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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Raisinb on April 14, 2012, at 22:33:33
He had me fill out a raft of screening forms and it turns out I might have "soft" bipolar, or what he called "bipolar 3," borderline personality disorder (I've heard that one before, too), and a new thing: adult ADHD. No one has ever suggested I had ADHD before, but then again I don't think I've ever been screened for it. I am chronically disorganized, fidgety, impatient, and irresponsible. I do not pay bills, file taxes, or keep my house or car clean (they always look like landfills). But I thought that was the depression--or is the depression from being borderline, or--
Dude! How do you know what you actually have?
Posted by Phillipa on April 15, 2012, at 0:10:56
In reply to New pdoc, more confused than ever, posted by Raisinb on April 14, 2012, at 22:33:33
You don't but from what I've read you don't develop adhd if you didn't have signs of it as a child. Now this was my reading only.
Posted by Christ_empowered on April 15, 2012, at 1:35:02
In reply to New pdoc, more confused than ever, posted by Raisinb on April 14, 2012, at 22:33:33
Unless its severe--voices, for instance--treatment is kind of murky. So is diagnosis. Personally, I'd rather be treated for ADD/ADHD than for borderline. At least ADD gets you uppers.
Posted by sigismund on April 15, 2012, at 4:27:47
In reply to Re: New pdoc, more confused than ever, posted by Christ_empowered on April 15, 2012, at 1:35:02
> Personally, I'd rather be treated for ADD/ADHD than for borderline. At least ADD gets you uppers.
Yes
Posted by Raisinb on April 15, 2012, at 9:08:44
In reply to Re: New pdoc, more confused than ever, posted by Christ_empowered on April 15, 2012, at 1:35:02
Yeah, but I don't know if uppers would be good for me right now. I'm having severe rage and irritability problems. It may be a dysphoric mania. I beat up the printer in my office the other day.
Posted by bleauberry on April 15, 2012, at 15:17:36
In reply to New pdoc, more confused than ever, posted by Raisinb on April 14, 2012, at 22:33:33
I think humans instinctively want to understand things and be able categorize things. With psychiatry the mysteries are so profound that the best we can do is give names to certain clusters of symptoms. Just because we have a name for our symptoms isn't really very helpful. We still don't know what it is, what causes it, or how to fix it. No matter what the name of the cluster of symptoms is, that cluster overlaps with other clusters. It isn't clear cut. There is no objective way to determine what is what, so it is done subjectively....based on opinion. So if you went to 10 different doctors, you could possibly come home with 5 to 8 different diagnosis.
What really matters is to try stuff to find what helps you. The name of the symptoms is partially helpful in that it gives us a general starting point. If our starting point turns out unfruitful then we can start looking elsewhere, but at least we had some sort of attempted organization to it all.
I think basically in psychiatry we are winging it, because we don't know what will work in each person, or if anything will at all, so we are at the mercy of trial and error experimentation. As humans we try to make it as compartmentalized and understandable as we can, despite it is far beyond that for us at this time. Using experience and observation we have been able to basically isolate different clusters of symptoms and give each a name. While that is somewhat helpful, but not really, I think the whole process is an overglorified one. But it's the best we have right now.
I wouldn't worry too much about the names. If he thinks you have some adhd in there, fine, then ritalin and adderall should be on your radar screen. Depression is a problem so whatever meds you've already tried....don't go that direction...go a different direction with other antidepressants. If bipolar is in there, maybe a mood stabilizer and maybe not. I personally would address the most crippling symptom with the highest priority and deal with the others along the way.
In terms of actual med choices, I am of the belief that balanced norepinephrine vs serotonin strategies have the best outcomes. That means nortriptyline+zoloft, nort+prozac, savella, nardil, or parnate. Ritalin or Adderall might feel good, with or without the other meds.
Anyway, you've made a little step forward, so, cool! Next step.
> He had me fill out a raft of screening forms and it turns out I might have "soft" bipolar, or what he called "bipolar 3," borderline personality disorder (I've heard that one before, too), and a new thing: adult ADHD. No one has ever suggested I had ADHD before, but then again I don't think I've ever been screened for it. I am chronically disorganized, fidgety, impatient, and irresponsible. I do not pay bills, file taxes, or keep my house or car clean (they always look like landfills). But I thought that was the depression--or is the depression from being borderline, or--
>
> Dude! How do you know what you actually have?
Posted by Raisinb on April 15, 2012, at 15:58:34
In reply to Re: New pdoc, more confused than ever, posted by bleauberry on April 15, 2012, at 15:17:36
That is a very sane and helpful post. Thank you!
Posted by phidippus on April 15, 2012, at 20:35:19
In reply to New pdoc, more confused than ever, posted by Raisinb on April 14, 2012, at 22:33:33
Do you need the labels, or do you want to concentrate on your symptoms?
Eric
Posted by Raisinb on April 16, 2012, at 12:59:32
In reply to Re: New pdoc, more confused than ever » Raisinb, posted by phidippus on April 15, 2012, at 20:35:19
It really bothers me that I could have three or four different things and nobody knows what. I would like to concentrate on symptoms but it's not so easy to piece them out. Am I depressed or ADHD? Do I get DBT or take antipsychotics/mood stabilizers? If I am bipolar, that dictates that I should be on a mood stabilizer but those have just made me worse.
It would be on thing if I'd found anything that worked at all, but I have been through a million meds and eight years of talk therapy and nothing has made a lasting improvement. The suicidal times just get longer and more intense.
Ideally, no, the labels would not matter, but I am at my wits end, I don't know what to do, and I'm sick and frustrated by dealing with my illness with no help because the doctors do not know what it is or what to do.
Posted by phidippus on April 16, 2012, at 15:53:33
In reply to Re: New pdoc, more confused than ever » phidippus, posted by Raisinb on April 16, 2012, at 12:59:32
Depressed or ADHD? Neither have much in common for them to be mistaken for each other. People get hung up on the difficulties concentrating while depressed. If you have a lot of trouble in executive areas-keeping organized, staying on track, attention defecits, etc. Then you most likely have ADHD. ADHD and depression should never be confused: here are the criteria for being depressed:
Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation
If you feel you fit 5 of the above criteria, than you are most likely depressed.
What else do you see are your symptoms?
Eric
This is the end of the thread.
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