View Full Version : Pdoc says I'm depressed but I disagree....


Ivy0202
04-08-13, 11:20 AM
Hi!

I'm a long time lurker, rare poster.

I have a long story that I might share with you guys later if I can pull myself together. The short version is that I was diagnosed about 6 years ago with BPI and about 4 years later with ADD inattentive by the same pdoc. I was treated with Lamictal for the BP and - after trying Strattera for many months, then Focalin XR - Dexedrine XR for the ADD. Things were great until I developed a lupus-type reaction to the Lamictal and had to stop taking it.

I was ok for months before experiencing a major BP relapse in January. I started seeing a new pdoc because my old one just wasn't listening to me when I insisted that that current treatment was working.

So here comes my problem and I'd love your insight:

I started seeing a new pdoc who is convinced that my ADD symptoms are not ADD but depression. I have been on lithium and Wellbutrin, both of which have done WONDERS for stabilizing my mood. I'm generally pretty happy except that I'm still unmotivated, unable to focus or concentrate, easily bored, and the queen of procrastination. I had hoped that the Wellbutrin would have helped with these but they're worse than ever. I had to take a leave from work because by bosses say I'm just unable to do the job right now (I'm a neuroscientist ironically).

Before the new pdoc took me off the dexedrine, these symptoms didn't exist. And yet she's convinced that I'm depressed and that's why I'm distracted, etc.

I see her later today and hope to convince her that there's more going on with me than just the BP.

What do you guys think of this situation? I'm so frustrated, both with my inability to get anything done and my pdoc's certainty that it's all just depression.

Thanks!

sarahsweets
04-08-13, 01:14 PM
did the dexedrine help? Why cant your doctor look at you old doctor's records?

dvdnvwls
04-08-13, 01:29 PM
Being not motivated, unable to focus, easily bored, and procrastinating, are all symptoms of depression. Consider the possibility that the new doctor might be right.

Ivy0202
04-08-13, 04:49 PM
Whelp. I just returned from my appointment.

She has all my previous records, knew that I was on Dex which helped me greatly. When I started seeing her, she told me to stop taking the dex and we started treating the bipolar. That worked great. On lithium and Wellbutrin, I am happier (not pathologically so :P ) than I've been in months. I'm stable mood-wise and my anxiety has all but disappeared.

But I was still having the spacy, unable to focus, disorganized symptoms that led my previous pdoc to diagnose co-morbid ADD. So now that my moods were stabilized, I wanted to turn my attention to treating the ADD.

When I told my current pdoc this and listed all the things I'd tried and the things that worked for me (Focalin XR and Dex), she became very defensive and abruptly told me to find another pdoc. She showed me the door and wished me good luck. This was perplexing given that we'd discussed stopping the Dex and my ADD symptoms on multiple occasions.

I didn't ask for a script. I just told her what worked before and asked what her thoughts were.

She really made me feel pathetic. This is the first time this has happened to me though I've read that others have had similar experiences.

So back to the drawing board. Now I will definitely be asking potential pdocs if they have experience treating co-morbid bipolar/add.

Ivy0202
04-08-13, 04:55 PM
Being not motivated, unable to focus, easily bored, and procrastinating, are all symptoms of depression. Consider the possibility that the new doctor might be right.

This is true which is why you always solve the mood disorder problem first. But I'm not depressed. At least not the way I was (I was hospitalized on New Year's Day 2013 for suicidal ideation). I feel better than ever mood-wise but am still having problems reading more than one sentence, skipping the details on things (like forgetting to put detergent in the washer), spending hours watching TV or surfing the web, and having nothing to show for any of my perceived efforts at the end of the day.

The Wellbutrin has done wonders for my depression, no doubt. But it's not solving the ADD-type symptoms the way that Focalin XR or Dexedrine did.

dvdnvwls
04-08-13, 05:27 PM
Medication working is not a diagnosis. With multiple medications going on, things can get confusing.

I'm not saying blindly follow the doctor's lead - but I am saying don't assume you have ADHD.

Ivy0202
04-08-13, 05:32 PM
Medication working is not a diagnosis. With multiple medications going on, things can get confusing.

I'm not saying blindly follow the doctor's lead - but I am saying don't assume you have ADHD.

That's exactly what I'm trying to get to the bottom of. Adult ADD is tricksy for sure. How does one dissect one's childhood and diagnose post hoc? Was I just a rowdy tomboy or did I have ADHD that is now affecting me as an adult? Who knows.

What works, works. And if a drug works on some symptoms and we know a little about how that drug works, don't have a clue as to the etiology and subsequent diagnoses?

fracturedstory
04-09-13, 05:43 AM
Being not motivated, unable to focus, easily bored, and procrastinating, are all symptoms of depression. Consider the possibility that the new doctor might be right.
Doctors can also be narrow minded and will not even explore the notion that they could be wrong by considering for one second that their idea of what ADHD is might just be a little bit biased.

I think when a person has depression they are well aware of it. I got misdiagnosed with severe depression.

Yes those can be the symptoms but those symptoms manifest in a way different to ADHD. In Inattentive ADHD especially it would be easy to confuse it as depression.

Fuzzy12
04-09-13, 06:50 AM
Bipolar disorder comes with cognitive impairments, many of which are similar to ADHD. Unfortunately, it's been found that these cognitive impairments can be present even when you are euthymic (i.e.normal, neither manic nor depressed). But then BP and ADHD are often comorbid as well. It really is difficult figuring out exactly what is wrong with you and how to treat it.

Could you ask some close relatives about how they viewed your childhood? Sometimes, it helps getting their opinion.

Lunacie
04-09-13, 08:23 AM
Our psychiatrist (mine and my g-daughter's) prefers to treat symptoms
rather than treating a diagnoses. Maybe the OP needs to find a psychiatrist
like ours.

If the Dex was helping the distracted-unfocused symptoms without making
the bipolar symptoms worse, it makes sense to keep using the Dex, no?

dogluver358
04-09-13, 01:29 PM
Is that a typo? Hospitalized in January of this year? If it was this year, that's not that long ago. What happened to the doctor who diagnosed you with ADHD? Can you not see him/her again?

Ivy0202
04-10-13, 08:05 AM
Is that a typo? Hospitalized in January of this year? If it was this year, that's not that long ago. What happened to the doctor who diagnosed you with ADHD? Can you not see him/her again?

First of all, thanks for all the input, guys. I really appreciate it.

That's not a typo. I went to the ER on New Year's Day. I was in the midst of a serious mixed episode. If anyone has experienced this, you know how intense it can be. When I'm depressed, I might have suicidal thoughts but they're rather vague and take the form of "Everyone would be better off if I wasn't here", "It would make no difference if I was gone", etc. And I'm usually too fatigued and unmotivated to act on them.

With mixed episodes, I have the suicidal thoughts of depression AND the energy and impulsivity of mania. I've only had one other mixed episode. But this one was serious enough for me to tell my fiance that I needed to go to the ER. I was admitted for a few days.

The doc who prescribed the dex had been my pdoc for five years prior to January. He helped me greatly with stabilizing my mood and then tackling the ADD-type symptoms. I was on Strattera for over a year before it crapped out on me. He worked with me - slowly and methodically so as not to set my moods off balance - to find a regimen that worked and we finally achieved it with Dexedrine, 10mg 1-3X per day as needed. It worked perfectly for me. No manic episodes. It DECREASED my anxiety and I actually started to sleep better too.

The reason I left his practice is complicated. Essentially, I think he took on more patients than he could handle. He wasn't returning phone calls or calling in script refills, sometimes not until days after the fact if at all. And then I found out that it was his receptionist who was determining whether or not I needed a refill. If it was one day before I ran out of something, it was too early to refill according to her and wouldn't pass the request on to my doctor. I discussed these problems with him directly on several occasions but nothing seemed to be done about them. So I decided to find someone else.

I guess I could call and ask him for a refill but I'm afraid of how that would look. I mean, I left him for another doctor. That doctor won't refill it so I'm coming back to him for it. It was a messy break-up, too.

Now the doctor I left him for says my symptoms are out of her realm of expertise (or is simply afraid of prescribing stimulants) so I'm trying to find someone who is. Someone who treats the symptoms, as mentioned by someone else, might be the way to go. As much as I hate polypharmacy, I think a cocktail is the only way to treat bipolar.

Sorry about the long story. I even left out a lot of the details.

keliza
04-10-13, 12:09 PM
It sounds like the most recent pdoc who passed you off has a god complex and doesn't want to be wrong, that's why she showed you the door. A good physician would be willing to work with you and keep trying to find the right treatment for your issues. A good physician would at least articulate to you the reason WHY she wouldn't prescribe those medications, not just tell you to find someone else.

I don't think doctors should just hand out drugs based on what their patients say, of course, but if you had a good response in the past and she has all of your doctor's records from the previous office, the only reason I can see for flat-out refusing to treat you is that she doesn't want to be wrong. That kind of ego in doctors is maddening, and also dangerous. I've run into it a few times. I really like my psychiatrist now because he listens to what I have to say, talks to me intelligently about his rationale for things, and together we come to a decision about how my health is going to be treated.

I think you would do well to find a doctor who is more familiar with bipolar disorder and/or adult ADHD. Are you seeing a therapist, can they make any recommendations about someone good to see in your community? Or can your general doctor recommend someone they like in your area? I've found that some of the best recommendations I've had came from other mental health professionals in my area. When I had to change therapists because mine moved, I got a great rec from her before she left. When my previous psychiatrist felt that she wasn't the best person to treat my bipolar disorder, she told me that flat-out (no ego, very humble, liked her a lot) and referred me to someone who specializes in mood disorders. That is who I see now.

Hang in there. If you're really not depressed and your left-over symptoms are ADHD-related, you'll find someone else who sees that, sees your medical records, and knows how to put the pieces together.