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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by twinmom on April 13, 2004, at 14:16:47
I am not just depressed, I am not Bipolar as my new pdoc seems to think, I score off the scales on Adult ADD quizes and the only time I can remember being really happy in the last nine years is when one dr, had me on a combination AD and ritalin...WHY OH WHY is it so hard to get anyone to listen to me and believe me. My son is ADHD, my dad only ever responded to a elavil/ritalin combination and it is what has worked for me.
Now I cry everyday my pdoc has me on risperdol, lexapro, and topamax (after gaining 30 pounds on a zyprexa trial) I am tiered all the time I can't think I can't wotk and 2 weeks ago I actually took a box cutter to my wrist. I know what I need but no one will listen and with each job or insurance change I have to start all over again - it sometimes it so hard it is not worth the fight. But I have 4 kids who need me including 2 two year old - this is so unfair to them.Please help me - what do I say to my doctor on friday to convince her I need AD and ritalin and not all this other crap. I just need the med for my Depression and my ADD.
Thanks.
Posted by cybercafe on April 13, 2004, at 15:49:26
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
> I am not just depressed, I am not Bipolar as my new pdoc seems to think, I score off the scales on Adult ADD quizes and the only time I can remember being really happy in the last nine years is when one dr, had me on a combination AD and ritalin...WHY OH WHY is it so hard to get anyone to listen to me and believe me. My son is ADHD, my dad only ever responded to a elavil/ritalin combination and it is what has worked for me.
> Now I cry everyday my pdoc has me on risperdol, lexapro, and topamax (after gaining 30 pounds on a zyprexa trial) I am tiered all the time I can't think I can't wotk and 2 weeks ago I actually took a box cutter to my wrist. I know what I need but no one will listen and with each job or insurance change I have to start all over again - it sometimes it so hard it is not worth the fight. But I have 4 kids who need me including 2 two year old - this is so unfair to them.
>
> Please help me - what do I say to my doctor on friday to convince her I need AD and ritalin and not all this other crap. I just need the med for my Depression and my ADD.
>
> Thanks.
ask her what it takes to get diagnosed with adult ADDperhaps suggest some abilify instead of zyprexa as i find it's better for motivation and probably ADD (doesn't block D4 as strongly as zyprexa)....
if you don't mind me asking... do you have addiction problems or some other reason your doc would be hesitant ?
ummm... actually on your last line you did say you were depressed ? i'm confused... and perhaps your doc is worried about the stimulant causing psychosis (if you're on risperdal)... maybe you just need a little while of stability on risperdal to prove you're far from psychosis and he may risk a stimulant ??
Posted by twinmom on April 13, 2004, at 15:59:01
In reply to Re: Why is it so hard to get diagnosed wit Adult ADD?, posted by cybercafe on April 13, 2004, at 15:49:26
> > I am not just depressed, I am not Bipolar as my new pdoc seems to think, I score off the scales on Adult ADD quizes and the only time I can remember being really happy in the last nine years is when one dr, had me on a combination AD and ritalin...WHY OH WHY is it so hard to get anyone to listen to me and believe me. My son is ADHD, my dad only ever responded to a elavil/ritalin combination and it is what has worked for me.
> > Now I cry everyday my pdoc has me on risperdol, lexapro, and topamax (after gaining 30 pounds on a zyprexa trial) I am tiered all the time I can't think I can't wotk and 2 weeks ago I actually took a box cutter to my wrist. I know what I need but no one will listen and with each job or insurance change I have to start all over again - it sometimes it so hard it is not worth the fight. But I have 4 kids who need me including 2 two year old - this is so unfair to them.
> >
> > Please help me - what do I say to my doctor on friday to convince her I need AD and ritalin and not all this other crap. I just need the med for my Depression and my ADD.
> >
> > Thanks.
>
>
> ask her what it takes to get diagnosed with adult ADD
>
> perhaps suggest some abilify instead of zyprexa as i find it's better for motivation and probably ADD (doesn't block D4 as strongly as zyprexa)....
>
> if you don't mind me asking... do you have addiction problems or some other reason your doc would be hesitant ?
>
> ummm... actually on your last line you did say you were depressed ? i'm confused... and perhaps your doc is worried about the stimulant causing psychosis (if you're on risperdal)... maybe you just need a little while of stability on risperdal to prove you're far from psychosis and he may risk a stimulant ??I meant to say I am not Just depressed. I have no history of any psychosis and no addictions at all. I have had troubles with sleeping and maybe pdoc is worried about stimulant interfering with sleep? But my biggest problems are motivivation and organization and concentration, which have all lead to a pretty bad depression right now. I have printed out several of the ADD screening quizzes and plan to take those with me on Friday.
Thank you for the response - it helps so much knowing someone is listening.
Posted by HelenInCalif on April 13, 2004, at 17:43:19
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
Here is something applicable I wrote a few days ago
on a thread on brain fog- I'm emphasizing a couple of major points with "*".http://www.dr-bob.org/babble/20040407/msgs/333745.html
"
The daydreaming, mind-wandering, unable to concentrate and get things done sounds like me. I have the non-hyperactive type of ADD, and didn't get diagnosed until after college (too bad, I might have gotten A's not C's).Because of this ADD I became depressed and stressed at times- poor school or job performance- and it really was the effects of ADD causing those problems. Post diagnosis they went away because I can finally live up to my potential.
Luckily a family member was diagnosed and I saw that "hey, I'm like that too." I started reading and researching it. (A book I liked was "Women with ADD..." because it focuses on this lesser known type of ADD. (useful to read even if you aren't female.)) I found a pdoc familiar with ADD, got ritalin, and my life changed. I could focus on tasks and not get constantly distracted.
**Its very important that you ask if they've had other adult patients with ADD. If you are female or have the non H ADD, ask if they're familiar with that too**
Its true he probably won't give you a prescription right away. You'd want to come prepared for scepticism and/ or diagnosis tests.
One problem is some docs believe ADD only exists if you were diagnosed in childhood. I think that's wrong, because
1. the Daydreamy ADHD type of ADD wasn't well known then
2. This ADHD isn't disruptive to others, so is less likely to be noticed
3. If you're smart enough you can compensate throughout high school. I could. But then college- what a nightmare. Everyone was just as smart and I couldn't study as well as them = trouble.So you might have to show that retrospectively you had ADD. For me I had good evidence (high SATs, high GREs, yet low grades in college, inability to study like everyone else, inability to focus at work and in meeting like everyone else (yes, high grades in high school but you never needed to study that long).) That I was about to get laid off for bad performance EVEN THOUGH I'm competent and could do the work was a BIG clue too.
Now, 8 years later, adult ADD is better known. Just saw an advertisement for it in a major magazine recently (for Strattera?). Of course, you'll have to show that you're not just jumping on a bandwagon.
** Instead, be able to show a long term trend of ADD symptoms, and also perhaps show how they are the core cause of your other problems.** Like for me: I didn't have depression AND ADD, I had depression BECAUSE of ADD. Treating the ADD made that depression go away.
Posted by Racer on April 13, 2004, at 18:22:54
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
Just telling your doctor that the best response you've ever had was to a combination of AD and stimulant?
That's not to say anything about the diagnosis part. It's just a suggestion about communicating with your doctor. Doctors are trained to watch for the Profession Patient, they get resentful if you seem to be stepping over the line in your care, they get weird about bio-science-wonks like me, and they get weird with women. (Even women doctors get weird with women.) So, instead of saying, "I think I have ADD, since I score off the charts on quizzes," think about saying something like, "You know, the ADs alone aren't doing the job. The best response I ever got was when ritalin as added to an AD. Do you think we could try that again?"
Also, read some of the journal articles about Adult ADD -- there's a LOT of stuff going on about pathologizing lifestyle choices, and the problems doctors are having with patients coming in after taking a quiz put out by a drug company as part of its marketing campaign for a new ADD drug, etc. I'd be surprised if that doesn't have a lot to do with your doctor's reluctance to diagnose you as ADD.
Good luck!
Posted by Xanablu on April 13, 2004, at 19:54:15
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
Twinmom-It took me until the age of 45 to find a doc who understood the fact that my depression was rooted in undiagnosed ADD and chronic anxiety (perhaps brought on by, and certainly made much worse by the untreated ADD).
First, you must find a doc, preferably a psychiatrist, who is familiar with treating ADHD/ADD in adults. There are still many dr.'s who simply do not accept this particular diagnosis, or, they do not want the responsibility of prescribing schedule II meds due to paranoia concerning DEA regulations.
Since there is no black and white test u can be given that proves u have it, u must have a confident p-doc who can evaluate you from a clinical standpoint. I believe it does help to print out any simple ADD/ADHD quiz u have taken and bring it with u to your 1st appt. so u can show your doctor why you have reason to believe that this could be your possible diagnosis. Also, make a concise list of the symptoms u have which are most disruptive in your life (even if they do not typically fall under an ADD dx).
But, let the doctor guide the interview. He/she will ask what he feels is pertinent to an accurate dx. Altho ADD docs well know that frequently interrupting a speaker is typical behavior of ADD'ers, it really can slow down the process of his accessment of you, and, interfere with the doctor's ability to concentrate!I was given many tests, the huge comprehensive personality survey, as well as a long (3-4hr.) IQ test by a therapist about 4-5 yrs. ago. She was leaning toward an ADD dx., but, all meds had to be prescribed by my g.p., who was a a real hardhead and would not prescribe anything my therapist suggested except Wellbutrin and then ritalin. Ritilan was one of the most noxious, disagreeable drugs I have ever taken, it simply made me angry for 45 minutes, then I crashed hard, and had to nap for 2 hours in order to shake off the intense dysphoria it induced. WB at least helped me slightly, I was less foggy on it, but nothing exceptional. When I asked my g.p. for a short trial of Adderall, he said, 'NO way.' Flat. 'You have depression and depression overlaps many of the same symptoms of ADD.'True, but... All of this he based on asking me one ?. 'Can you read a book from cover to cover?' I replied, 'Yes.' He then said, 'then you do not have ADD.' (He obviously knew nothing about how many ADD'ers can focus well for hours on subjects that engage them, and are often quite intelligent, which can mask symptoms. I didn't know either, at that time). I tell ya, I felt so put down, so stupid, so drug-seeking and hypochondriacal that I threw the book I had brought with me, "Driven to Distraction", away, stopped therapy, and simply went on to the next antidepressant my g.p. descibed.
Bad idea. I had already auditioned several A-D's, both SSRI's and TCA's and they had not helped. Then, lo and behold, I was given an old computer, found Dr.Bob, and tons of info on dozens of websites. I also went to a psychiatrist recommended by my g.p. and tried again.
This guy was a total bomb, dx'd me w/dep., and refused to consider ANY other possibility. I was caring for my mom who had Alzheimer's, and he concluded I wd. be well once my nursing days were over. I kept telling him that was NOT the case, I had felt this way since I was 14, no trauma, just an inability to concentrate, organize, focus, control my moods, make decisions-all of which greatly affected my previously excellent schoolwork (which I accomplished in grade school due to high IQ and lack of hormonal fluctuations/sexual distractions). My IQ falls into the top 1/2% and yet, after 6 yrs. of college, I was still a sophomore...????? bAnd became a dropout, stuck in a low-paying job.
Well, Mom passed away 16 mos. later. I was completely sapped and had no p-doc support, only zoloft and klonopin from my g.p., which barely kept me afoat.
After Mom passed, my object of hyper-focus (a common ADD trait-I was a vigilant, loving nurse and was thankful to be able to be with her, hourly, until she died, holding my hand) was gone, I, between Apil anD june, sank into major, clinical depression. I lay on the sofa for 3 mos.-chronic pain eating me alive, until my best friend finally 'allowed' me to see her therapist (she had had a major transference problem, which suddenly vanished when she discovered he was married to his assistant).
He WAS great. Saw him twice, gave him my full history, we clicked, we laughed even. He asked me one very important ?. 'When was the last time you felt good?' I was honest and told him it was the 6-12 months after I had my baby, when I was going to a diet clinic and had been prescribed phentermine, a central nervous system stimulant, a diet med. He said, 'Well, it sounds like you need a stimulant in your meds.'
Whoo-hoo!!!!!!!!!!!!! He asked me if I wanted to go thru my g.p. for prescribing (HELL no) or visit the psychiatrist in the building. I saw the psych, of course, began Adderall & Effexor, and within the 3 weeks from my first vist to the new therapist, then p-doc, I was quickly climbing out of the pit. I found an orthopedist who prescibed darvocet and Soma (the KEY) which allowed me to manage my herniated disks and fibro, and I began the long road (I'm still on it) back to wellness.Over the course of a year, I switched to dexedrine and lexapro, and retained my darvocet, soma (both prn), propanolol (headache prevention & a good anti-anxiety med as well) and klonopin (I use Teva generic).
Life is not perfect, but my drug cocktail is very good, and the rest of the work must be done by me.
I am pre-menopausal, have an active 7 yr. old (my only child, a surprise at 40!) and my husband wants a divorce (he doesn't believe I actually have these 'disorders').When I received my inheritance from my mother, my hub. quit his job and we were forced to live on what was supposed to be 'my/our' debt reducer/therapy fund/investment fund. I also needed major dental work. Instead, I paid rent, bills, creditors, etc. and decimated my funds.
After the money dwindled down to nothing, he went back to work and is on his 3rd job in a year.
We are deep in debt, but I am happy to be splitting, my girl and I will move my sister's in another state. He plans to come too, but live alone. I'm glad, b/c I want her and her dad to be close. And, I plan to get half my inheritance back from him in our divorce settlement.
Life is positively saturated w/obstacles I must overcome, but, at least now, I am hopeful, and feel like I actually have a future that can include self-reliance and self-acceptance.God, I'm babbling-Twinmom, u must see a doc who is a specialist or at least well-educated about adult ADD. You can ask him or his/her nurse about this over the phone, otherwise it may take you years to get what you need.
Check out the physicians /psychiatrists guide in the yellow pages, some now list that they are specialists in the field off ADD diagnosis.
Perservere and avoid asking a g.p. to diagnose you for a neurological disorder. They are not shrinks. They treat common physical compaints or send patients to a specialist. There are a few who are really top-notch and stay informed in many areas, but they are in the minority.Best of luck-I understand your frustration so well-let us know how you do!
Xanablu
Posted by cybercafe on April 14, 2004, at 5:37:21
In reply to Re: Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 15:59:01
> > > I am not just depressed, I am not Bipolar as my new pdoc seems to think, I score off the scales on Adult ADD quizes and the only time I can remember being really happy in the last nine years is when one dr, had me on a combination AD and ritalin...WHY OH WHY is it so hard to get anyone to listen to me and believe me. My son is ADHD, my dad only ever responded to a elavil/ritalin combination and it is what has worked for me.
> > > Now I cry everyday my pdoc has me on risperdol, lexapro, and topamax (after gaining 30 pounds on a zyprexa trial) I am tiered all the time I can't think I can't wotk and 2 weeks ago I actually took a box cutter to my wrist. I know what I need but no one will listen and with each job or insurance change I have to start all over again - it sometimes it so hard it is not worth the fight. But I have 4 kids who need me including 2 two year old - this is so unfair to them.
> > >
> > > Please help me - what do I say to my doctor on friday to convince her I need AD and ritalin and not all this other crap. I just need the med for my Depression and my ADD.
> > >
> > > Thanks.
> >
> >
> > ask her what it takes to get diagnosed with adult ADD
> >
> > perhaps suggest some abilify instead of zyprexa as i find it's better for motivation and probably ADD (doesn't block D4 as strongly as zyprexa)....
> >
> > if you don't mind me asking... do you have addiction problems or some other reason your doc would be hesitant ?
> >
> > ummm... actually on your last line you did say you were depressed ? i'm confused... and perhaps your doc is worried about the stimulant causing psychosis (if you're on risperdal)... maybe you just need a little while of stability on risperdal to prove you're far from psychosis and he may risk a stimulant ??
>
> I meant to say I am not Just depressed. I have no history of any psychosis and no addictions at all. I have had troubles with sleeping and maybe pdoc is worried about stimulant interfering with sleep? But my biggest problems are motivivation and organization and concentration, which have all lead to a pretty bad depression right now. I have printed out several of the ADD screening quizzes and plan to take those with me on Friday.
>
> Thank you for the response - it helps so much knowing someone is listening.your welcome....
if you have no history of psychosis and are not bipolar, i'm wondering why you're on an anti-psychotic and topamax
abilify is very good for motivation, if you can tolerate it
Posted by twinmom on April 14, 2004, at 10:42:04
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
Thank you to everyone - I will keep at it, but go about it from a low key "this is what has helped" not "I am ADD, now diagnose me!" approach and if this doc won't or can't help I keep trying until I find one who can. I am sure about my history and symptoms and family history - but I don't want to be one of those "I know better than you do" patients.
Thanks for the advice - and keep your fingers crossed my appt. on Friday goes well.
Posted by Bill LL on April 14, 2004, at 12:36:38
In reply to Re: Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 14, 2004, at 10:42:04
The "doctor ego" issue is one that a lot of us have to deal with.
Insurance companies put pressure on docs to practice in a certain way. If docs over-prescribe certain drugs or do too many tests, the companies can drop that doc from their list of preferred doctors. If that happens, the docs will lose some business. This situation can be even worse if you are in an HMO.
Keep trying!
> Thank you to everyone - I will keep at it, but go about it from a low key "this is what has helped" not "I am ADD, now diagnose me!" approach and if this doc won't or can't help I keep trying until I find one who can. I am sure about my history and symptoms and family history - but I don't want to be one of those "I know better than you do" patients.
> Thanks for the advice - and keep your fingers crossed my appt. on Friday goes well.
Posted by f l y on April 14, 2004, at 23:05:08
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
i have been taking dexedrine off and on for 5 years. off and on because my pdoc is constantly trying to talk me out of taking dexedrine - so occasionally i've stopped, only to go back because i haven't found anything that works better, including adderal. i also have been taking lamictal for about 6 weeks and it seems to be working better and better.
best to ya,
fly
Posted by Viridis on April 16, 2004, at 2:39:36
In reply to Why is it so hard to get diagnosed wit Adult ADD?, posted by twinmom on April 13, 2004, at 14:16:47
An ADD diagnosis need not be difficult. You just need to find a pdoc who's familiar with the condition. I resisted the diagnosis at first, but eventually realized that the doctors were right. Since treatment typically involves highly controlled drugs, you really need to see a psychiatrist who is experienced with this condition, and be able to provide a history that goes back to childhood.
If your doctor/pdoc doesn't understand, then see another. Like people in any profession, doctors are hardly infallible, and many (especially GPs) are afraid to medicate appropriately. But a few actually have common sense -- you just have to seek them out. Never stick with someone who is treating you inappropriately, as most do.
Posted by Aldus Huxley on April 21, 2004, at 19:13:51
In reply to Re: Why is it so hard to get diagnosed wit Adult ADD?, posted by Bill LL on April 14, 2004, at 12:36:38
> The "doctor ego" issue is one that a lot of us have to deal with.
>
> Insurance companies put pressure on docs to practice in a certain way. If docs over-prescribe certain drugs or do too many tests, the companies can drop that doc from their list of preferred doctors. If that happens, the docs will lose some business. This situation can be even worse if you are in an HMO.
>
Let's not forget how insane the DEA and FDA are by threatening license revocation (e.g., the whole overblown oxycontin mania). My suggestion is similar to others; do research and come in educated. Also be patient and do not expect to get a SII drug simply by asking for it. If your doctor trusts you maybe this might happen, but if not, the pdoc has to feel comfortable in the fact that he or she did their job diligently and tried other options first (i.e., non SII options), so they have a valid defense if sanctioned or threatened by one of our glorius parental federal agencies should some problem arise. So many doctors are frightened to prescribe SII drugs which may have some abuse potential (Adderall), and instead prescribe something 10% as effective and damaging to the liver (Cylert). Even when compared relatively, the deaths and damage as a result of using/abusing alcohol are exponentially greater than those of any SII drug.
This is the end of the thread.
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