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Depression/ADD/ anxiety? What's my problem
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An_242357 posted:
I'm a 38 to male, have been taking adderall xr 60 mg day 4-5 days/week over past 5 months. Initially it was great and helped my motivation, focus and ability to finish tasks. For the last month it seems my mood is either changing or I'm becoming more aware of other issues I've had all along. I have for many years (since childhood) had anxiety with social situations, I avoid them if I can. I always thought of this as just my shy personality and that I chose to be less social because that's what I wanted, had not until recently started seeing this as a problem. Also lately my motivation is declining and have less patience, generally in more of a down mood. Im now confused about if my problems all along were more anxiety and depression or if it's a combination of all 3 (add,anxiety,depression). I will see my psychiatrist next month and almost feel embarrassed to tell him about all these new complaints, especially since everything had been working well and I was so confident that my main issue was add and i downplayed other issues at the time of my initial eval. Should I stop adderall and take something like wellbutrin, or add an antidepressant to adderall? Just not sure. I know that there is defiantly something different about me compared to other friends and coworkers, and there has to be something to get me going in the right direction. I do have an extensive family history of add/ depression/anxiety, parents, cousins,several if my siblings and aunts/uncles on both sides of my family have been diagnosed with some form of mood disorder. Any input on proper meds, adderall exacerbating my pre existing problems and how to approach all this with my MD.
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Raven951 responded:
I understand everything that you are experiencing because I have experienced them as well. It wasn't until I was diagnosed with ADD at age 40, that things started making sense"026all the way back to my early childhood. It was like a light bulb just exploded in my head and all of the uncertainty and "weirdness" that I had experienced throughout my life finally had a name. From that point on, things started getting better because I had a baseline from which to move forward and begin to improve my life.

That said, I understand your anxiety and concern about your meds as well as all of the uncertainty that you have described. I'm not a doctor, so I'm not going to recommend or speak against medications. I can only tell you my experience and to offer a few non-medical suggestions that have helped me. I am currently taking 2 different ADHD meds, including Adderall, and 1 anti-depressant. Since I was diagnosed, it has been a bit of trial and error, adjusting dosages, strengths, and combinations to find the right mix. I also take them daily. (If I don't take my meds daily, it can affect the coping skills that I am developing. For example, soon after I was diagnosed, there were a couple of days when I forgot to take my meds. On the second day, without meds, I locked myself out of the house and had a full-blown panic attack. There was also a lock on the gate and a tall fence all around, so I had no way of getting out, at least that I could see. I felt like a caged tiger and I was petrified. I couldn't think straight, I was pacing back and forth, etc"026if my neighbor had not been at home and heard me trying to break into my back door, I don't know what I would have done. Anyway, after that I have taken my meds daily.)

Regarding your doctor, I understand that it can be hard to verbalize your experiences, especially in the short amount of time that you are sitting in the office. The longest appt that I've had with my Doc is about 10 minutes. That hardly seems like enough time to discuss anything. However, if you tell them that you need a little more time, my experience is that they will allow for it. Also, you need to be completely honest with them. If they don't have the right details, then they can't help you like you need. Trust me, they have heard it all. If it is your doctor that you don't feel comfortable with, then you may need to find a doctor that you do feel comfortable talking to and that you trust. I feel that Trust is a very important part of the doctor/patient relationship. (As a side note, in your explanation, you are asking for advice about meds. I must say that I don't think it's a good idea to take a layman's advice about medication, especially some random blogger on the internet. Based upon the limited knowledge that I have and have researched, some of the advice that I have read on the internet has been biased, incorrect or even what I would consider dangerous. Obviously, you are free to decide for yourself, but regarding medication, I trust my doctor.)

(Continued, next posting--not enough room.)
 
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Raven951 replied to Raven951's response:
Continued from Above:

One thing that might be helpful to both you and your doctor is to put everything in writing. You could create an activity journal and list everything from the time you get up and how you are feeling before you take your meds, what you have for your meals, when you eat, how you feel after you've taken your meds in the morning verses in the afternoon, how long you sleep, etc. I would also include behavioral things like any hyperactivity, impulsiveness (including blurting out, inappropriate or interrupting of conversations), daydreaming episodes, focusing issues, motivational issues, problems with attention while driving your car, etc. Be very honest and try to look at it as an observational diagnostic tool rather than a personal journal. (I also think that it would be very helpful to have a personal journal that is completely separate. This way you can express all of those thoughts and feelings that have been swirling around in your head all day, but don't have to worry about someone else reading it.) When you go to your appointment, you would have a detailed account of what you have experienced all month. Your doctor can look at it and discover both medical and psychological patterns and may even find something new that you hadn't thought of before. Also, some doctors seem to pay more attention when something is written rather than something recalled from memory. It will show that you've really thought about things. (Don't be surprised if they need to take it with them to look at further. Not much understanding can be gleaned in a 10 minute time frame when there is a month's worth of data to study.)

I also see an LPC (Licensed Professional Counselor) every week for therapy. This has helped me enormously. I have learned about myself psychologically and have learned better coping techniques. I have also learned things that I can go back and tell my Psychiatrist that I wouldn't have thought about previously. Another good thing is that rather than a 10-minute session where you pick up a prescription, my sessions typically last around an hour, so you can just unload all of the junk that is swimming around in your head. There are also group therapy sessions just for people with ADHD.

There are also a few books that have been very helpful to me throughout my learning process: "You Mean I'm Not Lazy, Stupid or Crazy?!" By Kate Kelly and Peggy Ramundo; "Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD" by Daniel G. Amen; "The Gift of Adult ADD: How to Transform Your Challenges and Build on Your Strengths" by Lara Honos-Webb; "More Attention, Less Deficit: Success Strategies for Adults with ADHD" by Ari Tuckman; and "Is it You, Me or Adult A.D.D?" by Gina Pera and Russell Barkley (for your friends and family). There are tons more out on Amazon.com.

I truly hope this helps! Lots of luck to you and please let us know how you are doing. Remember, you aren't alone in this. It will take a little work, but try to look at it as a self-discovery adventure. The more you learn about yourself, the more you'll want to learn.
 
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Patricia Quinn, MD responded:
Raven did an excellent job at responding to your recent post, but I would like to emphasize a few points. First, ADHD rearely travels alone and anxiety and mood disorders are frequent co-occuring conditions. Your family history probably predisposes you to these disorders as well. Second, stimulant therapy, particularly the amphetamines, can make anxiety worse. I would suggest that you discuss your symptoms with yoru treating physician as soon as possible. If he or she is unaware of them appropriate changes can not be made. In addition, I agree that you should not be embrassd to discuss anything with your physician. If you don't feel comfortable for any reason, I suggest that you seek out another physician that you trust and can talk with. In order to treat you he will need all of the information that you can provide. If you don't feel like you have enough time, ask for a longer consultation appointment. You deserve to live well. Working with your physician on the treatment of your ADHD and co-existing conditions is a majoor step to making that happen.


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