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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by Raisinb on July 20, 2012, at 17:52:51
Hello everyone,
My main dx these days is bipolar II, but my new pdoc, who seems very good, thinks I might have comorbid ADHD, which is a new idea for me. What are people's experiences being diagnosed as an adult and taking meds for it?
Posted by enndub on July 20, 2012, at 17:55:50
In reply to Experience with adult ADHD?, posted by Raisinb on July 20, 2012, at 17:52:51
I have been diagnosed with ADHD as an adult, although now I think my disthymia and atypical depression were just mimicking ADHD symptoms.
Whatever the case, Vyvanse was the second best med for me after Nardil, and I think you could get pretty good results combining ADHD medication with a mood stabilizer.
Posted by ron1953 on July 20, 2012, at 18:10:17
In reply to Experience with adult ADHD?, posted by Raisinb on July 20, 2012, at 17:52:51
I got that diagnosis couple of times, and this is my take: Adult ADHD is BS.
Posted by 10derheart on July 20, 2012, at 20:05:34
In reply to Re: Experience with adult ADHD?, posted by ron1953 on July 20, 2012, at 18:10:17
But you "believe in" ADD in kids then, since you made the distinction? Does it magically disappear as you grow up? If so, what do you base that on?
Anyway, I couldn't disagree more. I would hope you understand that just because the dx was BS for **you** hardly means it is b*llsh*t in general or doesn't exist, if that's what you mean. It seems pretty dismissive to tell me my brain *is* wired like everyone else's when I've struggled with my difference (which I prefer to disorder) for years, or that my symptoms don't exist. Why did I recover about 80-85% of my ability to function like any average adult after finding the right med for me (Strattera)if ADD is BS? Wouldn't the meds have either had a bad effect or no effect? Taking my medication - a vital tool in treatment - is the difference between a chaotic, nearly unmanageable mind and life, and being able to contribute and participate without constantly needing massive help from family and friends. And I don't mean help with a tough job or challenging college classes - I mean I used to need help finding my car keys, remembering most anything, cleaning my house or navigating a grocery store without freaking out from the massive input of sounds, colors, decisions, etc. I could go on...but this is already too long.
I precisely fit the vast majority of symptoms reported by hundreds, no, thousands of others in books, newsletters, magazines and blogs about ADD. When I first discovered there was a name for this and read about real adults describing their daily lives, I was astounded to the point of saying, "How the hell could these people/this author KNOW all these things about me??" It was past uncanny and a tremendous relief not to be defective, crazy or alone. Before identifying this, I thought I was lazy, crazy, stupid, weak and not trying hard enough. Are all of us experiencing nearly identical clusters of symptoms....what? Experiencing mass hysteria? Imagining the symptoms, even when we don't know each other?
Do you dispute the various scans (PET, SPECT, MRI) that show specific and clear differences in areas of the brain that are "on" or "off" between those who fall in the ADD spectrum and those who do not?
http://www.akidjustlikeme.com/id92.htm
I think these are real, tangible proof that during focus and memory tests certain brains do not metabolize glucose the same as others, and therefore functioning is impaired or absent.
I had what I call diagnosis by prescription about 10 years ago. Not necessarily the best way, but understandable under the circumstances. (When a fairly "rough" stimulant like methylphenidate [MPH] does the opposite of ramping you up or causing any "hyper" sensation, but instead steadies, calms and relaxes you, it obviously means something varies significantly in your brain....)
The only pdoc I had access to at that time did not have the time or flexibility (military clinic) to administer a battery of tests and do an extensive personal and family history. This is the optimum way to isolate true ADD since it does show up somehow in childhood, and especially to try to tease it out from other problems its manifestations overlap symptoms of depression, anxiety and bipolar, just to name a few.
With me, there was no psychologist readily available where I was (overseas) to do a proper evaluation anyway. But I had done months of my own research and taken many self-tests. I discussed all this with my pdoc and therapist and even tried psychotherapy alone for a while longer. When things really did not get much better and as I was already suffering from depression and taking an SSRI, my pdoc slowly added MPH and it was.....life-altering. This combo of an AD and MPH was a common and accepted treatment for the condition in 2002. I suspect it still works for some fortunate people like me. After a few months and raising the dosage of Ritalin to 80 mg/day, my concentration, focus, memory and organizational skills all vastly improved. Later, when I switched to Strattera it was nothing short of miraculous how the endless noise in my brain jerking me from thought to thought, task to task, quieted and the executive function area of my brain began to actually....well, function. I will never forget after just a few days of Strattera thinking, "So this is what other people's brains are like?!! Wow!"
Dx and tx of adult ADD has been a huge positive life change for me. No sh*t ;-)
Posted by 10derheart on July 20, 2012, at 20:12:07
In reply to Experience with adult ADHD?, posted by Raisinb on July 20, 2012, at 17:52:51
Hi raisin,
I wrote a rather long reply to ron below after he.....prodded me with his BS description of adult ADD :-) Yes, the idea of BS or nonexistence is a pet peeve of mine.
I know the post is long, but if you feel like reading it you'll get a sense of some of my journey with adult ADD. Also, if you Google Strattera and my posting name here on PB, you should get links to many old threads on this subject from the past 5-6 years, if not longer.
Any particular questions you have I'd by happy to answer. I would think it would be a challenge to separate out ADD from bipolar so I do wish you and your pdoc the best with that.
Posted by rjlockhart04-08 on July 21, 2012, at 0:18:57
In reply to Experience with adult ADHD?, posted by Raisinb on July 20, 2012, at 17:52:51
adult adhd is usally not seen maybe as much as hyperactive as kids are...still there are cases out there. Usally in ADDorADHD case the person has difficulty with memory and concentraton to the point where it effects their daily tasks...
I did not write this....this is from wikipedia. I'm just tired tonight, usally I could easily write a response to this. Anyways, here it is..
Predominantly inattentive type symptoms may include:[29]
Be easily distracted, miss details, forget things, and frequently switch from one activity to another
Have difficulty maintaining focus on one task
Become bored with a task after only a few minutes, unless doing something enjoyable
Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
Not seem to listen when spoken to
Daydream, become easily confused, and move slowly
Have difficulty processing information as quickly and accurately as others
Struggle to follow instructions.
Predominantly hyperactive-impulsive type symptoms may include:[29]
Fidget and squirm in their seats
Talk nonstop
Dash around, touching or playing with anything and everything in sight
Have trouble sitting still during dinner, school, and story time
Be constantly in motion
Have difficulty doing quiet tasks or activities.
and also these manifestations primarily of impulsivity:[29]
Be very impatient
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
Have difficulty waiting for things they want or waiting their turns in games________________________________________
stimulants depend on the person, some people respond well to methyphenidate...others dextroamphetamine usally its a bit more potent. A good choice with it is to take Strattera or Intuniv....and actually I have say these off label use
Clonodine
Zyprexa ... i've noticed it produces a calmness to my hyper thinking, i don't feel like doing silly things when I'm on zyprexaanyways hope this helps...good night
rj
Posted by ron1953 on July 21, 2012, at 0:33:18
In reply to Experience with adult ADHD?, posted by Raisinb on July 20, 2012, at 17:52:51
1) The specific subject was ADULT ADD
2) The question was, what were YOUR experiences
3) The DSM criteria by which the diagnosis is made is where I see the problem. Yes, I scored several "points" and was diagnosed by some bozos, but I don't have it (at least not anything like the above description, nor anything debilitating). I suspect many get the diagnosis and treatment unnecessarily. And yes, if the DSM existed when I was a kid, I would have been given the diagnosis like so many have more recently, but I was just a bright kid bored out of my effin skull and not happy to be trapped in a schoolroom with unreasonable demands to sit still and shut up. I'm always happy for folks who get effective treatment. And I'm sad for the ones like me who get screwed by incompetent and over-zealous practitioners.
Posted by huxley on July 21, 2012, at 3:48:52
In reply to Re: Experience with adult ADHD?, posted by ron1953 on July 21, 2012, at 0:33:18
I could make up a disease just as real as adhd.
Of course people are going to do better in the short term on amphetamines.
Posted by Raisinb on July 21, 2012, at 11:45:32
In reply to Re: Experience with adult ADHD? » Raisinb, posted by 10derheart on July 20, 2012, at 20:12:07
Thanks, 10dr. The pdoc thinks this might be the missing piece in my treatment. He says often when there is a comorbidity with ADHD, the treatment response to meds for bipolar depression is somewhat incomplete. He gave me a couple books to read, and they do sound like me, but I think it's going to be a case of just putting me on the meds and seeing how it goes.
Posted by Raisinb on July 21, 2012, at 11:47:03
In reply to Re: Experience with adult ADHD?, posted by enndub on July 20, 2012, at 17:55:50
That's what's difficult. My bipolar depressions and ADHD can look very much like each other. I think I'm just going to have to try the meds and see what they do.
Posted by Christ_empowered on July 21, 2012, at 15:39:36
In reply to Re: Experience with adult ADHD? » enndub, posted by Raisinb on July 21, 2012, at 11:47:03
Some people do quite well on amphetamines or ritalin. They're good mood elevators for a lot of people. I have a relative who takes lamictal+low-dose adderall xr. The diagnosis is adhd, but its really effective for depression--the kind of intense depression that makes you stupid.
I think instead of asking "do I have ADHD" (or any other diagnosis...), it'd be best to ask "do I have problems that would substantially benefit from this drug/these drugs?"
Posted by SLS on July 22, 2012, at 11:45:04
In reply to Re: Experience with adult ADHD?, posted by huxley on July 21, 2012, at 3:48:52
> I could make up a disease just as real as adhd.
I would like to see you do that. Since ADHD is real, you will surely help a great many people by describing a yet unrecognized illness.
> Of course people are going to do better in the short term on amphetamines.
Well, I don't know if that is true about the short term. However, in the long-term, amphetamines can alter the course of someone's life from a path of abject frustration, academic and vocational failure, and joylessness to one of achievement, reward, and happiness.
Would you like to see amphetamines be made unavailable to those of us who suffer from ADHD?
- Scott
Posted by ron1953 on July 22, 2012, at 13:31:34
In reply to Re: Experience with adult ADHD? » huxley, posted by SLS on July 22, 2012, at 11:45:04
One person says it's BS (me), one person calls it "made up", one person calls it "real". Makes ya wonder.
It seems that the "real" crowd not only ignores the context, but adamantly REFUSES to take it into account. What context? The context of the made-up constraints/expectations/etc. of our so-called civilized society. If one doesn't easily fit into and comply with mainstream standards, one is likely to be labeled as abnormal or diseased, and in need of treatment. So, which is made up - the disease or the narrow definition of "normal".
Bottom line is: with ADHD and many other "diseases", the context cannot be ignored, or you're only working with part of the picture. Is "help" only limited to facilitating fitting into the mainstream?
Posted by SLS on July 22, 2012, at 13:47:22
In reply to Context, posted by ron1953 on July 22, 2012, at 13:31:34
> One person says it's BS (me), one person calls it "made up", one person calls it "real". Makes ya wonder.
>
> It seems that the "real" crowd not only ignores the context, but adamantly REFUSES to take it into account. What context? The context of the made-up constraints/expectations/etc. of our so-called civilized society. If one doesn't easily fit into and comply with mainstream standards, one is likely to be labeled as abnormal or diseased, and in need of treatment. So, which is made up - the disease or the narrow definition of "normal".
>
> Bottom line is: with ADHD and many other "diseases", the context cannot be ignored, or you're only working with part of the picture. Is "help" only limited to facilitating fitting into the mainstream?
I apologize. I am clueless as to what is the meaning of anything you have written here. I am even more clueless as to how what you have written would enhance the life of my friend with ADHD.What do you think of Len Adler's stuff? Honestly.
- Scott
Posted by ron1953 on July 22, 2012, at 14:00:24
In reply to Re: Context - What? » ron1953, posted by SLS on July 22, 2012, at 13:47:22
Scott, I find it quite telling that you don't understand what I'm saying. And I really don't know how to enlighten you further. I really wish I could.
Perhaps an analogy might help: Masturbation might be considered a disease in a sexually-repressive culture.
Posted by SLS on July 22, 2012, at 14:16:04
In reply to Re: Context - What? » ron1953, posted by SLS on July 22, 2012, at 13:47:22
Hi Ron1953.
> What do you think of Len Adler's stuff? Honestly.
Never mind. I know of his work only because of my dealings with the staff at NYU. I was just wondering if you came across his name in your research. You can look him up on Medline if you wish.
http://www.ncbi.nlm.nih.gov/pubmed?term=Adler%20LA[Author]&cauthor=true&cauthor_uid=22537184
Dr. Adler also wrote a book called, "Scattered Minds: Hope and Help for Adults with Attention Deficit Hyperactivity Disorder". I haven't read it, but I imagine it is more accessible than the Medline stuff.
I don't know upon what you base your conclusions that ADHD is "BS". Would you care to be specific?
- Scott
Posted by SLS on July 22, 2012, at 14:17:37
In reply to Re: Context - What?, posted by ron1953 on July 22, 2012, at 14:00:24
> Scott, I find it quite telling that you don't understand what I'm saying. And I really don't know how to enlighten you further. I really wish I could.
>
> Perhaps an analogy might help: Masturbation might be considered a disease in a sexually-repressive culture.Ah. Why didn't you say so in the first place.
You like to edify us all with your opinions. Why stop now?
- Scott
Posted by SLS on July 22, 2012, at 14:37:42
In reply to Context, posted by ron1953 on July 22, 2012, at 13:31:34
> > I don't know upon what you base your conclusions that ADHD is "BS". Would you care to be specific?
I really look forward to your answering this question and edifying us further.
How might you advise someone on Psycho-Babble who has just been diagnosed by their doctor with ADHD and prescribed Focalin? Do you tell them that their diagnosis of ADHD is "BS"? In your research of ADHD, what, specifically, has led you to the conclusion that it is "BS"?
- Scott
Posted by SLS on July 22, 2012, at 15:07:18
In reply to does it matter?, posted by Christ_empowered on July 21, 2012, at 15:39:36
> I have a relative who takes lamictal+low-dose adderall xr. The diagnosis is adhd, but its really effective for depression--the kind of intense depression that makes you stupid.
That is an intriguing combination. I believe that both drugs serve to increase limbic dopaminergic activity, albeit in completely different ways. I'll have to tell my doctor about that.
> I think instead of asking "do I have ADHD" (or any other diagnosis...), it'd be best to ask "do I have problems that would substantially benefit from this drug/these drugs?"
For now, sometimes things have to occur in reverse. You guess first, treat second, and diagnose last. People are working on establishing reliable biomarkers for diagnostics, but that might be just a few years away from becoming part of mainstream medical practice. There is also PET and fSPECT scans, but they are still too expensive to consider as step one of a diagnostic algorithm. I remember being incensed when the folks at Columbia wanted to diagnose me based upon my drug responses. I thought they knew enough to produce a definitive diagnosis before beginning treatment. They even used the dexamethasone suppression test and the tyramine conjugation test on me. I tested positive on both. The rest is a long story, but suffice it say, their limitations motivated me to take my first trip to the medical library.
They did the best they could.
- Scott
Posted by ron1953 on July 22, 2012, at 16:54:34
In reply to Experience with adult ADHD?, posted by Raisinb on July 20, 2012, at 17:52:51
I have an opinion that it's *often* BS, not a blanket conclusion. Also, I'm not familiar with Adler.
The lure of the empirical scientific approach is understandable, but it often fails miserably when it comes to the human psyche. Think of the android character, Data, from Star Trek, whose computer brain, however complex, could not understand human emotion, humor, etc.. The scientific approach often employed in psychiatry and psychopharmacology has its limitations, and is mostly based on acceptance of the status quo of standard academic teachings, conventional wisdom and accepted beliefs. Ir rarely, if ever, goes outside of the box.
Scott, I haven't studied ADHD, but I observe. And by the way, if I challenged you to support your beliefs, I think you'd be hard-pressed to do so, aside from citing other people's work. And I'm not saying you're wrong; just that there's more than just cold fact and statistic involved, and it's difficult to qualify or quantify.
What would my advice to an ADHD patient be? I'd advise that they analyze the ENTIRE situation, especially in regard to their purported problem versus assumptions and expectations of others. I was a programmer for twenty years, and knew many poor-to mediocre programmers who were diagnosed with ADHD. Their poor performance was NOT because of ADHD (in my opinion, of course); it was simply a bad match between their true talents/desires and the career itself. The job demands a great deal of organizational skill, which these folks simply didn't have. It wasn't pathology; just a bad match. So, the question is, should they be treated for ADHD, or maybe consider another career - one that they're better suited for? Or BOTH? My point is to look at the big picture.
Posted by SLS on July 22, 2012, at 19:56:33
In reply to Re: Experience with adult ADHD?, posted by ron1953 on July 22, 2012, at 16:54:34
> I have an opinion that it's *often* BS, not a blanket conclusion.
That is not what you said. Your words indicated that you had come to a blanket conclusion. Go read them.
http://www.dr-bob.org/babble/20120718/msgs/1021860.html
> Also, I'm not familiar with Adler.
Okay.
What facts do you use to support your opinion?
> The lure of the empirical scientific approach is understandable,
The lure of knowledge understandable.
> but it often fails miserably when it comes to the human psyche.
What fails miserably, the scientific method? So, you are also going to opine against the validity of psychology experiments?
> Think of the android character, Data, from Star Trek,
I know he is one of your favorite metaphors.
> whose computer brain, however complex, could not understand human emotion, humor, etc..
You are wrong. It could very much understand all of those things. He would have displayed such understanding much sooner in the series had Dr. Noonien Soong not purposely withheld the emotion processor chip from Data's positronic brain. For you see, the loss of a very small locus of circuitry can affect a great deal of function. This may not be so different from ADHD.
> The scientific approach often employed in psychiatry and psychopharmacology has its limitations,
Name one.
> and is mostly based on acceptance of the status quo of standard academic teachings, conventional wisdom and accepted beliefs. Ir rarely, if ever, goes outside of the box.
Oh. What teachings and beliefs would you like to employ? Your own? Name one that relates to ADHD.
> Scott, I haven't studied ADHD, but I observe.What do you observe, specifically?
> And by the way, if I challenged you to support your beliefs, I think you'd be hard-pressed to do so,
What kind of support would you like to see?
> aside from citing other people's work.
Oh, I see. I only get to use my own work. Is that how you operate?
> What would my advice to an ADHD patient be?
>
> I'd advise that they analyze the ENTIRE situation, especially in regard to their purported problem versus assumptions and expectations of others.One can speak in such generalities when addressing many unrelated aspects of life. Would you care to amplify how you would go about applying these concepts to a new ADHD patient specifically?
I have a certain amount of confidence in my own observations of real people with ADHD. However, I have more confidence in the consensus of the hundreds of researchers and thousands of physicians who observe ADHD in the 8 million or so sufferers every day.
Where is the BS?
- Scott
Posted by ron1953 on July 22, 2012, at 21:20:16
In reply to Re: Experience with adult ADHD? » ron1953, posted by SLS on July 22, 2012, at 19:56:33
"Where is the BS?"
The phucking bullshitt is right here in this phucking board, where differing views are not welcome, and career mental health patients wish to stay just that.
Especially you, Snott
Posted by SLS on July 22, 2012, at 21:46:43
In reply to Re: Experience with adult ADHD?, posted by ron1953 on July 22, 2012, at 21:20:16
> "Where is the BS?"
>
> The phucking bullshitt is right here in this phucking board, where differing views are not welcome, and career mental health patients wish to stay just that.
>
> Especially you, Snott
:-)
- Scott
Posted by ron1953 on July 22, 2012, at 22:10:37
In reply to Re: Experience with adult ADHD? » ron1953, posted by SLS on July 22, 2012, at 21:46:43
I was 100% sure you'd be smugly pleased, douchebag. Very good at putting others on the defense, but a douchebag nonetheless. Both excellent skills if you were an attorney. But alas, you're just an online douchebag on an obscure web forum.
Posted by ron1953 on July 22, 2012, at 22:15:54
In reply to Re: Experience with adult ADHD?, posted by ron1953 on July 22, 2012, at 22:10:37
I remember seeing people like you in the schoolyard in grade school. They were really good at getting a rise out of other kids, making them cry, etc.. They're called bullies.
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