Could my ADHD diagnosis be wrong? Or be expanded?
April 16, 2013 2:32 PM   Subscribe

Hi. I'll try and cut a long story short, about 6 month ago I've been diagnosed with ADHD and now I'm doubting my diagnosis. (more down there, all sappy again)

First I was given Ritalin, which was ok, but would suddenly get to something I can only describe as "too much" after around 4 days, and have since been using dexedrine (I'd say I'm using it for around 3 weeks in total, with gaps in between). The dexedrine has been better, "milder" (as my psychiatrist would say) and is easier to manage (I have to use IR, since my insurance doesn't cover ER, managing 4 doses of Ritalin a day was a bit a crazy).

However, I still have a feeling though that not much has changed. When on the meds, my house is generally cleaner and a bit more consequent, but I have a feeling my work (a creative discipline) hasn't improved in any way, maybe even suffered as I get a feeling that the meds kill my intuition in a way.

I think that, at the time when I contacted the centre/clinic I'm going to I self diagnosed with ADHD to begin with, and easily fulfilled all the criteria, but one question that still bugs me, which they asked as soon as we sat down was "Why did you come here? What is your goal with us?", at which I hesitated and eventually kind of wiggled my way out if with some answer I thought they might like to hear like "Get more consistent, more steady in my work bla bla"

Recently I've been thinking an answer to that is something really simple like, "Get happier", which now I definitely am not (nor was before).

I do talk to a psychotherapist as part of the treatment, but in general I present myself as quite functional when I get there, and I have a feeling he doesn't know how I operate when not on that chair facing him. He suggested and thought me stuff like mindfullness, planning and organization, all of which I got very enthusiastic about and then dropped it a few days later. This is my fault of course, but I think I have a hard time responding to any questions regarding emotional states, so it's mostly "Yeah, ok" or "Yeah, really good".

So I'm wondering if I have depression, or whatever else, because I'm getting worried and feel like I'm jeopardizing my studies, which are really a great opportunity, that now feel like I'm throwing away. I feel like I lack motivation, I'm indecisive and can't determine what I'm interested in. I'm honestly not productive, altough I do get moments where I produce a lot in a short period, but this is hardly on a regular basis. I have no things I fall back to, and nothing specific provides me pleasure anymore. I get jealous at others' successes, and have a hard time processing positive feedback towards my work. I haven't cried in about 4 years, which really worries me, even though I rationally think I should be really saddened by some things, but I feel blunt. This has been going on for a while though, and I couldn't describe it as being "sad", hence my confusion if depression is a possibility....

I'll mention this stuff to my psychotherapist next time, although I feel awkward about it, since we haven't really talked about things in that way so far (we only had a few sessions).

Anyway, not sure what I'm asking here, I guess it would just be good to hear from someone with a similar experience?
posted by ahtlast93 to Health & Fitness (12 answers total) 7 users marked this as a favorite
My experience with ADD and meds is this: the don't give you skills you missed out on while growing up without the meds.

Use the drugs to help you learn the skills you're seeking. They won't give you new habits but should make it easier for you to form them.

First, of course, you need to identify what the skills/habits you are missing.
posted by trinity8-director at 2:41 PM on April 16, 2013 [5 favorites]

My husband has ADHD so I will try to describe his experiences as best I can to help you.

He was on meds when he was younger but they made him a "Zombie" and he hated it. He felt really lulled out, could focus great, but didn't have fun. So he hasn't taken any meds since he was a child.

Being the person that deals with him, he has a mild to moderate case of ADHD. I am not sure how severe you are. He gets hyperactive, can't focus, and being his wife I sometimes just look at him and say "Take a walk and burn off some energy!!"

He (with my help) has developed work strategies that work for him. He likes to listen to music. We live in a 2 bedroom, with one bedroom being an office so that if he needs to focus he can cut out the world. Obviously that may not work in an office environment, but I'm sure you can pop in some headphones?

He has also worked on making lists or calendar alerts for tasks that he needs to get done. He really works hard to tune out the world when he has to, but sometimes it's a struggle.

On another note, I don't at all have ADHD or ADD. Yet I am normal and can't focus for the life of me some days. Part of that is just normal and you still have to figure out what motivates you to get work done, whether or not you have a focus-disorder.

Therefore I agree with trinity8-director. Meds help some people, however they won't fix all your problems. They could help you focus but just because you are focused on something doesn't mean you are focused on work.

A classmate of mine went on meds, and instead of listening during class, he drew intricate drawings non-stop. His grades did't really improve because he still wasn't studying.

Is there a source that can help you sort out work motivation and focusing for work? I am sure there are recourses out there for people specifically with ADHD and ADD who can help in this area also.
posted by Crystalinne at 2:50 PM on April 16, 2013

In my experience* depression doesn't always feel sad. Sometimes it feels numb. Some of your statements sound like depression:
I feel like I lack motivation,
nothing specific provides me pleasure anymore
even though I rationally think I should be really saddened by some things, but I feel blunt

I'd suggest talking to your therapist about these feelings. If it's hard to do so when you get to therapy, you could always write a journal entry ahead of time and then read it to the therapist when you see him/her next time. That would get the discussion started.

*Of course, IANAT, IANYT, etc., etc.
posted by tuesdayschild at 2:50 PM on April 16, 2013 [2 favorites]

Judging from what I've read, you and I have hugely similar experiences. I was having issues for months while still in college with doing homework and papers and such. At home, I had NO motivation, no creativity, no drive to do anything whatsoever no matter how much or little it interested me. My hobbies that I'd enjoyed were basically sitting untouched because I didn't have the energy, desire, etc. to do anything. I didn't finish things I'd started. Conversations were pretty much meaningless to me. Misplacing things more often than normal. And it wasn't that I lacked the desire to do things...I just lacked the motivation and drive. And there wasn't so much 'depression' as just being lethargic, tired, and generally not driven at all. But I was never really 'depressed'.

We (my doctor and I) had tried a couple medications with no success. One day while in an abnormal child psych class (I was a psychology major), I read something and talked about something that prompted me to immediately schedule another doctor visit. I went in to my doctor a few days later having researched the possibility of having ADHD-I (inattentive type ADHD). Basically, the opposite of 'normal' ADHD where you're hyper and such.

My doc and I discussed a lot of possibilities and we settled on testing out a low dose of Adderall. That was 4 years ago, and I'm happy to say I've been much better ever since. I get the generic version from my local chain-store pharmacy because it's cheapest...but to be honest it's helped me so much it's worth every penny. (The only sucky part is that, at least in my part of the USA, it's irritating as hell to get because of the high abuse potential and the fact that there are so many idiots who use it as a recreational drug that it keeps people who actually NEED it from being able to have access as easily...*hops off mini-soapbox* =P)
IANAD, I'm not an advocate for any particular drug or medicine, and it may be totally different for you. But this sounds nearly identical to what I've gone through. It've got my sympathies and trust me, it does get just took me a while to weed through all the crap to find something that legitimately helped. =)
posted by PeppahCat at 2:51 PM on April 16, 2013

If your doctor prescribed the Ritalin based on your own self-diagnosis, you might want to find out about getting a formal screening. It involves a series of tests that measure attention, working and long-term memory, intelligence, executive function, etc. It's usually done in two testing periods, usually separated by about a week--for one, you go off your medication and caffeine and anything else that might be affecting your ability to concentrate, and then, for the other, you go back to taking your regular dose, which helps demonstrate whether the medication you're on is working. There is also often a very detailed questionnaire -- you fill out one copy, and then you give the other to someone you're around a lot and who knows you very well, like a significant other or a parent or a close friend, and they answer to the best of their ability based on their observations of you.

It was helpful to me in a few different ways. My doctor was pretty sure about the initial diagnosis, but it did confirm for both of us--and also, for my husband--that I did indeed have ADHD-inattentive type, which eliminated my tendency to second-guess myself about this issue once and for all and accept that, no, I wasn't, as the title of that book goes, lazy, stupid, or crazy--that it was a brain chemistry issue. The tests also showed that although I didn't notice all that much difference when taking the medication, my performance on the test with it was drastically better than without; it relieved any fears I had about losing brain cells; and it put to rest my very irrational fears about early-onset Alzheimers, with which my grandmother was afflicted (although at a much later age!). And although it was sometimes hard to look at my husband's answers on the questionnaire, they were enlightening, because he had apparently been observing some things about me that I had not noticed or was in denial about how bad they were (like my inability to be punctual or to follow through on things I said I would do).

If the screening shows that you actually don't have ADHD, that's still progress, because it just means something else is probably going on--depression, anxiety, OCD, low thyroid, etc. It could be ADHD-I and depression, even--they often go together, since the ADHD is often responsible for poor self-image. I've been suffering from depression for much of my life and am also on an antidepressant, and it wasn't until about a year ago that I started to wonder if the depression itself could have been caused by undiagnosed ADHD.

I was on Ritalin at first, too, but it made me drowsy and spacey, so my doctor switched me to Adderall. That really did help, apparently, but I've also been wondering if the dose has been too low--a few days ago I took a pill, spaced out, and realized, after I'd swallowed it down, that I'd already taken one five minutes before and therefore now had twice the dose. I worried about side effects (e.g., increased heart rate), but I didn't feel weird or anything, and yet I found that my concentration and my motivation to remain on task were much better that day than they'd been for months.

However, before that there was also a period where I went without it for a week (my prescription ran out at a time when I couldn't get to the doctor's to pick up the new one, which has to be walked across the street to the pharmacy because it's a restricted substance--so annoying), and my ability to get anything done just went completely out the window--something my husband also observed. My doctor had told me that I might not realize that it was working until I went without it--and he was right. If your house is cleaner, that could be a sign of improvement, although it could also be structured procrastination...

So, yeah, more information always helps, even if only to confirm what you've suspected. And it also takes a while to figure out what medication works best for you and in what dosage.
posted by tully_monster at 4:29 PM on April 16, 2013 [5 favorites]

What I found when I was on ADD meds was that I could get more done (see cleaner house) but the price for that focus was that I was slightly less intuitive, observant and creative. It's a competition for mental assets - put more energy into the stuff you've got to get done and, well, it's got to come from somewhere.
posted by Kid Charlemagne at 6:48 PM on April 16, 2013

It will take a while to learn the behaviours you need to cope with your new-found attention span. I do disagree with Kid Charlemagne, though: ADD meds have made me more intuitive, observant and creative. I still get the 1000 ideas a minute, but they're no longer a cloud of gnats buzzing around my head. I can pick an idea, and work on it, and without being stuck in a pirouette between several ideas.

I'd recommend getting a more detailed assessment. It can take months to titrate just one set of medication, and even then you might switch to something different and start the process over.
posted by A Friend of Dug [sock] at 7:05 PM on April 16, 2013

My experience with ADD and meds is this: the don't give you skills you missed out on while growing up without the meds.

A thousand times yes. I think one of the hidden pathologies of untreated ADHD is that sufferers cope with it by waiting for "inspiration" to do certain chores and tasks. They might call it batch processing, but it is really procrastination.

The problem with this is that the drugs sort of take away those "lightning bold of energy and motivation" moments. We have to re-train ourselves to not wait for them, because they aren't coming and they really aren't all that healthy to begin with.

So what you have to do is change your mindset. Chores and tasks won't be nearly as boring and disjointed if you are medicated. You have to re-learn to schedule your time, and not walk past things that you shouldn't be ignoring.

ADHD has nothing to do with motivation, except that it causes us to misinterpret and ignore "normal" motivations, because our untreated selves were incapable of completing tasks that are of low importance. So we jump from crisis to crisis and forget how to be proactive and follow a plan.

Finally, my experience with the medication is that dosing makes a huge difference. 5mg of Adderall too much and I can't sleep. 5mg too little and I might as well have not taken it at all. So experiment with your dosage and timing. Look at the metabolism of the drug and shoot for as straight of a line as you can.
posted by gjc at 7:33 PM on April 16, 2013 [3 favorites]

> I do talk to a psychotherapist as part of the treatment, but in general I present myself as quite functional when I get there, and I have a feeling he doesn't know how I operate when not on that chair facing him. He suggested and thought me stuff like mindfullness,

Yeah, I went to my therapist for a solid year before I gave up on her. I tried, she tried, but it was clear that she just didn't understand what I was talking about, what was troubling me.

The other stuff, the apathy and indecision, that sounds a whole lot like how I felt when my dosage was too high. Unmedicated, I'm indecisive for completely different reasons. Maybe try talking to your prescribing doc about what he/she thinks about titrating your dose down a bit.
posted by desuetude at 7:48 PM on April 16, 2013

I know you've just started seeing your therapist, but he can't help if you're not telling him that you have problems with following stuff through, or brush of his attempts to get at how you're really feeling. You don't sound "okay" to me. It'd you have problems answering those types of questions-.- think about them beforehand. Tell him your struggling to answer them because you're not sure -tell him what you've told us. Show him this post.
posted by canine epigram at 9:30 PM on April 16, 2013

From my understanding, to be diagnosed with ADHD, the symptoms have to persist from childhood. So I would definitely question your diagnosis if what you're experiencing is a relatively recent phenomenon.

There's also no reason that you can't be suffering from both ADHD and depression. Feeling numb, having no motivation, being unable to find anything that interests you or makes you happy, definitely sounds like depression.

Personally, I have never found that ADHD medications killed my creativity, they may have dulled the impulse of "oh man, I have this great idea and i have to do it RIGHT NOW and ignore everything else i have to do, including sleep!" Which you know, isn't really that great all the time anyway.

Whether or not you have ADHD, depression can seriously affect your attention span, motivation, creativity and productivity. Personally, those are things I struggle with when I am depressed, despite the fact that I take my meds, have been on the same Rx for years which generally works great for me.

I also agree with trinity8-director. Medication isn't going to give you any skills that you don't have. Part of the struggle with ADHD is that growing up with it you don't learn how to do things like a normal person, such as breaking a large task down into parts as opposed to panicking the night before it's due and working like crazy. Figuring out what skills you are missing, and how to work on that is definitely something to discuss with your therapist.
posted by inertia at 8:06 AM on April 17, 2013 [2 favorites]

This is coming kind of late, but it's my understanding that the parts of the brain that control focus are also the parts that control mood, and because of that, it's pretty common for people with AD(H)D to be periodically depressed or to have persistent "low" mood. Therapists give it different labels like ADD, ADHD, SAD, Dysrhythmia, etc, but really it's all slightly different versions of the same thing. Some things that help with depression, like getting enough exercise and being in the sun as much as possible, also help with ADD, from what I understand.

From what I know, ADD is also frequently comorbid with bipolar disorder, so if you felt like you were going off the rails when you were taking Ritalin, that might be something to watch out for, maybe? I have ADD (officially), and I limit the number of days in a row I take stimulants for the same reason.

There's been some research lately suggesting that ADD, depression, bipolar, autism and schizophrenia have some of the same biological root causes, which I think is pretty interesting. There isn't always a clear, bright line between one condition and another, I think - it all depends where you fall on a spectrum of symptoms. I think if you keep an eagle-eye on how you are feeling and keep communicating with your doctor, you should be able to figure out what's going on with you, although it might take a while.

In any case, good luck!
posted by subdee at 3:54 PM on April 30, 2013 [1 favorite]

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