![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by MomO3 on May 14, 2002, at 15:17:27
In reply to Re: Self Diagnosis Anyone?, posted by bookgurl99 on May 14, 2002, at 4:04:08
When I went to my pdoc for the 1st time 2 months ago, I was just SURE I had ADD... I brought my amen clinic check list with me, talked with him for an hour - he prescribed adderall.
I guess I was overly optimist hoping that the meds would 'solve' it. Within 2 weeks I was in despair because they weren't having the desired effect.. I started to second guess - maybe this is not it, maybe ADD is wrong. I went through concerta then dexadrine for 2 months and told the doc this is NOT it for me. I am yelling at my babies and this will not work.
My Dad is clearly bi-polar (but would never set foot in a shrink's office). So in the back of my mind I am thinking.. well maybe... Without changing the original diagnosis the pdoc prescribed neurontin instead of the stimulants. So in researching neurontin & BPII, I also found Asbergers Syndrome(very mild high functioning autism). I have traits for that one too. So now I am feeling like a hypochondriac (sp?).. and I am wondering if I should stop all the research and let the doc do his job... but it's hard to accomplish much in a 15 minute follow-up... I just don't know what to think or what to do...
> What are you concerned about? You feel that you were misdiagnosed?
>
> I understand how you feel, both in self-diagnosing and in regretting it. My pdoc is very cautious. He thinks I may be BP, but started me just on an AD recently to see if I'm 'merely' having severe anxiety. I'm so unable to focus that I want to call him and say 'put me on a mood stabilizer now!'
Posted by BobS. on May 14, 2002, at 19:14:09
In reply to Re: Self Diagnosis Anyone? » MomO3, posted by IsoM on May 13, 2002, at 16:42:46
Speaking of delving in, did you get a chance to interpret the Nature articles on 5-HT1a and whether anxiety sufferers should be on an SSRI as opposed to BZD monotherapy, or both?
Posted by MomO3 on May 14, 2002, at 23:31:06
In reply to Re: Self Diagnosis Anyone?, posted by BobS. on May 14, 2002, at 19:14:09
HUH?
> Speaking of delving in, did you get a chance to interpret the Nature articles on 5-HT1a and whether anxiety sufferers should be on an SSRI as opposed to BZD monotherapy, or both?
Posted by IsoM on May 15, 2002, at 2:16:57
In reply to Re: Self Diagnosis Anyone?, posted by BobS. on May 14, 2002, at 19:14:09
Posted by krazy kat on May 15, 2002, at 9:21:09
In reply to Re: Self Diagnosis Anyone?, posted by MomO3 on May 14, 2002, at 15:17:27
Mom:
I would sit back and let him do his job. Especially after you have seen him for awhile. But that doesn't mean you can't have your opinions and stick with them.
Have him explain why he feels a certain course is appropriate. I think most of us do have multiple diagnoses.
It can take a couple of years to get it close to right. But do be diligent if a med isn't working for you - some pdoc have favorites and they'll just keep pushing you to take something that isn't right. Even mine has done this.
- kk
Posted by MomO3 on May 15, 2002, at 11:52:04
In reply to Re: Self Diagnosis Anyone? » MomO3, posted by krazy kat on May 15, 2002, at 9:21:09
Thanks,
I'll try... I am just very impatient (now which disorder is that??)... I saw a pdoc after the birth of child #1 but I was nursing so they couldn't help me... then pg with #2&3 (twins) and nursing them... so I have been waiting since 1999 to try new meds.Also, my hi-tech hubby just took a paycut and I am afraid that my psychiatric budget will be cut before I find the right med/combo. uugh
> Mom:
>
> I would sit back and let him do his job. Especially after you have seen him for awhile. But that doesn't mean you can't have your opinions and stick with them.
>
> Have him explain why he feels a certain course is appropriate. I think most of us do have multiple diagnoses.
>
> It can take a couple of years to get it close to right. But do be diligent if a med isn't working for you - some pdoc have favorites and they'll just keep pushing you to take something that isn't right. Even mine has done this.
>
> - kk
Posted by krazy kat on May 16, 2002, at 10:48:34
In reply to Re: Self Diagnosis Anyone?, posted by MomO3 on May 15, 2002, at 11:52:04
> I'll try... I am just very impatient (now which disorder is that??)... I saw a pdoc after the birth of child #1 but I was nursing so they couldn't help me... then pg with #2&3 (twins) and nursing them... so I have been waiting since 1999 to try new meds.
-- I am very impatient as well. When one has been suffering for many years and finally decideds to, or can, get help, it's frustrating to wait any longer. I waited a good 12 years to get going. AND Bipolar Disorder gets worse with age, as I imagine other Disorders do as well.
> Also, my hi-tech hubby just took a paycut and I am afraid that my psychiatric budget will be cut before I find the right med/combo. uugh-- Definitely express this to your pdoc. If he's a good one, he'll help you come up with options to get around this. Especially if you're doing trials right now on meds, he should samples for you so there is no initial cost. Also, there are some great resources for that on this site.
What was your other comment, Mom? That it's your hubby who all are worried about because, I assume, he's the "breadwinner" at the moment? I understand that actually. But you all are a unit, and if you can't keep up your end healthily, it'll shut down. And three kids, I can't even imagine not having any. You're doing this for yourself, but also for your family.
Stick with it! Those who have had these difficulties can offer some suggestions along the way.
- kk
Posted by MomO3 on May 16, 2002, at 14:32:08
In reply to here are my thoughts... » MomO3, posted by krazy kat on May 16, 2002, at 10:48:34
kk
Thanks for the input... Do you know what exactly a mood stabilizer (neurontin) is supposed to do? I have been on it 2 weeks now and I feel like I am losing the 'will' to fight. I know it's supposed to make be less aggressive, but gee... I never back down from a good debate.
I am involved with a local mothers of multiples group and there is a lot of bickering right now, normally I would be all over it, but I just can't even THINK about dealing with it... it makes me tired.
But if this is my stabilized mood, it is awfully low.
Posted by krazy kat on May 17, 2002, at 10:52:24
In reply to Re: here are my thoughts..., posted by MomO3 on May 16, 2002, at 14:32:08
Mom:
Neurontin is a "mild" stabilizer, and some think it's actually an anti-anxiety drug.
Yeah, it should be calming, and that may mean you lose your fight. Post a question to Wendy B. if you get a chance, and Ritch - they both have taken it for awhile and have a bit of experience with it.
Frankly, I don't know what a stabilizer if one is not bipolar, and i don't recall what your symptoms are. As a Bipolar, it very literally stabilizes - I don't get depressed or manic. Some would say one Has to have an Anti-Depressant as well, but that's not the case for me.
Now mania and sever depression are not just extreme emotions for Bipolars - they have a life and definition of their own. One acts unlike oneself (suicidal or reckless) and one's perceptions become completely off-key.
Again, repost this since it was just archived and stick Neurontin in the subject line.
Good luck.
- kk
Posted by MomO3 on May 18, 2002, at 23:24:46
In reply to Re: here are my thoughts... » MomO3, posted by krazy kat on May 17, 2002, at 10:52:24
KrazyKat,
Thanks for talking with me... my symptoms or original diagnosis leads me full circle back to my original post. Before I went to the pdoc, I did a little research and thought "I have ADD" - I took my reasons to the pdoc and he agreed with me. At that time I knew little of Bipolar and was unaware that BPII existed... Pdoc & I have 'discussed' BPII and I could probably make a pretty convincing argument there - but haven't yet. I don't want him to re-diagnose me and be wrong. He prescribed the neurontin to reduce irritability, anxiety, and help with my sleep disorder.
If it works better than the pstims is that an indication that BPII might be a better diagnosis than ADD?
If the pstims make me manic is that an indicator?
I mean - ok - my depressive episodes are obvious -
But the mania or hypomania are not so obvious to me. Does packing up everything you own and moving 1000 miles for a job INTERVIEW qualify? I got the job, so that was good (I guess) I don't know what I would have done if I hadn't gotten the job...
I was definitely experiencing grandiosity - paying exorbitant rates to stay in the top of the tallest hotel in Denver. I bought thousands of $$ worth of clothes, ski wear, etc before my first day at work. I was (as I wrote on the post card) "on top of the world". Six months later I sat on the kitchen floor in my apartment and took a knife to my wrists, I didn't do enough damage to end up in the hospital, but some girls at work saw the bandages on my wrists and my employer sent me to the EAP - who put me back on Prozac. Two months after that I moved home with mom & dad.
What do you think? Manic? Hypomanic? strange coincidence?
> Mom:
>
> Neurontin is a "mild" stabilizer, and some think it's actually an anti-anxiety drug.
>
> Yeah, it should be calming, and that may mean you lose your fight. Post a question to Wendy B. if you get a chance, and Ritch - they both have taken it for awhile and have a bit of experience with it.
>
> Frankly, I don't know what a stabilizer if one is not bipolar, and i don't recall what your symptoms are. As a Bipolar, it very literally stabilizes - I don't get depressed or manic. Some would say one Has to have an Anti-Depressant as well, but that's not the case for me.
>
> Now mania and sever depression are not just extreme emotions for Bipolars - they have a life and definition of their own. One acts unlike oneself (suicidal or reckless) and one's perceptions become completely off-key.
>
> Again, repost this since it was just archived and stick Neurontin in the subject line.
>
> Good luck.
>
> - kk
Posted by IsoM on May 19, 2002, at 1:22:13
In reply to Re: Neurontin ...here are my thoughts..., posted by MomO3 on May 18, 2002, at 23:24:46
I hope you don't mind me jumping back in, MomO3, but your description sounds VERY manic to me. I may not be BP but I've had two good friends who are & it sounds quite like something they would've done when they were manic.
From previous posts on this forum, there's many who say & feel themselves, that BP & ADD can co-exist. Having one doesn't necessarily rule out the other occuring too.
Learning for yourself what you might have isn't a bad thing at all. Jumping to conclusions a little too soon is though. As you said, you did a "little research" that you presented to your doctor. While my ADHD would have me jumping on a diagnosis for myself, it would also have me researching it to 'death', backwards & forwards. Because you're perhaps not ADD, but instead BP, you didn't look further. You saw something that fit you & seized on it. I tend to get a little too obsessive & overdo it. You may instead underdo your research.
I wouldn't stop reading & trying to understand yourself better. But be hesitant about concluding what you may have till you have lots of info & evidence for your doctor. But your description certainly sounds manic. Is there any other diagnosis that would fit such a situation? I'm not sure of any myself.
Posted by Krazy Kat on May 19, 2002, at 19:07:04
In reply to Re: Neurontin ...here are my thoughts..., posted by MomO3 on May 18, 2002, at 23:24:46
Mom:
This is ashort response, I'm afraid, but sounds very manic to me as well. And I think IsoM's response is correct re: the co-existence.
I'll gwt back to you again.
Come see us on Social sometime (I spent half of my childhood in Colorado).
- kk
Posted by MomO3 on May 19, 2002, at 23:18:31
In reply to Manic? » MomO3, posted by IsoM on May 19, 2002, at 1:22:13
It's interesting that as I wrote it down it DID seem pretty obviously manic.... but I had never really thought of it in that context before. When I packed up and moved away with less than a week's notice my parents didn't seem to think anything of it. In fact my dad thought it was a good idea. But my sister and I are convinced HE is bipolar.
Thanks for the opinion.
Posted by Ron Hill on May 21, 2002, at 18:03:37
In reply to Re: Neurontin ...here are my thoughts..., posted by MomO3 on May 18, 2002, at 23:24:46
Mom03,
Sounds like you and I have traveled similar roads. I've been on this road for six years and, as a result, I have learned where some of the potholes are located.
I am BP II and I currently take 600 mg/day of Lithobid. I'm doing very well. However, six years ago I was initially misdiagnosed as ADHD and prescribed Ritalin. The Ritalin pushed me into mania big time. But the mania felt so good that I could not be convinced by the people around me that something was wrong. And my ex-pdoc did not recognize my mania but instead kept writing scripts for Ritalin (can you say malpractice?).
To make a long story short, I lost my job as an environmental engineer, ran up $70K of credit card debt, cashed in and spent my retirement account, etc. The thing about mania (hypomania) is that these actions actually seemed logical at the time.
I'm posting here just in case I can help you in some way. If I can help, let me know.
Everything you have written in this tread leads me to believe that you are probably bipolar, but I'm not a pdoc. Also, it is common to use Neuronin as an adjunct medication for BP patients, but I have never seen it recommended for monotherapy use in treating BP disorder. Here is a good technical article regarding medication options for BP patients:
http://www.psychguides.com/gl-treatment_of_bp2000.html
It's somewhat understandable that BP II patients are routinely misdiagnosed as ADHD because the symptoms of BP II hypomania are very similar in outward appearance to ADHD hyperactivity. I have a couple very good articles listing specific behaviors that differentiate the two disorders. For example, BP II patients are typically not morning people in that they have trouble getting up in the morning, whereas, ADHD patients generally bounce out of bed raring to go. General statements such as this are not true in all cases, of course, but the articles sure seemed applicable to me. My wife and I recently bought a new computer and the bookmarks to these articles are on the old computer which is currently not hooked up. I'll try to remember to send these links to you went I can.
In cases of comorbid BP II and ADHD, it is important to treat the BP II first. Put a moodstabilizer fully in place BEFORE adding a pstim (or an AD)!
-- Ron
Posted by Krazy Kat on May 21, 2002, at 18:23:54
In reply to Re: Mom03: BP II or ADHD? » MomO3, posted by Ron Hill on May 21, 2002, at 18:03:37
Ron:
Do you think there is any reason Not to out a mood stabilizer in place first? I ask because I felt that should have been my first treatment - it was not. I was placed on AD's, then atypical AP's, then Neurontin + AD... on and on. Only when I really pushed it was I given Topamax to try. And eventually have ended up on Depakote, with a trial for a stim to offset the ADD-like side effects.
I can't imagine why a pdoc wouldn't try a stabilizer first, whether they're certain of the BP or the ADD diagnosis. Would there be an ill-effect?
Just curious.
- kk
Posted by Ron Hill on May 21, 2002, at 19:22:13
In reply to mood stabilizers first - ron and mom, posted by Krazy Kat on May 21, 2002, at 18:23:54
KK,
I agree with you fully! And I have read several medical documents that state the exact same thing. If the pdoc can not decide between BP II or ADHD, then the pdoc should be conservative and treat with a moodstabilizer first and observe the results. A moodstabilizer will typically not hurt nor help an ADHD (or ADD) patient but great damage can be done to a BP II patient by feeding him/her pstims and/or AD's without a moodstabilizer fully in place.
I'm opinionated on this issue because I lost a lot and endured much unneeded mental health pain because an inept pdoc misdiagnosed me as ADHD (without conducting any formal testing) and sent me home with a pocket full of Ritalin telling me to figure out my dose by trial and error. When I became very moody two months later, he added an AD (Paxil). Shortly thereafter mania took over and it was off to the races.
-- Ron
Posted by katekite on May 21, 2002, at 20:49:48
In reply to Re: mood stabilizers first - Absolutely! » Krazy Kat, posted by Ron Hill on May 21, 2002, at 19:22:13
I agree totally, mood stabilizer first.
I can say that having gone the exact opposite route.... I'm ADD and was misdiagnosed BP II.
Of course I wish that I had been formally evaluated for ADD at the beginning... but I did come in complaining mostly about my mood.
Had I been bipolar it would have been dangerous to start me on stimulants.
In the end I was delayed starting on stimulants because of the incorrect BP dx for about six months. Feels too long (mood stabilizers impaired my concentration and made me physically ill), but going manic would have been worse.
kate
Posted by JonW on May 21, 2002, at 23:46:55
In reply to mood stabilizers first - ron and mom, posted by Krazy Kat on May 21, 2002, at 18:23:54
Hi kk,
I understand the current thinking when treating bipolar disorder to be to start out with a mood stabilizer alone, regardless of the presentation. My psydoc told me that it takes a bipolar patient an average of something like 8 years to be correctly diagnosed -- certainly holds true in my case. That's horrible when you think of how many people die from suicide each year.
Jon
> Ron:
>
> Do you think there is any reason Not to out a mood stabilizer in place first? I ask because I felt that should have been my first treatment - it was not. I was placed on AD's, then atypical AP's, then Neurontin + AD... on and on. Only when I really pushed it was I given Topamax to try. And eventually have ended up on Depakote, with a trial for a stim to offset the ADD-like side effects.
>
> I can't imagine why a pdoc wouldn't try a stabilizer first, whether they're certain of the BP or the ADD diagnosis. Would there be an ill-effect?
>
> Just curious.
>
> - kk
Posted by krazy kat on May 22, 2002, at 9:46:13
In reply to Re: mood stabilizers first - ron and mom » Krazy Kat, posted by JonW on May 21, 2002, at 23:46:55
thanks all, for the input. i hope this helped some, mom03.
just to reconfirm, i, too, lost about two years of fairly successful treatment because my pdoc did not place me on a stabilizer at first. i suppose there's a case against it in that the side effects can be numerous, but i can't imagine not giving one a trial. lithium and depakote kick in within two weeks, so results, or lack of, are going to be pretty quickly evaluatable (I know that's not a word. ;)).
- kk
Posted by Ritch on May 22, 2002, at 10:12:39
In reply to mood stabilizers first - ron and mom, posted by Krazy Kat on May 21, 2002, at 18:23:54
> Ron:
>
> Do you think there is any reason Not to out a mood stabilizer in place first? I ask because I felt that should have been my first treatment - it was not. I was placed on AD's, then atypical AP's, then Neurontin + AD... on and on. Only when I really pushed it was I given Topamax to try. And eventually have ended up on Depakote, with a trial for a stim to offset the ADD-like side effects.
>
> I can't imagine why a pdoc wouldn't try a stabilizer first, whether they're certain of the BP or the ADD diagnosis. Would there be an ill-effect?
>
> Just curious.
>
> - kk
Hi KK, Ron, et al,I just got through looking in my mood chart for the last four months and highlighting all of the "unremarkable" mood days and the longest strings of "unremarkable" mood days were when I was on Dexedrine+Neurontin+Depakote (all low dose). Every time I see a lot of "kinks" (cycling) were when I was taking SSRI (and no dex). The stimulant seemed to "displace" the need for the SSRI, without triggering any cycling. I am convinced of my ADHD dx, however I have bipolar traits for sure as well. I have had two "technical" hypomanic episodes (4 days each) in the last four months (but *not* associated with dexedrine). I know there is a lot of dispute about comorbidity. I think in my case antimanic/anxiolytic agents such as Depakote/Neurontin combined with a stimulant (like dexedrine) seem to work the best for me anyhow. The Depakote seems to work the best for impulsiveness and hostility, the Neurontin the best for anxiety, and the dexedrine as an *anticycling* agent-in my case anyhow. I suppose one could start an antimanic agent and see if their symptoms improve, and then add on a stimulant if a large cluster of ADHD-like symptoms are still unresolved. ??
Mitch
Posted by BarbaraCat on May 24, 2002, at 0:47:30
In reply to Re: mood stabilizers first - Absolutely!, posted by katekite on May 21, 2002, at 20:49:48
Wish I had a chunk of those 20 or so years back. Gee! I coulda had a lithium!
Posted by katekite on May 26, 2002, at 20:57:07
In reply to Mood stabilizers first - Absolutely! Positively!, posted by BarbaraCat on May 24, 2002, at 0:47:30
Hi,
Wanted to add on to my previous post. I wrote that yes agreed mood stabilizers first.... but want to clarify that should only be for the case where ADD and BP are suspected to coexist.
If there is any question that someone is one or the other only, or if its just not clear, get an expensive ADD work-up by an independent learning and attention disorders tester, AND do some sensitive testing for BP disorders. Do the MMPI or some other personality inventory. The money is worth it absolutely over the potential lost year or so spent trying the wrong drugs and reacting poorly. Insurance will often pay. Docs can't request all the testing on every person because insurance companies would scream. So unless you ask you may not get referred for it. The more insistent one is on getting tested, the more cautious you are, the more likely you are to get a correct diagnosis in the first place and skip months of the wrong meds.
Be assertive and ask to have the tests that you know exist. Doctors generally just talk to you for an hour, have you fill out a checklist, and then guess. Plus we all present ourselves in particular ways in an office to an authority figure such as a doctor that can be misleading: there are objective ways to assess us where testing is combined with personal opinion. The more information they gather, the more likely they are to be correct.
Sorry for the harangue, just hope someone can be saved 6 months if they get good testing done.
kate
Posted by BarbaraCat on May 26, 2002, at 21:22:08
In reply to Lots of testing first, diagnosis first, then meds, posted by katekite on May 26, 2002, at 20:57:07
Have you had these tests done yourself? If so, say more on them - names, what they're like, anything that would help. I think testing is an excellent idea and wasn't aware of their existence, nor of specialists that can sleuth such things out. You'd think in over 20 years of therapy, pdocs, non-responding to meds and general Hell, someone would have mercifully mentioned them to me.
Posted by katekite on May 28, 2002, at 6:38:09
In reply to Re: Lots of testing first, diagnosis first, then meds » katekite, posted by BarbaraCat on May 26, 2002, at 21:22:08
There are psychological tests such as those described here: http://www.deltabravo.net/custody/psychtests.htm
The most common is the mmpi which is supposedly very good at picking up subclinical obsessiveness or depression etc as well as personality type.For possible ADD a "continuous performance test" is useful. Those who take and 'fail' the test are something like 90% likely to have ADD.
Then there is brain imaging such as PET scans, horribly expensive but can show which parts of the brain are more or less active than normal, helping target drug therapy. Something to do probably only if many drugs have failed and the diagnosis is becoming murkier and murkier.
An EEG is cheaper. May pick up on seizure activity for people who have 'episodes' of anything. Also some disorders show other EEG changes, particular waves are slower, etc.
A routine blood panel will show things as weird as hypophosphatemia which can present as only panic attacks. No one should start drug therapy without a routine blood panel and thyroid check.
Then there is ruling out all hormonal problems. This isn't usually done because they are uncommon (except thyroid which usually is done) and its not cost effective to check everyone for everything.
Here's an excerpt from a text on pharmacology:
"Patients with depression exhibit increased hypothalamic–pituitary–adrenocortical (HPA) activity, as evidenced by an increase in the number of adrenocorticotropic hormone (ACTH) secretory episodes and an increase in the magnitude of cortisol secretory episodes. This HPA overactivity is further reflected in elevated urinary "free" cortisol (UFC) levels, which appear to be about twice as high in depressed patients as in normal controls, but lower than in patients with Cushing's syndrome."
So suppose you feel depressed, you're gaining weight, freaking out all the time. Option one is telling your family doctor you feel depressed and they prescribe an ssri. Option two is asking for hormonal testing and then a referral to a psychiatrist and getting them to do an MMPI. Suppose the hormonal testing picks up early Cushings because cortisol is higher than even depression should be? Well then the ssri would have been the wrong approach. A percentage of people with cushings commit suicide before their disorder is even discovered.
Suppose you were depressed before but this year you've gotten really even more depressed. Is that just worse depression that needs a higher dose, or did something else start?
This is not to say that most people who have treatment responsive depression or anxiety etc don't have that only.
Sometimes people's presenting complaints are just the new symptom that they aren't used to. Someone who's always been slightly depressed but now also has panic attacks isn't going to come in and say, hi I don't know what its like to be happy.... they will say, I've been having anxiety attacks. They most likely would be treated for panic and not for their less severe but more chronic problem. An mmpi might well pick that up.
To me it seems more like an issue of getting the class of medication right the first time. The varieties of problems we have just can't be diagnosed in the time a typical practitioner has, plus we generally come in in some sort of crisis which makes it hard. Many docs have favorite drugs they always start with no matter what the presenting complaint.
I'm just bitter because I started pulling my hair out at 12. An impulse control problem. I got depressed at 20, was on and off depression meds for 10 years. I got an anxiety disorder at 25, added in benzodiazepines. I got misdiagnosed as bipolar last year. I really have ADD. Had that been found by an easy 20 minute test back at age 12 I wouldn't have pulled my hair out for so long. Had it been found at age 20 I would have been treated for the primary problems and not the secondary symptoms.
So maybe I'm the only one that needed more testing and objective assessment back when I first presented. But I doubt it.
Its all a matter of cost effectiveness to insurance companies and payback on effort and liability avoidance for doctors. Its acceptable to them if they miss 1% of medical diagnoses or misdiagnose 5% of psychiatric problems -- but it isn't fine for us.
If anyone replies to this harangue we should probably move to psychosocial babble.
kate
Posted by BarbaraCat on May 28, 2002, at 17:54:12
In reply to Re: Lots of testing first, diagnosis first, then meds, posted by katekite on May 28, 2002, at 6:38:09
This is the end of the thread.
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