two to three months. Vanadium has been associated with mood-altering properties, but I have not had the occasion to intervene with this mineral in any of my patients. Chromium can be used in doses of 150 to 200 micrograms three times a day. Patients need to be monitored because toxicity can occur, manifested by dermatitis, gastrointestinal ulcers, and kidney and liver disease.
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