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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by stargazer2 on July 29, 2007, at 20:05:20
I'm starting to wonder if i have been misdiagnosed with depression for all these years when perhaps I have undiagnosed ADD. I have suggested this to my pdoc over and over again and although he says it is depression, something tells me that ADD may be causing alot of my depressive symptoms.
Perhaps this is why none of the AD's work and I believe that Adderall worked when I was on it in combination with Celexa and wellbutrin. I think many of my symptoms of ADD like distraction, lack of motivation, rumination and lack of focus may be causing depression and the diagnosis of ADD may be missed since the depressive symptoms can be the result of untreated ADD.
Has anyone else found out they are ADD as a primary diagnosis and once treated with a stimulant alone or in combination with an AD has had remission of the depressive symptoms?
I am starting to think my lack of motivation and interest in anything may be from misdiagnosed ADD.
Has anyone else treated with a stimulant found that their depression improved significantly once the stimulant was initiated? If so, what stimulant was the most successful for your ADD symptoms? Were you also on an AD and what one in combination with the stimulant?
Stargazer
Posted by brooke484 on July 29, 2007, at 20:54:05
In reply to Can ADD mimic depression and be missed?, posted by stargazer2 on July 29, 2007, at 20:05:20
stargazer,
I'm just wondering how you are doing on Nardil these days. I decided to go off after 9 weeks of feeling no change except for nasty side effects. My doctor wants to add lamictal but I'm not so sure if that will make a difference.
Hope you're doing ok.
brooke
Posted by Phillipa on July 29, 2007, at 22:17:28
In reply to Can ADD mimic depression and be missed?, posted by stargazer2 on July 29, 2007, at 20:05:20
Stargazer you know I've wondered those same things about me with the anxiety and remembering the not thinking things I did as a child before they had ADD. Of course the other possibility is bipolar?????Love Phillipa
Posted by elanor roosevelt on July 29, 2007, at 23:10:49
In reply to Re: Can ADD mimic depression and be missed? » stargazer2, posted by Phillipa on July 29, 2007, at 22:17:28
the over-stimulation of the ADD agitated state can cause a retreat into depression
your mind trying to still the staticthat said, i find adderal to be a mixed blessing
but for now i am working on my mind set with a just for now approach
taking half a zoloft at night for a (somewhat)better morning headtook me 15 years to get a doc to medicate my ADD
Posted by stargazer2 on July 30, 2007, at 8:28:12
In reply to Re: Can ADD mimic depression and be missed?, posted by brooke484 on July 29, 2007, at 20:54:05
Brooke, still on Nardil 45, Wellbutrin 300 SR and most recently Abilify 2.5, although when Abilify was added before nothing good came of it.
I'm still depressed but differently, in a way that makes me feel very inferior to others that don't have depression. I find it too awkward to be around others because I feel so defective and everthing I say I question becasue I have so little spontaneity andcomfort in what comes out of my mouth.
I am convinced that if I was treated for ADD, which my pdoc doesn't agree with (although he hasn't gotten it right in 20 years), I will feel more productive and organized and therefore will not feel as defective as compared to others. I have always compared myself with others, especially when depressed, and then see how much I don't measure up. That is one way to feel depressed but I have no control over how I compare myself with others.
I do feel my brain does not pay attention, cannot finish or start projects, unable to read...is this ADD or depression? The two are very close in some respects but what's the harm in treating me for ADD as a primary diagnosis, since treating me for depression has not been too successful over so many years. I remember when Adderall was doing something positive for me, when combined with celexa and wellbutrin. Perhaps it was the Adderall specifically that was the most helpful, rather than the wellbutrin or celexa. I have never tried a stimulant on its own.
My next step would be to try Strattera or adderall again and see what happens.
Brooke, I can't really see an improvement in things, just major constipation, and cramps.
I wonder if increasing the dose of nardil will help more. I just hate trying pills and taking large amounts of them unless I feel something good will come of it. I'm not so sure about nardil but Ace (see his post below) swears by it and is on 90 mg. Perhaps an increase is warranted before I stop nardil prematurely.
Stargazer
Posted by med_empowered on July 30, 2007, at 13:25:01
In reply to Re: Can ADD mimic depression .../Brooke, posted by stargazer2 on July 30, 2007, at 8:28:12
DSM diagnoses aren't "real" like cancer is "real"; if you have, say, a tumor in your lung, a doc must go through steps x,y,z to address this problem. Not so mental illnesses...people respond to different drugs, so its not such a straightforward process.
Stimulants can be great for some kinds of depression--sometimes there may be ADHD-type symptoms, sometimes not. Back in the day, docs recognized this: hence the common use of amphetamines and upper/downer combos (dexamyl, eskatrol) to treat various states of depression. Even now, stimulants are used a good bit in depression, except its "off-label," b/c stimulants are now conceived of as being primarily for the treatment of ADHD.
So..I guess I'm saying it doesn't really matter if you "reall" have ADHD instead of/in addition to depression; its entirely possible that, whatever the diagnosis, an added stimulant could be beneficial.
Why do you think your doc hasn't used stims yet? Is s/he afraid of increasing agitation or something, or just not willing to rx a stimulant? I'd ask and see; if there's a valid reason for not using one, talk about; if your doc's reason(s) don't make sense to you, or seem stupid, you may want to go to a different doctor, since you seem to be having some residual problems. there's no reason to put up with less than optimal treatment from a shrink, so if your doc isn't cooperative, fire and move on.Good luck.
Posted by brooke484 on July 30, 2007, at 20:46:13
In reply to Re: Can ADD mimic depression .../Brooke, posted by stargazer2 on July 30, 2007, at 8:28:12
Well, I would never be able to get to 90 mgs, even if I wanted to. As soon as I got passed 45, the side effects got really bad. I had palpitations, major anxiety, weight loss, etc for about 3 weeks when I said, enough is enough. I am thinking about just quitting all together. It hasn't done one thing for me in 9 weeks. We're taking our vacation in a week and a half and I would like to be off it by then. My doctor is pushing me to stay on it, but he's not the one suffering. I would like to try Marplan with Lamictal next. Have you thought about trying that again?
I hope you can find some relief. Keep us posted.
Oh, and when are you seeing the endo?brooke
Posted by stargazer2 on July 31, 2007, at 12:01:20
In reply to not an either/or thing..., posted by med_empowered on July 30, 2007, at 13:25:01
ME, My pdoc has used Adderall before with me and I found it, along with Celexa and wellbutrin effective but eventually it pooped out. I attributed the failure to the meds, yet I was in a really bad work situation and that made me decompensate more than the wrong meds. Despite that combination, I did sink into a major depression. The only thing my pdoc did not do in retrospect was increase the wellbutrin before switching me to another combination of meds, which I still have not found to work for me yet.
I am on Nardil so my pdoc is reluctant to try stimulants, although I believe a small dose (5 mg) of amphetamine is allowed with nardil. I would like to take Adderall again, but he isn't sure about adding it safely to nardil. I don't even care about safe anymore, since I am so desperate for relief after the last 2-3 years of med trials. He did just add a small dose of Abilify (2.5) to the nardil and wellbutrin. He loves the atypical AP's so much I wonder why since after trying them several times they don't so squat for me yet he continues to try them.
On Friday when I see him I will continue to insist on trying another stimulant or something like Strattera which may be safer to add to nardil, do you know if it is?
Stargazer
Posted by stargazer2 on July 31, 2007, at 12:38:43
In reply to Re: Can ADD mimic depression- stargazer, posted by brooke484 on July 30, 2007, at 20:46:13
Brooke,
I did try Marplan this last year with no success. Bummer, since when I took it in 1992 it worked beautifully until Roche discontinued it fo "business" reasons, aka lack of profits. Perhaps the new version of Marplan was chemically changed when they reformulated it since Nardil and wellbutrin are no longer the same thing as the brand name formula. The generics are supposed to be the same but they're not, they have a soft coating not a hard shell, which causes the medication to be more quickly absorbed. The generic manufacturers stand behind their assertion that the generic is the same thing as the brand meds. I'm not convinced of that and many others are not either.I see an endo nurse practitioner next Monday since the soonest I could have seen the endo was March of 2008!
The meds I currently take are:
Nardil 45 mg at night
Wellbutrin 150 SR, 2X day
Abilify 2.5 mg at night.Yesterday and today I tried generic Amphetamine to see what effect would result and it seems to be helping with motivation and ability to start projects and follow through.
Despite never offically being diagnosed with ADD, I have so many obstacles to normal interest and focus it is well worth trying a stim. I guess I'm not sure if I need both an AD and a stim. Sometimes I don't feel depressed only unfocused and overwhelmed with the demands and responsibilities of life, that I feel this is the cause of my depression.
I'm interested in trying Strattera, but would it make sense to stop all the other meds so as not to risk a side effect with several meds interacting with one another. That is the problems with trying a new drug, it is never given to me by itself, it is always given as an add-on to whatever I am taking at a given time so I never know if one med alone will work well.
My pdoc never takes me off the other meds before trying a new med. Oftentimes I wonder if it is the combination of meds that causes me to never find the med that will work. My pdoc is relatively conservative and will not take me off all my meds as he feels the risk of relapse is too great.
I would like to try a stim or strattera on it's own to see what onedrug alone will do for me. Then I would really know what that med will do on it's own.
The process never gets easier as time goes on. For me, it actually has become more difficult the longer my depression exists and the more meds I try. Med trials are so unpredictable and time consuming that the last 20 years have been wasted on many trials, I feel like the time has all been wasted since with each trial, there has never been a really successful outcome, except with the original Nardil and Marplan, back in the late 80's and early 90's.
I'm not convinced that any of the med trials are actually helpful and that my suggestions at least are trying something new, not continuing to try more AD's that do not help me at all.
How can psychiatists know so little about what meds will work given the symptoms of each patient. Am I that unusual and med resistant that there is no chance of a remission. It seems that way at times...
SG
Posted by med_empowered on July 31, 2007, at 18:32:35
In reply to Strattera or stimulants with nardil???Med emp..., posted by stargazer2 on July 31, 2007, at 12:01:20
if its cool to do reuptake inhibitors w/ nardil. I think wellbutrin+parnate is OK though, so who knows.
Ivan Goldberg is apparently a big MAOI+stims fan; he uses up to 60mgs/day amphetamine with Parnate...I imagine since Nardil is more sedating, stims are pretty common with it. If I remember correctly, adding a low-dose TCA along with ongoing MAOI can actually make a hypertensive reaction less likely (or maybe you have to start them together...I forget).
Anyway, good luck!
Posted by brooke484 on July 31, 2007, at 20:54:48
In reply to Brooke/answers...more questions, posted by stargazer2 on July 31, 2007, at 12:38:43
They didn't change Marplan too, did they? Did you try a high enough dose? I know that when I take generic klonopin it's like taking a sugar pill, but when I take the real thing, it works great. There is definitely a difference. But for it to work I have to be off all other meds. I'm not sure why.
I was on Wellbutrin before they came out with the generic but it didn't work for me unfortunately. I really hope you can find some kind of combo that works. If I knew now what I knew then I would still be taking 400 mgs of imipramine.
Let us know what happens on Monday. I saw several endos, but none took me seriously. They all said I needed a psychiatrist. I already knew that!
brooke
Posted by Phillipa on July 31, 2007, at 21:02:23
In reply to stargazer, posted by brooke484 on July 31, 2007, at 20:54:48
Booke same here even though they can't regulate my thyroid. It was the beginning of me needing something for depression. Before that I had anxiety covered with low dose benzos. An ER nurse here told me she saw all the endos in Charlotte and they were jerks so her internist treats hers and she fine but he doesn't take new patients. Our of luck Love Phillipa
Posted by HelenInCalif on August 2, 2007, at 19:05:21
In reply to Can ADD mimic depression and be missed?, posted by stargazer2 on July 29, 2007, at 20:05:20
I was diagnosed with ADD only after my inability to work efficiently caused me to become severely depressed.
It was taking me 8 hours to get 4 hours worth of work done, and I was falling behind compared to everyone else at the company. You bet that was depressing, but the depression was an effect of something else- the ADD.
I was lucky:
1. a relative of mine was diagnosed with ADD, and I recognized the symptoms and,2. the HMO's nurse liaison (between my workplace and the HMO) believed me and recommended a Pdoc who had dealt with adult women with ADD. She fast-tracked me to the new Pdoc.
#2 was really lucky, because the first pdoc I'd seen for the depression didn't believe in adult ADD. He wasn't going even going to consider it until the depression was gone. Wow- by then I'd have been fired!
Posted by stargazer2 on August 3, 2007, at 8:14:17
In reply to Yes, in that my ADD caused depression, posted by HelenInCalif on August 2, 2007, at 19:05:21
Helen, What are your ADD symptoms and what meds are you taking? Have you ever tried Strattera? Was it helpful or are you on traditional stimulants? On an antidepressant too?
Thanks for any info on how your ADD caused depression. I'm not sure ADD causes mine exclusively but I believe that there may be a greater impact than my pdoc is aware of. He is convinced the majority of my symptoms are related to depression but I think many of my disorganized and unfocused traits are from ADD too. I take too much time with my work and rather than be considered thorough, I am considered slow and unproductive. There is no time for being accurate anymore, just for volume. Modern times do not agree with my ADD traits. I am unable to focus enough to read and most things I read do not hold my attention and I almost never complete any book or article.
Stargazer
Posted by belljar on August 3, 2007, at 14:39:16
In reply to Can ADD mimic depression and be missed?, posted by stargazer2 on July 29, 2007, at 20:05:20
Hi Stargazer
I agree with you - After 15 years on SSRIs I saw a new doctor who listened to the symptoms and thought ADD, put me on ritalin. I was really sceptical, not knowing much about ADD. The first day was like a brand new life for me - I couldn't believe the change. THe background noise disappears, I complete tasks quickly and easily, I don't get frustrated or upset with people, I'm happy and calm, really steady. it was incredible. I am now going off the SSRI (paxil) to see if I function ok with just the ritalin, because I really hate the paxil side effects, and other SSRI's I've tried give me stupidbrain, or make me really paranoid and antisocial. My other attempts to leave the paxil world were without ritalin, so maybe this time will be different - it seems to be, so far.
Unfortunately that doctor moved and my new one thinks that adults shouldn't be using stimulants, but so far is prescribing them anyways (for now). I try to only take it on work days, I don't take anything on weekends or holidays when it's ok to be "lost and confused."
I've only been off the paxil for several weeks so I don't know what it will be like later on, but so far it's going well.
belljar
Posted by stargazer2 on August 3, 2007, at 18:16:38
In reply to Re: Can ADD mimic depression and be missed?, posted by belljar on August 3, 2007, at 14:39:16
BJ, that's what I hope will happen with me, being put on the right stim along with possibly an AD or not.
Can I ask what your symptoms were before you took Ritalin? I feel like I have ADD but it has taken a second seat to depression but it may be the cause of my depression since I've changed jobs often due to boredom or irritating events or people.
I also have trouble reading and completing tasks in a reasonable period of time.
I just wanted to compare my symptoms with yours for similarities.
Thanks for your post, it made me realize I could have been misdiagnosed all these years and depression is a factor but it may have it's roots in ADD symptoms and lack of self esteem due to me comparing myself to others who are successful.
Stargazer
Posted by belljar on August 4, 2007, at 11:00:11
In reply to Re: Can ADD mimic depression and be missed?BJ, posted by stargazer2 on August 3, 2007, at 18:16:38
> Can I ask what your symptoms were before you took Ritalin?
WHen not on ritalin, I have a very low tolerance to outside distractions. I can read a book ok if I am alone and it is a "good book". I can't sit an watch a movie, though - I have to get up and do something else every once and a while. I can't sit and carry on a conversation, I have to be up moving around "multitasking". It drives my friend nuts. At work (I'm a teacher) if there is any movement or conversation happening in the room when I'm trying to follow a thread of thought, or talk to someone, I can't deal with it, I shut right down. I get REALLY irritated and always insist on SILENCE, hence I have quite a nasty reputation, but I just CANT function when something is happening beside me. It's like I get confused and can't think, can't remember what I was saying. WHen I need to sit still and complete a project / paper work / prep work, I eat steady. SMoking used to work (back in the 80s when it wasn't "bad" !!) then gum (now I have TMJ).. so now I eat, or tap my foot, or play with a stress ball... WHen I take ritalin, I can focus on a task without any aids. it's amazing.WIthout ritalin I'll start to clean house, be on one task, see something else that needs to be done, leave on job half done, etc - at the end of the day my husband comes home to a disaster zone with a million things started and none finished.
Without ritalin if I'm trying to talk to one person and kids come up to me and demand stuff and then the phone rings and .... I FREAK OUT, shut right down, want to yell and panic and run away. On ritatlin I get through each day dealing with all the stuff and somehow manage to do it all, calmly - and after work I am calm and in control of it all.
without ritalin Changes in routine or disorder make me really upset, everything has to be "the way it's supposed to be". I react with emotions rather than my brain.
Does any of that make sense ??? I do have mild OCD, (worrying constantly, checking electrical plug in over and over, etc) which was the diagnoses that first put me on paxil back in 1992. ALl of the other stuff was just "me" I didn't question it. In those days "ADHD" was for the hyper kids who dropped out of school, it wasn't as understood as it is now. ALso back then I was a chain smoker, severely overweight, drank too much, had all of those bad coping tecniques. Once on paxil I couldn't get off of it, even though it makes me really agressive and angry. QUit smoking and lost 50 pounds, and lost my "coping techniques". So I was pretty hig maintenance. I just lived like that until 2006 when a new doctor through out "wow, you sure sound like an adult ADD..." and here we are.
So who knows ??? At this stage of my life I just want to be as healthy as I can be on as little drugs as possible, taking only what is really needed. SO I do hope that this will work, ie just the ritalin. Time will tell.
I have a good support system, watching my behaviour. Please be careful if you try to come of an SSRI - make sure you have someone wathing you , it can be really freaky.
Belljar
Posted by rina on August 4, 2007, at 18:35:41
In reply to Re: Can ADD mimic depression and be missed?BJ, posted by stargazer2 on August 3, 2007, at 18:16:38
Hello All,
Just a side note for those taking a stimulant for ADD and suffer from depression as well. I suggested taking a holiday from my stimulant to my doctor on weekends so that my body doesn't develop tolerance or popout tendencies and he said to me that sometimes this tends to make depression worse because it's a start and stop effect, confusing the body and beginning a possible on a off withdrawal state. So just a suggestion.
Have a good weekend.
Posted by sometimesblue on August 6, 2007, at 15:01:17
In reply to Can ADD mimic depression and be missed?, posted by stargazer2 on July 29, 2007, at 20:05:20
I've suggested the same thing to my doc and she also insisted it was just depression..."if it were ADD you would have been diagnosed years ago, as a child"...so,, idon't know. She's the expert but, I know how i feel.
> I'm starting to wonder if i have been misdiagnosed with depression for all these years when perhaps I have undiagnosed ADD. I have suggested this to my pdoc over and over again and although he says it is depression, something tells me that ADD may be causing alot of my depressive symptoms.
>
> Perhaps this is why none of the AD's work and I believe that Adderall worked when I was on it in combination with Celexa and wellbutrin. I think many of my symptoms of ADD like distraction, lack of motivation, rumination and lack of focus may be causing depression and the diagnosis of ADD may be missed since the depressive symptoms can be the result of untreated ADD.
>
> Has anyone else found out they are ADD as a primary diagnosis and once treated with a stimulant alone or in combination with an AD has had remission of the depressive symptoms?
>
> I am starting to think my lack of motivation and interest in anything may be from misdiagnosed ADD.
>
> Has anyone else treated with a stimulant found that their depression improved significantly once the stimulant was initiated? If so, what stimulant was the most successful for your ADD symptoms? Were you also on an AD and what one in combination with the stimulant?
>
> Stargazer
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