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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by B Jackson on June 19, 2000, at 20:07:32
Has anyone ever developed symptoms of ADD as an adult, subsequent to the onset of major depression (single episode)? I am new to the use of antidepressants and stimulants and now take Effexor XR (150 mg/day) and Adderall (20 mg 2x/ day). It seems very strange to place myself in the ADD category, as I never had significant symptoms until developing depression (long string of situational nasty, rotten luck -- husband's job loss (while I was pregnant), two deaths in family -- father and brother, bipolar teenage daughter, financial worries, etc. ...). Now I find myself unable to concentrate or be productive at work (which has REALLY become a problem). AM I ALONE?????
Posted by KarenB on June 19, 2000, at 21:12:52
In reply to Depression as a trigger to adult ADD, posted by B Jackson on June 19, 2000, at 20:07:32
> Has anyone ever developed symptoms of ADD as an adult, subsequent to the onset of major depression (single episode)?
Dear B,
From everything I have read, in order to be diagnosed as true ADDD, symptoms need to be present prior to age seven. What you list sounds like classic symptomology of depression.
I am ADD, inattentive type w/o hyperactivity. Depression, in my case, is part of the package. I thought for years it was only depression, was diagnosed (incorrectly)later as bipolar and finally, as an adult, was diagnosed with ADD. I suggest you do some reading about ADD(www.chadd.org - follow their links for more info. also, www.addclinic.org) to see if you fit the profile, have ALWAYS fit the profile or if this is a wrong assumption altogether.
I have never heard of a sudden onset of ADD but I suppose anything is possible. Probably not likely, though.
Karen
Posted by Sara T on June 19, 2000, at 22:42:10
In reply to Re: Depression as a trigger to adult ADD, posted by KarenB on June 19, 2000, at 21:12:52
> > Has anyone ever developed symptoms of ADD as an adult, subsequent to the onset of major depression (single episode)?
>
I agree with Karen. My experience was similar in that for years I thought it was only depression and anxiety and I knew very little about ADD until my kids came along. In researching it for myself I had to go back through old school records to find the tell-tale evidence. ADD does not come on in adulthood. But depression and anxiety symptoms closely mimic those of ADD.ADs and stimulants are often used together these days as you will read here. I think if you are having memory and concentration problems, some of the same things that work for ADD could work for you too.
Sara T.
Posted by Johnturner77 on June 20, 2000, at 10:53:53
In reply to Re: Depression as a trigger to adult ADD, posted by Sara T on June 19, 2000, at 22:42:10
How do you motivate yourself under when your aren't depressed? If nothing is pleasurable, nothing holds your interest. Perhaps your condition is stress induced anhedonia as much as depression
Posted by Angela5 on June 20, 2000, at 12:34:53
In reply to Re: Depression as a trigger to adult ADD, posted by KarenB on June 19, 2000, at 21:12:52
> > Has anyone ever developed symptoms of ADD as an adult, subsequent to the onset of major depression (single episode)?
>
> Dear B,
>
> From everything I have read, in order to be diagnosed as true ADDD, symptoms need to be present prior to age seven. What you list sounds like classic symptomology of depression.
>
> I am ADD, inattentive type w/o hyperactivity. Depression, in my case, is part of the package. I thought for years it was only depression, was diagnosed (incorrectly)later as bipolar and finally, as an adult, was diagnosed with ADD. I suggest you do some reading about ADD(www.chadd.org - follow their links for more info. also, www.addclinic.org) to see if you fit the profile, have ALWAYS fit the profile or if this is a wrong assumption altogether.
>
> I have never heard of a sudden onset of ADD but I suppose anything is possible. Probably not likely, though.
>
> Karen
Karen -I know I've read it somewhere in all of these posts, but I can't begin to remember where - what medications do you take/what did you end up finding to bue useful for your depression and ADD?
Thanks,
Angela
Posted by KarenB on June 20, 2000, at 19:14:27
In reply to Depression and ADD - ? for Karen B » KarenB, posted by Angela5 on June 20, 2000, at 12:34:53
> Karen -
>
> I know I've read it somewhere in all of these posts, but I can't begin to remember where - what medications do you take/what did you end up finding to bue useful for your depression and ADD?
>
> Thanks,
> AngelaAngela,
Funny you should ask, because just last night I was thinking from your posts that you remind me of myself. I wondered if ADD may possibly be part of the picture in your case. You should do some reading at those websites I mention. There is a test, specifically for young women (geared at teenagers but very enlightening for those older) - I will try to find it and post the URL address later.
A few things I didn't know until recently: Hyperactivity is NOT present in 1/3 of all people suffering from ADD. When hyperactivity is not present, HYPOactivity often is...and most often in girls/women. Innattentive type (daydreamy) ADD is many times not diagnosed and treated because those suffering are not "disruptive" like their hyperactive brothers and sisters. Most often there is a high I.Q. with mediocre grades, trouble with long math problems such as in Algebra, learning to read music, keeping your mind "in the classroom." Have you always had trouble getting out of bed in the morning, even as a child? This is another symptom. I'm not a lazy person but I have struggled every day of my life to get out of bed - I always wondered what was wrong with me.
Meds: I take Adderall, 20mg 1/2 hour before getting out of bed in the morning, then 10mg five hours later. Buspar, (an anti-anxiety med with some antidepressant action - some hate it, some love it. It's working OK for me)10mg 3xper day. I take Inderal to keep me from getting migraines from the Adderall but if you don't get migraines, that's beside the point.
Oh, I wrote this really long response to your question about moving back w/parents but I spaced out and lost the whole thing. Just didn't have it in me to do it again. What did you decide, BTW?
Karen
Posted by Angela5 on June 20, 2000, at 21:12:44
In reply to Re: Depression and ADD » Angela5, posted by KarenB on June 20, 2000, at 19:14:27
Karen -
I just did the same thing you were talking about - I had this post halfway typed out and then I lost it - well, here goes again...
I have actually been doing a whole lot of reading on the subjects of ADD and ADD vs. bipolar. Of course, it's all a bit ironic, since retaining what I read is part of my problem... ;) I remember the main focus/point (mostly?), but I promptly forget ALL the details; it's a never-ending frustration.
Anyway, from what I've seen so far, the diagnosis of "atypical bipolar with no manic episodes" does not seem to fit me nearly as snugly as inattentive ADD does. What you wrote:
" Most often there is a high I.Q. with mediocre grades, trouble with long math problems such as in Algebra, learning to read music, keeping your mind "in the classroom." Have you always had trouble getting out of bed in the morning, even as a child? This is another symptom. I'm not a lazy person but I have struggled every day of my life to get out of bed - I always wondered what was wrong with me. "
You hit the nail on the head, so to speak, with all of those things. As far as getting out of bed goes, one of my most intimate relationships is with my Snooze bar, and always has been.From other research that I've been doing, as well as from my drug/no drug experiences, I'm not sure if SSRIs are right for me, either. Basically, my four years of Prozac, although with a bit of increasing "poop-out" (followed by dosage increases), did take the edge off of my depression. I was, at least, functional. I could get things done, basic everyday life. On the other hand, my short term memory went to hell - and I do mean hell. I feel like my IQ has dropped drastically in the past 4 years. All of the ADD symptoms got worse. Part of this is that it became increasingly difficult to arrange my life around them/compensate, I know, but they did just plain "get worse" as well.
You've seen from my previous posts that Serzone was a disaster, as was Celexa, though for different reasons. I know that serzone is atypical, but it does work on Serotonin mostly, right?
Currently, on nothing, I'm non-functional. Making phone calls can bring me to tears. Housework seems impossible. Packing is worse. (I'll get to that story in a minute.) So maybe, since I was at least functional on Prozac, an SSRI combo would be the answer - but with all that it made worse, I'm not so sure. Does anyone have any opinions on trying Wellbutrin as an idea? Also, how exactly do MAO inhibitors work/are they effective with this kind of thing/would they be an option?I'm going to see another pdoc tomorrow morning, but I don't know how that will go. From talking to him on the phone, everything seems to fall under the label of "depression," and while there certainly is that, there's more to it.
As far as moving back to Illinois goes, the jury is out, although I have to decide pretty much ASAP. This became even further complicated today, since the house I rent just got sold today - I have to be out in 30 days. In a way that's good, at least it narrows my options. If I decide to stay in Washington, though, I have to figure out if I find somewhere else on my own or look for a roomate ("Hello, I'm currently on short term disability for major depression. Want to be roommates with my dog and me?"). The roommate thing, although distasteful, would be the best financially, since I don't know how going back to work will eventually be, but... I keep wondering how I would think if I were well, but I just can't remember.
Hope this all made sense.
Angela
Posted by KarenB on June 20, 2000, at 23:46:36
In reply to Medication confusion, help » KarenB, posted by Angela5 on June 20, 2000, at 21:12:44
Angela,
If SSRIs have not worked in the past, tell your new pdoc and ask to try a med of a different class, like Wellbutrin. Be sure to WRITE DOWN all the ADs you have tried and what they did (made you sleepy, caused anxiety, etc.)so you won't forget when you're in your appt. Wellbutrin is definitely worth a try and would be one suggestion I would make, even if you hadn't mentioned it. I don't know about MAO inhibitors but I have heard they are effective in cases of atypical depression. There are dietary restrictions, though, which seem pretty difficult to follow. I guess if they work, it would be worth it.
It would be a good idea to also write down all the symptoms you have had (back to childhood) that sound like ADD and share this with him/her. Ask, "is ADD a possibility?" There is a test you can take that is like a very slow video game, to evaluate your attentiveness, called TOVA (don't ask me what it stands for). I have not taken it myself (yet) but would like to soon.
If they decide to start you on an ADD stimulant, Adderall is a good one - but everyone is different. I didn't like Ritalin, but others say they prefer it. I am (hopefully) going to try Provigil this week, following my doctors appt. on Thursday. Even Adderall leaves me a little bit edgy in the afternoon and Provigil reportedly increases energy without those side effects. It is used for Narcolepsy but is currently being (successfully) tested for ADD. I want to give it a try but we'll see what my doc says about that.
Hey, don't settle for something just "taking the edge off" your depression. A good version of normal is what you're shooting for. Why be just "functional" when you can actually feel good?
Have a good appt. and let us know what happens, OK?
Karen
Posted by Jonathan on June 21, 2000, at 0:38:09
In reply to Medication confusion, help » KarenB, posted by Angela5 on June 20, 2000, at 21:12:44
> From other research that I've been doing, as well as from my drug/no drug experiences, I'm not sure if SSRIs are right for me, either. Basically, my four years of Prozac, although with a bit of increasing "poop-out" (followed by dosage increases), did take the edge off of my depression. I was, at least, functional. I could get things done, basic everyday life. On the other hand, my short term memory went to hell - and I do mean hell. I feel like my IQ has dropped drastically in the past 4 years. All of the ADD symptoms got worse. Part of this is that it became increasingly difficult to arrange my life around them/compensate, I know, but they did just plain "get worse" as well.
> You've seen from my previous posts that Serzone was a disaster, as was Celexa, though for different reasons. I know that serzone is atypical, but it does work on Serotonin mostly, right?
> Currently, on nothing, I'm non-functional. Making phone calls can bring me to tears. Housework seems impossible. Packing is worse. (I'll get to that story in a minute.) So maybe, since I was at least functional on Prozac, an SSRI combo would be the answer - but with all that it made worse, I'm not so sure. Does anyone have any opinions on trying Wellbutrin as an idea? Also, how exactly do MAO inhibitors work/are they effective with this kind of thing/would they be an option?
>
> I'm going to see another pdoc tomorrow morning, but I don't know how that will go. From talking to him on the phone, everything seems to fall under the label of "depression," and while there certainly is that, there's more to it.Angela,
Yes, Wellbutrin (bupropion) sounds to me like a good idea. It's one of the antidepressants that has been used for ADD as well as depression. It's a noradrenaline reuptake inhibitor like reboxetine, which is working well but very slowly for me with very similar symptoms to yours -- it amazes me how you seem to describe more of my problems almost every time you post.
Compared with desipramine, the other possibility I suggested if reboxetine's not an option for you (and also with reboxetine itself), Wellbutrin's onset of action may be faster because it acts on dopamine as well as noradrenaline.
If tomorrow's pdoc insists on treating your problem as atypical depression alone (as they all do here in England), you can safely go to your other doctor when he returns from holiday next week and ask for more Ritalin, which you already know improves your ADD symptoms: it's reasonably common practice to prescribe Wellbutrin and Ritalin together. In fact, Ritalin may even shorten the waiting time before Wellbutrin's antidepressant action kicks in, which is just what you need.
Effexor is something to avoid at all costs, not only because it didn't suit me: it's quite similar in its actions to Serzone, which seems to have been the worst of the three SRIs you've taken. Personally, I wouldn't trust anything that increases serotonin levels not to make the inattention problem worse.Good luck,
Jonathan.
Posted by Angela5 on June 21, 2000, at 21:37:01
In reply to Re: Medication confusion, help » Angela5, posted by Jonathan on June 21, 2000, at 0:38:09
Well, went to see the new "2nd Opinion" pdoc today. His first recommendation was to put me back on the Prozac and go from there. Due to my other doc's opinion and also what I've learned here and elsewhere, I said no to that.
He REALLY wants me back on the Prozac ("the only medication the FDA has officially approved for eating disorders"), due to eating disorder problems that started about 7 years ago (I was wrong about my first major depression being 4 years ago - I was diagnosed with it then, too, I had forgotten). I was anorexic, then anorexic/bulimic, then bulimic. It's pretty much gone now, except occasionally in periods of extreme stress. Ironically, though, I'm not having trouble at all now - so why go back on Prozac for that reason? It actually seems easier off of it...
He wrote a book on the subject which he gave me to read, along with another book. I had to ask how I'm supposed to read them when I can't get to the second page without forgetting what's on the first one...Anyway, I had already talked to my main pdoc's partner (hard to keep these guys stratight) since my main pdoc is on vacation, telling him that I refuse to try the Effexor at this point, and he had agreed to let me try Wellbutrin. The "2nd opinion" pdoc isn't opposed to this, although his main opinion is the Prozac. Like pdoc #1's partner said, (and KarenB in a previous post, I think) I shouldn't have to settle for how Prozac just "took the edge off" and left all the other problems. The result at the moment is that I'm trying Wellbutrin, 100 mg/day for 4 days, then 100 mg 2x/day if all is tolerated, etc.
Another thought that has come up is thyroid, which occurred to me last night. This is another story entirely, although interrelated if the case... I'll keep you posted on that one.
I'm done writing for the moment; I'm pretty agitated over all these impending decisions about moving, and I've almost had it with doctors. At least I'm trying something that I hope will help.
Angela
Posted by Jonathan on June 21, 2000, at 23:17:22
In reply to Re: Medication confusion - UPDATE, posted by Angela5 on June 21, 2000, at 21:37:01
Angela,
Congratulations on standing up to them! I suspect that Prozac and other SSRIs will become known as the overprescribed drug of the 90s/early 00s, like the benzodiazepines before them, though I appreciate that some people really benefit from them.
I went in April to see a new consultant, already believing, after hours of my own research, that reboxetine would be best for me (of what the British NHS can provide), but willing to give way to a reasoned argument beginning "X would be better for you than reboxetine because ...", to be told at first that I should stay on venlafaxine for three more months, even though I felt much worse after four months already on it, because changing medications would slow down my recovery. Fortunately a second opinion from a more senior consultant was that my symptoms were of the type that responds better to reboxetine than SSRIs. This was probably correct, but no more so than a year earlier when I was given Prozac for the same symptoms.
Does your insurance cover psychological therapy? Despite my initial scepticism, by far the most impressive doctor I've spoken to was a psychologist, who correctly predicted a couple of important symptoms, procrastination and perfectionism, which I'd postponed telling him about because I couldn't find exactly the right words to describe them. He was confident that therapy can help my hypoactive-attention-deficit-type symptoms, so I'm now on a twelve-month waiting list to find out if he's right. To get this ninety-minute assessment interview and be placed on the waiting list, I first had to be on another waiting list for 6 months. (Waiting lists here in the UK are for people, not for drugs like reboxetine awaiting FDA approval.)
Has anyone any experience, positive or negative, of therapy for symptoms of this type?
I hope the Wellbutrin will work for you. Please keep us posted.Jonathan.
Posted by noa on June 22, 2000, at 6:29:26
In reply to Re: Medication confusion - UPDATE » Angela5, posted by Jonathan on June 21, 2000, at 23:17:22
> Has anyone any experience, positive or negative, of therapy for symptoms of this type?
Yes. Therapy has definitely helped me, in conjunction with medication.
Posted by noa on June 22, 2000, at 6:35:10
In reply to Re: Medication confusion - UPDATE, posted by Angela5 on June 21, 2000, at 21:37:01
("the only medication the FDA has officially approved for eating disorders"),
Is this what the 2nd opinion doc said? If so, I agree with you to question him. If my doc stuck to "on-label" medication uses, I would be left with few options. The more experienced docs in the trenches know that off label uses of meds are essential in many cases of psychiatric illness.Depending on the specifics of your eating disorder history, I would imagine, though that many docs would want to be cautious with wellbutrin. They would not want to be responsible if you had a seizure. But that doesn't preclude considering it as a possibility. You need a doc who is willing to take a closer look and not just dismiss a whole array of med possibilities offhand.
Posted by KarenB on June 22, 2000, at 12:46:47
In reply to Re: Medication confusion - UPDATE, posted by Angela5 on June 21, 2000, at 21:37:01
Angela,
Geez...I'd go with pdoc #1's partner's advice.
Let us know how the Wellbutrin works out for you. It has been known to decrease appetite and cause weight loss, so be sure to EAT (knowing your history of eating disorders this is especially important)!
Gotta go - we have a family camping trip this weekend and I have to plan, pack, etc. Better drink a protein shake to kick my brain into gear.
Karen
Posted by Angela5 on June 22, 2000, at 12:49:20
In reply to Re: Medication confusion - UPDATE, posted by noa on June 22, 2000, at 6:35:10
I actually talked about the seizure risks with both the 2nd opinion pdoc and with pdoc #1's partner. First of all, I haen't had any eating problems for a while. The 2nd opinion pdoc said that he was concerned about the seizures, but that they had all happened at 400 mg and upwards dosages, whereas I would be starting of on 100 to 200. The other doc, pdoc #1's partner, said that seizures used to be a concern - he explained that with the non-SR version of Wellbutrin, the seizures seemed to happen when the med hit its peak in the body. He said that no seizures have been seen with th SR version.
Angela
This is the end of the thread.
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