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Need Advice On Prescription And Diagnosis

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#1 In_Remission_notapsychologist

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Posted 24 April 2011 - 12:54 PM

For almost as long as I can remember I've been depressed (say about nine or ten years old). My teachers and standardized tests recognized me as bright but I was constantly getting in trouble for not getting my homework done. I meddled my way through junior high, high school, college, and then actually managed to excel when I transferred schools for my last year and a half of undergraduate. I worked for a couple years then went on for a master's degree, my studies at which I did pretty well but did not impress my professors enough to continue on for the Ph.D. program. I think my ability to do schoolwork did increase as I got older but the way I would get things done was to wait until the last minute and get myself worked up into a frenzy to get a paper done.

Throughout this time I tried various antidepressant and anxiolytics to deal with anxiety and depression. I even tried Ritalin for a couple weeks in my early twenties but the doctor sai.d it wasn't working for me because it made me hyper. I've also been in and out of therapy (mostly in) since high school.

Cue to a year and a half a go. I was in a job I hated and overworked me, requiring me to work weekends and weeks that averaged consistently 80 hours with no comp. I was feeling overwhelmed by work, my feelings of inadequacy in doing my job and I had no mental of physical energy to have any sort of life outside of work. I was drinking too much alcohol to relax at night and drinking too much caffeine to keep me going during the day. Then my dad was diagnosed with a pretty serious and potentially fatal disease and I was doing my best to be a support to him and his wife and to keep up with my obnoxious workload. After a lot of the busy rush at work was over and it seemed as if my dad was stable I collapsed. Not literally but I couldn't do my work, I would show up to work and just sit there browsing the internet. I was still drinking too much and plying myself with caffeine to stay awake at work. My lack of productivity at work led to my being fired and into a pretty bad depression in which I continued to drink to much and not do anything during the day. Seven months ago my apartment lease ran out and I ended up moving back in with my mom to save money. I've been in steady therapy with not much, if any, progress for the last six months. I've also seen a psychiatrist since around the end of this last year. I've been on Lexapro, Risperdal, Zyprexa, Lamictal, Luvox, Ambien for sleep, and Ativan for sleep and as a PRN. My diagnosis up to a month ago was depression with anxiety but I had negative reactions to upping the dosages of my antidepressants and my psychiatrist decided I was Bipolar NOS due to these negative reactions. This is when Lamictal was added to my cocktail, which is currently 50 mgs of Lamictal, 50 mgs of Luvox, 10 mgs of Ambien, and a PRN of up to two milligrams of Ativan

During this process my p-doc confidently told me he could make me better and that I should experience a sort of up and down effect with my having more ups than downs as the medication took effect. This hasn't happened and at most I would have a couple days where I felt better and then I would sink back into depression and anxiety. I saw my p-doc this past week and his tone changed. I told him I was still feeling depressed and anxious with no reduction in my symptoms. His reaction (or at least implied) was that we had gone as far as we could with meds and I needed behavior activation therapy, which I had never heard of. I was so completely stunned at his 180 with regard to medication I just sat there and nodded complicitly with this theory. After having time to process this, I'm pissed off. After all this time in his proclamations of making me better, he's punting. I do plan to speak to him about this in our next session, which is next month.

Why I'm posting in here is that I was looking depression and anxiety on the internet and came across ADD-PI, which quite a few features of what I've experienced both as a child and as an adult. I was wondering if that might be the reason I'm not responding to traditional drug therapy for depression and anxiety. I know that people can't and shouldn't diagnose me here but I'm interested if anyone here as any opinions on what I've presented and how and if I should approach this with my p-doc and therapist.

Thanks so much for reading.

#2 mj1127


    Would-be Neurologist

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  • Diagnoses:Bipolar NOS, ADHD, migraine
  • Current Meds:Lithium CR, Abilify, Latuda, Adderall, Wellbutrin

Posted 27 April 2011 - 10:35 AM

A lot of people have ADHD and a mood disorder and anxiety, so it is very possible that you do too. You need to be treated for all three, but you need to be treated for the mood disorder and anxiety first, before you add something like a stimulant for ADHD, as stimulants can muddy things. There are a lot of meds out there, and the fact you haven't had success with the ones you have tried just means you need to keep trying. If your pdoc isn't willing to help you do that, you need to find a new pdoc. If you and your pdoc (or new pdoc, if that is necessary) discuss the issue of ADHD and decide you do indeed have that, and at some point decide to try a stimulant, Ritalin is not the only stimulant, and the fact that it didn't work well for you only means that it didn't work for you. Some people have to try a few different stims in different formulations before they find the one that fits.

Good luck.
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Bipolar NOS, ADHD, migraine

300mg Lithium CR, 7.5mg Abilify, 40mg Latuda, 20mg Adderall BID, 150mg Wellbutrin XL

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