View Full Version : Help with mental health issues


Dansla
07-12-17, 08:45 PM
Hi all, Basically I have so many problems right now that im not sure where to start, I will give you the basics of what I am going threw and hopefully some of you can relate to it in someway and help me out. ( 25 year old male)

I was diagnosed with GAD/Panic disorder and depression almost 10 years ago. I have been on several different medications and been to several different health professionals since then but to no avail. My mind it seems is on a boot loop going from being ok to full blown panic/anxiety/depression every few weeks. I has a complete hold of my life and it is all I think about all dy everyday. Its ruined and currently ruing jobs/relationships/life goals. My indecisiveness I extremely bad where I cant even rely on my own decision without feeling completely overwhelmed. I have moved to different countries got new jobs and met new friends thinking that it will cure my brain. But no im still the same. I have had 26+ jobs since I left school in 2009 and havenít stuck to any career since then.
Recently I was diagnosed with ADHD and given ADDERALL and Concerta but only took them for 1 week then stopped because of my indecisiveness and distrust I felt between mw and my doctors diagnosis, Then I went to a second doctor and got a second opinion, He said it sounded more like Bi-Polar disorder or Borderline personality disorder and then offerd me long term anti depressant medication.
I donít know what to do, im getting different answers everywhere I go, I feel I am going to lose my mind or hurt myself.
If any body can give me some advice on what to do it would be much appreciated
Thank you all for reading

sarahsweets
07-13-17, 04:23 AM
When you say hurt yourself, do you mean because of the depression or are you worried that the meds will hurt you?

Lunacie
07-13-17, 10:47 AM
What kind of doctors diagnosed the ADHD and then the Bipolar?

Did either of the doctors ask about your family history? Most of these disorders
have some link through genetics. If you have family members who were ever
diagnosed with either ADHD or Bipolar that could help you understand which
you're most likely to have.

A therapist wrote in her notes that she suspected Bipolar in me, but when the
psychiatrist mentioned it, I informed him that there is NO history of Bipolar in
my family. However, there are lots of cousins and such with ADHD / Autism.
So I'm comfortable with my final answer being ADHD with a small side helping
of Autism.

Unfortunately there is no simple blood test that tells you if you have a disorder,
or which disorder you have. We rely on family history and personal history.
And matching symptoms with the diagnosis.

kilted_scotsman
07-16-17, 05:45 AM
As Lunacie says.... a good diagnostician will take a long time over a diagnosis, which will include a significant amount of family history, as well as tests to rule out various possibilities.

Yes there can be a genetic component to many disorders, however a good diagnostician will be on the look out for family issues associated with stress, attachment or neglect.

Diagnosis isn't a checkbox exercise.... this is where going to a good therapist AS WELL AS a good psych is called for. The label the psych gives you doesn't matter..... it's the assistance you get to improve your life that does.

If you read authors such as van der Kolk, Mate, Levine etc you'll find that the path from symptom checklist -> diagnosis -> correct medication isn't as clear cut as we'd like to think.

Lunacie
07-16-17, 10:18 AM
As Lunacie says.... a good diagnostician will take a long time over a diagnosis, which will include a significant amount of family history, as well as tests to rule out various possibilities.

Yes there can be a genetic component to many disorders, however a good diagnostician will be on the look out for family issues associated with stress, attachment or neglect.

Diagnosis isn't a checkbox exercise.... this is where going to a good therapist AS WELL AS a good psych is called for. The label the psych gives you doesn't matter..... it's the assistance you get to improve your life that does.

If you read authors such as van der Kolk, Mate, Levine etc you'll find that the path from symptom checklist -> diagnosis -> correct medication isn't as clear cut as we'd like to think.

I don't think diagnosis has to take a LONG time, but it does need to be
thorough and take family and personal history into account.

kilted_scotsman
07-16-17, 11:06 AM
Thorough = long..... ie well over an hour, more like three.

PoppnNSailinMan
07-16-17, 11:43 AM
Thorough = long..... ie well over an hour, more like three.

And how many GPs (PCPs) have time to do a three hour diagnosis (and that's assuming that they even know hardly anything about ADHD)?

My own GP gives new patients an hour and after that, his patients get half hour appointments. But he specifically left the place that had previously employed him because they were forcing their doctors to shorten appointment times down to just 15 minutes. Now my GP is asking me and his other patients to get their prescriptions directly from the non-profit 501(c)(3) Federally Qualified Health Center (FQHC) that he works for because they can make a couple of hundred dollars a patient every month selling them their meds and keep their appointment times at 30 minutes for their patients.

kilted_scotsman
07-16-17, 03:45 PM
It shouldn't be your GP that does the diagnosis..... it should be a psych with enough time to get to know the client and also enough experience to help the client access the support they need, be that the correct meds and/or other psychological support.

Too many people think that psychological diagnoses are like physical ones..... so they get confused when different psychs/GPs come to different diagnoses.

Remember.... a psychological label is an OPINION, and a shorthand for a cluster of symptoms, not a diagnosis of a specific physical malfunction/infection.

when you go to a GP with a physical problem the GP takes a history (the symptoms), they usually then take some bloods, temperature, get scans done.... (the tests), then they use all the info to make a diagnosis, from which flows a treatment plan and monitoring using more tests.

With ADHD/Psychological diagnoses the middle part is missing..... no tests.... Likewise monitoring is via symptom relief, not test results....so the psych is operating in the environment the GP was half a century ago.... though this is now slowly changing with advances in imaging..... however these advances are throwing the validity of the DSM into doubt.

Psych's don't like patients to know this..... most prefer their patients to remain powerless and knowledge free.

sarahsweets
07-16-17, 04:15 PM
And how many GPs (PCPs) have time to do a three hour diagnosis (and that's assuming that they even know hardly anything about ADHD)?

My own GP gives new patients an hour and after that, his patients get half hour appointments. But he specifically left the place that had previously employed him because they were forcing their doctors to shorten appointment times down to just 15 minutes. Now my GP is asking me and his other patients to get their prescriptions directly from the non-profit 501(c)(3) Federally Qualified Health Center (FQHC) that he works for because they can make a couple of hundred dollars a patient every month selling them their meds and keep their appointment times at 30 minutes for their patients.

You should really be seeing a psyche that specializes in adhd not your GP. Its very rare to get a gp good enough to treat adhd.

PoppnNSailinMan
07-16-17, 07:15 PM
You should really be seeing a psyche that specializes in adhd not your GP. Its very rare to get a gp good enough to treat adhd.

It's even hard sometimes to get a psychiatrist who really knows anything about ADHD.

Five years ago my GP referred me to both a therapist and a psychiatrist that are part of the Federally Qualified Health Center (FQHC) where I get my health care to be evaluated for ADHD and I eventually discovered that neither one of them really knew beans about the subject. The therapist diagnosed me with Predominantly Inattentive type and the psychiatrist with Combined type (I don't think I've got enough Hyperactive/Impulsive symptoms to be Combined type).

The psychiatrist started me off on Wellbutrin which didn't do a thing and then gave me instant release methylphenidate. During one of our appointments I brought up something I had read from Russell Barkley and this psychiatrist had never heard of him before which didn't give me much confidence in his ability to treat my ADHD since Barkley is one of the country's most well known experts on the subject of ADHD. Other comments by the psychiatrist made me realize that he didn't really know a lot about ADHD. Eventually, I stopped seeing him and stopped taking the methylphenidate because I just didn't feel comfortable having him treat me for my ADHD.

Then just recently, I talked to my GP again about my ADHD and he referred me back to the Behavioral Health division of the Health Center where I get my health care. They sent me to see a psychiatric Nurse Practitioner (NP). This guy was even worse than the psychiatrist I had seen before (who is no longer at the Health Center). He told me that he didn't think I should take a stimulant "because of my age" (I'm 56) and because of concerns about my heart. But this NP doesn't know a thing about my health or my heart and has never talked to my GP. He said that he thought that I should take Strattera instead. So I read a little blurb about Strattera to this NP from one of my ADHD books by Ari Tuchman called Integrative Treatment for Adult ADHD (p. 29):

The bottom line on Strattera is that it just doesn’t seem to be as effective as the stimulants. For some clients it works very well, but not with the same frequency that the stimulants do. An informal survey of therapists and psychiatrists whom I know support my experience with the medication in that it is just not as likely to be of significant benefit. Therefore, in my opinion, it should be considered a second-line medication unless there are specific reasons why the stimulants should not be used.

On top of that, Tuckman says this on the same page:

Strattera should also be used cautiously in adults with hypertension and other cardiovascular risks.

So why in the world did this NP bring up the issue of my age and my heart as his reason for recommending that I not take a stimulant and should take Strattera instead when Strattera also has cardiovascular risks? And, as I said, he didn't even know anything about the health of my heart. It doesn’t make any sense. Based upon other comments by this psychiatric NP, I decided that he's not very knowledgeable about ADHD.

I showed this NP one of my pill bottles for the methylphenidate which I had been taking previously and which was still partially filled and he made a ridiculous comment that I should get rid of the remaining methylphenidate because I might get in trouble for having it even though the pill bottle has my name on it and was prescribed to me by a psychiatrist. This NP obviously has a bias against the use of stimulants.

Finally, I was able to get a referral last week to someone who is not a psychiatrist but who has really educated himself on ADHD in adults. He's up to date on all the most recent research on the topic, has experience prescribing ADHD meds, and has met some of the top experts on adult ADHD such as Ari Tuckman and Ned Hallowell (the co-author with John Ratey of Driven to Distraction). He's planning on starting me on Vyvanse soon and if that doesn't work, we can try something different. I had almost lost hope of finding anyone to treat me.

This has taught me how hard it is to find clinicians who know anything about treating ADHD in adults. And even lots of psychiatrist don't know much.