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KShapiro
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Default Jun 19, 2020 at 10:04 AM
  #1
I've been diagnosed with depression, anxiety, and attention deficit disorder in two comprehensive evaluations in the last ten years. I had one about 6 years ago in my hometown and a psychiatrist requested that I get another before he would prescribe ADHD meds. That psych wasn't covered by my insurance and was very expensive and I stopped seeing him over a year ago. My depression got a lot worse and I finally found another prescriber (an NP), who's been treating me for several months now.

He said he wanted me to get my depression under control before he'd treat my ADHD. Which does make sense to me, I was really in a crisis point when I started seeing him. I never felt my depression went completely away when I was seeing my old psych so I was all for tackling that first.

And we did! I ramped all the way up to Sertraline 200mg, and I started feeling better. However I told him I was still having trouble getting started on things, getting distracted from work and chores, forgetting things -- all the ADD stuff I've been struggling with since childhood.

So my prescriber added Abilify? Which I was confused by at first but I guess it works on dopamine so sure? And taking it made me feel so much better!! I didn't even realize it before, but I still had some lingering anhedonia and that was gone like IMMEDIATELY. And suddenly I was able to work on at least the more fun projects I'd been putting off and getting more pleasure from jobs well done and stuff. So that was super cool. I had more energy and confidence. It was amazing.

But then I realized it getting TOO much. I wan't sleeping and I just had this weird thrumming energy coursing through my body sometimes that I didn't know what to do with. I got really impulsive and spent a bunch of money on Amazon on junk I didn't need and signed up for a bunch of projects that I don't actually have time to do. I've never had a manic episode before but it seemed like that?

I didn't want to stop taking the Abilify, so I dropped the Sertaline down to 100mg and decided to talk to my prescriber about it at our next appointment. I felt better right away and I still feel really really good, mood-wise! But also my home and work are still a wreck due to distraction, disorganization, etc.

So I saw my prescriber yesterday and told him all this and he seemed really happy and he was like, "okay so now we know your brain chemistry responds to this, let's try ramping the Abilify up and the Sertraline down, maybe switch to Lamictal" and at the time I didn't know what to say. I've told him I've never been manic in my life before this, but he's still thinking a bipolar mediation? I really think my mood is amazing the way it is. I'm more worried about not being about to get started on tasks.

When I mentioned having a hard time doing chores and the extreme degree to which my apartment's condition has deteriorated, he just said, "Have you tried just forcing yourself to do clean? Not letting yourself be distracted?" And I didn't know what to say to that. Besides, "yes, I've tried", I just let it drop because I didn't know how to communicate that I feel well moodwise but I still can't do things?

Anyway, I'd like any advice on how to talk to my prescriber about this stuff. I don't know if I really want to mess with my mood when I'm feeling really well right now, and I just want some help with my ADD... I'm worried I'll sound like a drug-seeker or a know-it-all if I say that.
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bpcyclist
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Default Jun 19, 2020 at 12:18 PM
  #2
Hmm. Well, couple things. One is, it may be that your initial diagnosis of depression and anxiety was in error. You may have a form of bipolar disorder, which may account for both. Not diagnosisng you here, obviously, just speaking as someoen who was originally diagnosed as depressive, then, became manic and psychotic years later. Not uncommon at all.

Abilify can be quite activating in people wiht bipolar 1, especially. Lamictal tends to help more for the depressive side than the hypo/manic side, so, personally, I would have thought more lithium or depakote, maybe, at thsi point for you--but that is just me.

Dunno about this reluctance to treat your ADHD. Some pdocs believe stimulants promote mania in people with bp 1, but the actual evidence for this is very, very thin. So, most people with bp 1 and ADHD do just great on stimulants. I think you should just have a very direct conversation with him and tell him you think he is reluctant to treat your ADHD and you would like to hvea it treated and see what the response is.

It is very common for people with bipolar disorder not to want to lose their hypomania, as they are often productive and feel really good. The problem is, flipping to frank mania is undpredictable and florid mania is an emergency, so, it becomes very important to treat hypomania as a result. It can, in fact, lead to very dangerous situations. Certainly has for me multiple times. Multiple hospitalizations. One arrest and prosuection for something I really did not do, but when prosecutors are pissed, none of the facts matter. They just hammer you.

So, I would definitely try to be open to treating any hypomania. It might save you some real heartache.

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Default Jun 20, 2020 at 03:02 AM
  #3
Have you asked him flat out if he has a problem prescribing stimulants? they are a first line treatment for adhd.

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Default Jun 20, 2020 at 10:42 AM
  #4
Quote:
Originally Posted by bpcyclist View Post
Hmm. Well, couple things. One is, it may be that your initial diagnosis of depression and anxiety was in error. You may have a form of bipolar disorder, which may account for both. Not diagnosisng you here, obviously, just speaking as someoen who was originally diagnosed as depressive, then, became manic and psychotic years later. Not uncommon at all.
[...]
So, I would definitely try to be open to treating any hypomania. It might save you some real heartache.

This is interesting and I've been giving it a lot of thought. However, I really can't think of a single time I've felt those symptoms outside of that short window of time when I was on Abilify 2.5mg + Setraline 200mg. I don't think I've ever been hypomanic before, and I'm a 35 year-old who has struggled with depression since I was 10.


I did read about the bipolar spectrum and bipolar without hypomania and somethings did seem familiar. I'm open to the idea that's what's going on, especially since the medication seems to be helping. Still dunno about adding more mood stabilizers when I've never experienced mania.
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Default Jun 20, 2020 at 10:46 AM
  #5
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Originally Posted by sarahsweets View Post
Have you asked him flat out if he has a problem prescribing stimulants? they are a first line treatment for adhd.

Not outright. I'm pretty nervous about annoying prescribers due to a few bad experiences. I did tell him how well I did on Adderall when I was prescribed it several years ago, but he said he wanted to address the mood disorder first, and I agreed. I think that's why I was so taken aback when I was like, "I feel great but I can't work or do chores" and he wanted to mess with my mood meds some more.
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Default Jul 15, 2020 at 05:49 AM
  #6
If your goal is adhd meds when they ask you about adding something else throw your hands up, laugh, and say ‘doc I’m doing real good right now, (shift discussion about your plans and goals). Don’t mention adhd meds. Once you go Back tell them your overwhelmed and discouraged the meds have helped in a way in life but Your tired of taking more pills to help cope with real life obstacles. Now you let them know your interested in Cautiously revisiting The stimulant medication as a lot has changed and things are going good ‘i just Need to keep it that way’

School is a good way to go. Get to a successful point again and tell your current provider that you want nothing more than to continue working on your dream. Nothing else matters. The trick is, you gotta strive for success. 500 bucks or pitch a good sell. Patience. If you spin your wheels at a low point your just going to be in the same place in 5 years
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Default Jul 16, 2020 at 07:42 AM
  #7
It annoys me to no end when doctors do not address adhd with medication when it’s a first line treatment proven effective. I personally think the opiate crisis made doctors afraid of any CII substances. I have been on adderall for 14 years and have not abused it, run out or had more than one dose adjustment and that was because my absorption physically changed. I know it looks druggy to ask but it’s not the same as “I wanna try adderall “. Sometimes it’s worth it to come in with research from good medical sources (not webmd) and show the doctor what you read. But I don’t know for sure if that’s right for you.

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