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Old 09-30-2018, 09:26 AM
Nate Jones Nate Jones is offline
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Member Since: Sep 2018
Location: Salem, OR
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Nate Jones Nate Jones is offline
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Nate Jones has no updates.
Member Since: Sep 2018
Location: Salem, OR
Posts: 7

Default Re: 45 y/o only now got diagnosed... Alas.

Originally Posted by mossanimal View Post
Thanks for the note. The thing is is that I was originally diagnosed with ADHD and was put on Adderall by a primary care physician... but there was no real follow up or change... except that I lost some weight. But 8 years after I had a bad spell of depression that led to a brief hospitalization and care was transferred to psychiatrists who gave me the bipolar diagnosis. But it just doesn’t sit right with me.. especially the mania. And then I come to a forum like this and see people with such similar life experiences. Anyway... I see my psych next week so hopefully we will explore this further. All I know is that I’ve had a crazy life with sooo many hobbies and professions all ending up with a crash and burn and moving onto something else. I’m disorganized and can only focus on things that are my current passion. Until now... the Wellbutrin has killed that aspect for sure.
Hopefully my own ADHD experience can help you towards a solution:

1) ADHD's traits are reactive to external stimuli while Bi-polar is a inner chemical process of cycling between manic and depression states. Someone with bi-polar disorder will not have clear catalysts for their mood and energy focuses. They just move between their various states based on their own inner brain chemistry and whatever regulatory cycle is misfiring. ADHD though goes into hyperfocus or distraction/space out based on whatever activity your doing or is going on around you. ADHD highs and lows will respond to the people and events as they occur to you, often at emotional extremes.With ADHD you are dealing with poor dopamine uptake (which causes the lack of focus, being easily distracted and some of the depression like symptoms) and then compromised executive functions.

The executive functions oversee our time-awareness/management, fore/hind sight, task prioritization, task, thought and spacial organization, self-esteem (which is part of the depression we get), planning and self-awareness, working memory (basically our brain's RAM or temporary memory) and emotion inhibition. Every ADHDer has some deficit in one or more of these due to their under-developed frontal lobe but which ones are affected and to what degree varies between ADHDers. This is the reason both for the labeling (ADD vs ADHD) and sub-types (inattentive, hyperactive etc). But experts are finding its all the same disorder and really not different types, just variety among us due to severity and location of the development issues in our prefrontal cortex. Stack co-morbid traits on top of that, and ADHD is fairly varied but at its we all share focus/attention issues and compromised executive functions. The rest is how our other brain functions and hormones (especially for women with ADHD) are affected.

Sidenote: If you don't know what co-morbidity is, these are other tag-along disorders tied to your ADHD. They can vary (like dyslexia, Tourette's OCD, autism, depression, ODD (opposition defiant disorder). Often an ADHDer has on average two of them and, get this, they are genetic. So, since ADHD is inherited, all of the ADHDers in your family will have them same co-morbid traits even if their ADHD varies in degrees of executive function compromise. Fascinating and tragic.

For example, my mom's side of the family is where the ADHD comes. My grandfather, uncle, mother, myself and my daughters all have it. My grandfather has passed and my uncle and mom are not officially diagnosed but I have plenty of experience identifying ADHD and have had so many interactions and stories from them that it is obvious. Ironically, my family thought my grandfather had bi-polar disorder, they still tout this. But he had no cyclic behavior and was all external stimuli. We all have ODD and some slight dyslexia and OCD. ODD when not treated with CBT can become violent (breaking objects or becoming hostile and threatening) and if not manage can change to Conduct Disorder which turns into abuse like hitting people. Well, he used to take physical punishment to his kids into that realm. But he was never diagnosed and this is way before they understood any of these connections or the genetics within it.

So first step, figure out if you are responding to external stimuli or are you in an internal manic/depression cycle.

2) Either way, you are dealing with atypical brain chemistry. Make sure you find a psychiatrist or medical doctor who specializes in atypical brain disorders and really understands the current findings on learning disabilities and their effect on executive functions. Which brings us to your medication.

ADHD medication is essential and kinda tricky. The reason is ADHD research by experts in the field and upcoming pediatricians are ahead of the curve, with the rest of the medical community about 10 years behind and then the remaining therapists and social workers being behind by up to 20 years. This means if you get tested and then medicated by a neurotypical focused therapist or primary care doctor, they very likely could misdiagnose you and even if they don't they may put you on the wrong medication or the wrong dosage.

I didn't receive the correct answers to what I was dealing with until a) I found Russell Barkley's books and videos and then b) got to a research hospital with the top neurologists in my state. I have run into all of the problems - having "experts" withhold medications claiming that diet or coping tools can solve ADHD (that's like telling someone needing glasses to squint or try hard to see clearly). I've had medical doctors admit they and their colleagues know very little about ADHD and treatments, and both my own and my children's doctors have all deferred to the experts at the research hospital after I got treated by them.

Now, I am not a doctor and I am just sharing my own experience so you can know what real ADHD support looks like. Medication requires you trying a variety of options and then dialing in the best one because every ADHDer reacts differently to their medication. I was told that Ritalin usually woks better in young children (it did nothing for me), while adderall and related drugs work better in adults. Some do better standard formula, where others need extended release or the reformulated stimulants like Concerta, Vavyanse, etc.

It should be noted, our brains physiology is different from a neurotypical brain. Because of the low dopamine uptake, when put on stimulants ADHDers do not typically experience the effects a normal brain does. We don't get addicted, we don't experience euphoria or heart rate increase we do not have many if any withdrawal symptoms if you choose to not take it, other than your dopamine receptors having to re-adapt to lower dopamine which causes you to feel sleepy. It should be noted, with Vayvanse, this caused a day of severe lethargy accompanied by suicidal thoughts. It wore off in 24 hours, but was scary because the hack who had prescribed me to it hadn't warned me and failed to check that our insurance didn't cover it, so when they took me off it I had no warning and wasn't titrated down. This is one of many examples of the lack of understanding the non-experts have.

When I was prescribed by the experts, they had me dial in my adderall and we ended up exceeding the FDA recommended maximum dosage. I started at 10mg per dosage. then each day, you increase by 10mg. Once your dosage makes you feel like you drank to much coffee, you go back down 10 mg. That is how they had me find the effective dosage to get my dopamine supported. Before that, if I just take the recommended FDA max of 30 mg, I don't feel a thing and get no benefit from the medication. My doctors said they have people on up to x3 the amount the FDA says is safe. The FDA is based on nuerotypical brains and treating narcolepsy, not ADHD. Likewise, your daily schedule is for number of times you take the effective dosage is based on how your brain metabolizes the stimulants. For me, my dosage of 60mg was out of my system in about 6 hours and I found myself distracted and drifting again. So, I need to take 60mg every 6 hours, which works out to 2 - 3 times per day. I do not have any negative side-effects from such high dosages.

So, its very possible if you do have ADHD, that you are on the wrong medication and if not, that your medication is to low of a dosage. My advice, find an ADHD expert. Ask any doctor or psychiatric expert what their experience with ADHD, Bi-polar, the differences and atypical brains with executive function disorders. Watch videos and read the books of Dr. Russell Barkley, he teaches the science behind all this. Then make sure you and the doctor helping you are on the same page. Be ready to defend your access to treatment and educating your primary care doctors too.

Finally, ADHD is the second most inherited trait next to height. You should see similar patterns of behavior in siblings, parents, and children. Find those patterns and if you have kids, getting them screen too, especially if they are girls as ADHD is much more deadly for them, as they have chemistry shifts at the end of their menstrual cycles that puts them into huge emotional drop offs that can lead to self-harm and suicide if not properly managed.

I hope this gets you to the answers you need. ADHD is a *****. Getting properly treated and learning how to cope with it is crucial, as it runs in families, can tear them apart and at its worse, it can destroy your life. I am speaking from first hand experience. I was undiagnosed and then a few years ago, had my synapses come apart and went into a mental breakdown from untreated ADHD. I am about 3 years in to a 5 year recovery. I've lost nearly everything I built and am have to relearn how to live my life again. Its been awful. But that would be a whole book into itself...

Let me know if I can offer any other help.

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