Depression

Vanderhoof_sl said:

If it's Adderall, the diagnosis would technically be Amphetamine Induced Mood Disorder, heh. Are you seeing a psychiatrist? I've never known a primary care provider who could properly diagnose and treat psychiatric disorders.

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The Amazing Gavinmad_sl said:

Set up a psych referral from my doctor so I can maybe get a second opinion or a more definitive diagnosis on the myriad of mental issues I've been diagnosed with

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The ADHD is legit, and the first time I went on Adderall it was pretty life changing. Went from being on the verge of losing my amazing job to being a superstar. So I'm willing to risk a month adapting to taking it again because of how much good it did last time. It was getting my ADHD medicated that set me on the path to figuring out I had autism once I started looking into the symptoms I was still showing after the ADHD was under control.

And yeah I want a more thorough diagnosis than a single long session with a social security psychologist, plus a single kinda short session with a mental health center psychiatrist who probably spends all day working with junkies and did everything in his power to pigeonhole me into his expectations of the kind of person who would be coming for a psych eval at a mental health center. Half-witted yellow bastard wanted me to stop taking the Adderall and start taking Geodon, which has one of the longest lists of negative side effects I've ever seen and supposedly turns people into zombies. Also described me in the evaluation as having a history of marijuana abuse when I admitted to having smoked a handful of times throughout my entire life. Fuck yo couch n-word. Went back the next day, returned the Geodon sample, and told him to pound sand.

Hence me setting up a psych referral from my PCP.

Vanderhoof_sl said:

I've never known a primary care provider who could properly diagnose and treat psychiatric disorders.

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Diagnostic agreement amongst healthcare professions varies depending on the disorder but, as you said, PCPs and nurse practitioners can really miss the ball. But, so can psychiatrists and, seemingly to a lesser extent, clinical/neuropsychologists. A MMPI +/- questionnaires and a semi-structured interview can go a long way at least to the extent the informant/information is reliable/valid.

Well I can't do a whole lot about manic cycles, I'm just fully cranked to 11 the whole time. If something makes me sad, I have to resist the urge to start bawling. If something makes me laugh, I laugh hysterically. I'm generally in a good mood during manic cycles, so anger hasn't really been a problem. As for the dopamine imbalance that ADHD meds cause when I first start them, after the third time it happened it never happened again. I can't say with certainty whether it was because my future dose changes weren't as dramatic, or because I was aware that I was prone to anger problems when I changed doses. Or both.

But I'm pretty confident that it's the awareness thing. We'll see how week 3 goes, because that was about when things went haywire the three times it happened. I will say this is probably the most dramatic dose change I've ever had in my life. My previous GP and I had a pretty good relationship because he knew that I always researched everything, especially medication. I had discussed my ADHD with him before but had said I was uncomfortable with the idea of taking a powerful stimulant to treat a hyperactivity disorder. However, when I came to him and said I needed medication or I was going to lose my job, he jumped right on board. I was still kinda hesitant so we started me off at 5mg, then 10, 15, 20, 30 which is about the maximum dose. I later scaled back to 15 because adderall wasn't cheap but he agreed to keep me on the 30mg prescription and I just split the pills, which saved me quite a bit of money.

This time I'm jumping straight from 0 to 15.

I work with junkies all day long hah. Out of approximately 500 people that I see, I have one person taking a stimulant, heh. I use atypical antipsychotics a lot for Bipolar disorder because I can't trust my patients to not miss doses of Lamictal or get lithium/depakote levels done on their own; we have a machine that can check lipids and glucose in the office with a finger stick.

I'm a psychiatric/mental health nurse practitioner. Most primary care providers confuse the symptoms of Bipolar disorder with borderline personality disorder. I frequently have patients say they have Bipolar disorder but have never had a manic or hypomanic episode.

I sometimes wish I could have a manic episode again, like when I was on Effexor. I got shit done and actually made an effort to pursue things that made me happy-ish, at least for a time.

I know people who will stay up for 5 days (UDS negative for drugs) and will run into traffic to try to lay hands on people driving by to absolve them of their sins.

Vanderhoof_sl said:

I work with junkies all day long hah. Out of approximately 500 people that I see, I have one person taking a stimulant, heh. I use atypical antipsychotics a lot for Bipolar disorder because I can't trust my patients to not miss doses of Lamictal or get lithium/depakote levels done on their own; we have a machine that can check lipids and glucose in the office with a finger stick.

I'm a psychiatric/mental health nurse practitioner. Most primary care providers confuse the symptoms of Bipolar disorder with borderline personality disorder. I frequently have patients say they have Bipolar disorder but have never had a manic or hypomanic episode.

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I'm on the fence about the bi-polar disorder, the lithium didn't seem to do much even when I was johnny on the spot with my doses which is why we discontinued it, but the lamictal does seem to help. We'll have to see how I'm doing on the adderall and trazodone after a month. But I definitely would like a more definitive diagnosis. I mean I've been diagnosed with adhd, autism, bipolar disorder, generalized anxiety disorder, and schizoid antisocial disorder, but all from single visits with 2 psychologists and a psychiatrist. I mean is it actually possible for one person to have all those things at once? I have no doubts on the adhd and autism, i do have a general cycle of moods relatively consistent with articles on bipolar disorder, and I definitely have had lots of anxiety attacks, at least one of which was so severe that I developed a hand tremor for the rest of the day. A lot of the stuff for GAD is spot on with my problems, but there's also a lot of overlap with ADHD symptoms, so do I have both or just ADHD?

I'm not sure 'schizoid antisocial disorder' is even a real thing, or just some psychobabble bullshit that particular psychologist came up with so she could put something on her form. Googling it just comes back with antisocial personality disorder, and I'm damn sure not a sociopath.

Troll_sl said:

I sometimes wish I could have a manic episode again, like when I was on Effexor. I got shit done and actually made an effort to pursue things that made me happy-ish, at least for a time.

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Yeah but in my experience the crash after a manic cycle is much worse than just staying down in a depressive trough. Not worth the brief rush. Which is why I'm sort of hoping the last two days have been the adderall and not a manic cycle, or that the meds will make the crash much less severe.

Schizoid personality disorder is totally different from Antisocial Personality disorder.

It definitely isn't out of the realm of possibility that someone could have those all those diagnoses. It would be hard to determine after one interview. The only information that really matters is the DSM V criteria when diagnosing. It takes a lot of practice to ask questions in a way that elicits useful information. There is also a real art to seeing the big picture (I've seen a lot people misdiagnosed with schizophrenia when PTSD better accounts for their symptoms, for rxample).

I tend not to diagnose people with ADHD because most patients can't provide a childhood history of symptoms or they were being abused at a young age. I work with a fucked up population and my patients are the worst of the worst. I don't give people stimulants because I live in Methville MO and don't trust my dumb ass patients hah

But she didn't say schizoid personality disorder. I distinctly remember she said schizoid antisocial disorder, and it was in the printed report from the session too. I was legitimately diagnosed with ADHD in like 2nd grade, but my parents didn't see enough positive change after a month on the ritalin so they stopped giving it to me. Stupid fucks. I understand that my life is my responsibility, but if that decision didn't ruin my life, it certainly stacked the deck against me. When I started adderall at the age of 25, it was like 3-4 months later that I noticed I still had other symptoms and investigating the OCD led me to autism, and I knew it wasn't confirmation bias because I didn't want it to be autism, because not finding out you're autistic until you're 25, the damage to your life has already been done. The worst part was that autism wasn't just a decent fit, it fit like a glove and explained basically everything that went wrong with my childhood and my inability to function in the public school system.

So yeah, maximum of 6 months after starting adderall, I had web diagnosed myself with autism and started talking with a counselor who conveniently had a son with high functional autism, and he agreed that what I described of my life fit his experiences with his son extremely well, although obviously he wasn't a doctor and could give me a diagnosis. But I feel like if my parents had stuck out the ritalin like they were supposed to, maybe 6 months to a year later when some of the symptoms were gone but others were still there, maybe a return trip to a doctor might have led him down the path to autism as well. Pretty sure my life would have been very different if it had been discovered that I was autistic when I was 8 instead of 25.

Definitely feeling milder this morning after a decent night's sleep, but don't feel like im dropping back into a depressive cycle, so presumably it was just my body being all jazzed up as it got used to the sudden dose of amphetamines.

Gavin, just a thought reading your earlier post, but you might not be able to rule out confirmation bias. Look at what you wrote, and then the jab at your parents after it. You were looking for reasons why you are the way you are. Your self diagnosis might be accurate, but be sure to keep a grain or two of salt.

Also, when you were 8 the ADHD and ritalin thing was just taking off. Your parents weren't necessarily wrong not to want their 8 year old on mind altering drugs just because he was hyper and had problems focusing. That's actually pretty normal. Also, how much was the prescription back then? How were finances around the home? There's definitely a lot of health care math that goes on even in the most extreme cases.

My belief that my life would have been wildly different if I'd stayed on ritalin is indeed confirmation bias. The initial discovery that I was on the autism spectrum was not confirmation bias, because as I said, I didn't want it to be autism. I wanted it to be anything but autism. Hell, for a while I even hoped that I was schizophrenic instead, since there was some very mild overlap of symptoms.

and no, I was not normal for a 7 year old kid, which is why a psychologist diagnosed me with ADHD and put me on ritalin. I can understand parents having doubts about what medications their young children are put on, but taking me off the medication after a month without even following up with the psychologist was hubris, and it cost me a lot. Even if the autism managed to stay under the radar until adulthood, being treated for my ADHD would have made my public school experience a lot less horrible.

Anyone have any experience with Pamelor? Prescribed for depression and I have neuropathy from having the myelit (lining of the nerves) stripped off by 2 concurrent ailments which I assume is leading to the depression.

a_skeleton_03_sl said:

This is one of the things I struggle with my daughter about. You can tell instantly when she is going to just be depressed all day. She knows it, we know it, everyone knows it. She just does zero to try and fight that though. Just resigns herself to it.

My dad died and I cried and then I picked myself up and ate food and told jokes with my siblings, cried some more, and even though my family were being gigantic assholes about the funeral I powered through it because I chose to.

I got cancer, I was miserable during treatment, I was so miserable that if it comes back I am pretty sure I will not do chemo again no matter what. I powered through and found whatever minuscule amount of joy that I could to not just give up and be depressed.

Maybe those of us that aren't afflicted with it can't understand it. I understand there are people who struggle with depression. It is real. It is an actual thing and important to take care of. What I don't understand is that if you can know exactly what's going on how can you do absolutely nothing to try and help yourself get through it.

I just don't get it and it makes it hard for me to help my daughter or friends that are constantly depressed and in my eyes don't do anything to get themselves out of it, and admit to that.

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Cancer, death. Those are acceptable things to think about and react to. But what if your daughter is on about unreasonable nonsense that she knows everyone would always find unacceptable?

Gavinmad they sure are diagnosing you with a lot of stuff. Sounds like each drug side effect is a newly discovered condition which requires a new drug and you are trapped in a vicious circle of drug dependency and side effect. These guys want to diagnose things and prescribe things, it's their job.

I was put on anti depressants for nearly a year and had a very positive experience from it, no complaints, it stopped my mood from dropping below a certain level and helped to get me through the worst. I didn't like how it felt though with just mild side effects so by the end I was glad to be off it. What I did during this time was learn to understand my condition (Books/Therapist) and regulate it myself more (CBT/Meditation) to replace the drugs, I learned enough to get started while being on drugs and the rest took years after.

Sounds like you have more going on but are you doing any work to move towards getting off the drugs instead of just replacing them when they stop being effective?

I've said repeatedly that I asked my doctor for a psych consult so I could get a more definitive diagnosis because of that very problem. Got called back and set up the appointment today.

Borzak_sl said:

Anyone have any experience with Pamelor? Prescribed for depression and I have neuropathy from having the myelit (lining of the nerves) stripped off by 2 concurrent ailments which I assume is leading to the depression.

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Tricyclic Antidepressants are as effective as SSRIs but have some bad side effects (dry mouth/other anticholinergic side effects, sedation and extra fatal in an overdose). If you can tolerate it, its a good medicine (better tolerated than other TCAs typically).