View Full Version : ADHD, wondering if Bipolar also present


adhdogwalker
06-24-07, 01:19 PM
I am in the process of getting diagnosed for ADHD and have my 1st neuropsych appt. this Thurs. I thought that I would post here, as I'm kind of wondering if I might have a bit of bipolar going on. I have no idea what my psy. and neuropsych. are going to say, but I thought some of you diagnosed with bipolar as well here might be able to tell me if some of your experiences/ behavior patterns are similar to mine. I have included a lot here, but not everything, so if you have questions, just ask.

My parents always said I was "hyperactive" as a child, but never medicated me. At the end of April, I saw a psychiatrist that specializes in ADHD and he put me on Adderall (my dose is 20mg. 2X/day), yet he won't say if he thinks that I have ADHD or not-- he keeps saying "if" that's the diagnosis, he also keeps mentioning that he thinks I have "personality issues" (what the heck does that mean?).

I never thought much of my psychiatric problems, I've just dealt with them over the years; however, I realized I needed help if I ever wanted to finish school. I've always gotten good grades (3.7 GPA from an Ivy League university). I would do well for a semester, then freak out and either go to the dean's office crying hysterically or so high on life that I felt it was my great destiny to drop out so that I could become a famous writer-- I believed that I would never succeed if I finished because I would be too "indoctrinated" to ever develop the sort of revolutionary and unique thought requisite to become a great writer. By the time I left university, I had a gigantic file at the dean's office detailing my meltdowns. The dean had walked me to the psychiatrist's office more than once. I never responded well to any of the medicines they gave me, so I finally decided to live unmedicated until recently.

Here's a list of the medicine and what happened (I include it here because I notice that some of my reactions are what occurs when someone with bipolar takes it. Do people with ADHD only have these reactions?)
Serzone- felt a bit like a zombie, then became extremely suicidal, got paranoid, tried to seek mental help but thought the social worker was "stupid" and flipped out, also felt like everything had germs and was going to contaminate me-- just stopped taking it and eventually these things went away
Zoloft- took 1 dose 1X-- crazy mania, restless legs worse than I can describe, stayed up for 2 days, left class to go jogging-- absolutely miserable
Wellbutrin- took this to quit smoking, made me high as a kite, I was super productive and life was fun, but I was neither eating nor sleeping and had to go to the gym 2-3x per day, extremely sexual
Depakote- I did very well in school that semester, remember that for the first time I could sit still and read calmly; however, I started taking afternoon naps and wasn't as energetic-- I've always been hyper, so I hated this feeling

I finally gave up on the idea of completing college 7 years ago, and have had physical jobs working with animals ever since. I have been much better, and I think that is due to the extreme amount of exercise I get everyday. Mon-Fri. I walk 8-10 hrs. a day and on the weekends usually for 3-4. However, I am still very moody. I can go from euphoric, to flipping out, enraged, to depressed to normal in an hour. Sometimes I have ultra-productive phases, then nothing. I am social for a while, then can't be around anyone. I get really excited about a new project, then stop working on it, even though I swear that this time I will finish it. I map it out in my mind and always see myself as achieving the highest level of success with it, then all the sudden, I find myself doing nothing and abandon it. I have a whole rotating series of life plans, none of which I ever accomplish.

I remember being moody as a child and remember being suicidal in late elementary school and junior high (don't think this was hormone related as I was an extremely late grower and did not even have my period until I was 17 1/2). I would have depressed meltdowns in the middle of class and get sent to the nurses office. I used to have extreme temper tantrums and cry for hours, I was so out of control that my parents would lock me in my room alone until I stopped. I used to love to pick fights with my brother, sister, and parents. I could also be very kind and tractable at times. My relationship with animals has been the only thing that has gotten me through all these difficult periods, and as horrible as I've been at times with people, I am extremely patient with animals. I asked my mother recently if she remembers me being moody as a kid and she said that I was the moodiest child she's ever known. However, my parents never took me to a psychiatrist or therapist, so I never received and mental help until I reached adulthood.

In my adult life I think I have suffered from a few episodes of mania and major depression, but I tend to cycle rapidly between different moods. None of them are so extreme as to be delusional or suicidal these days-- I occasionally have suicide days, but am also able to tell myself that "this too shall pass" and it does. I am absolutely convinced that exercising constantly is the reason that I manage as I do and I think it dulls the moods a bit. Yet, I still have a desire to achieve something more in life than just walking dogs-- I was in gifted/talented classes from the 4th grade on and did well at an Ivy League university; however, I have never had a decent job that uses my intellect in any way. At this point, I am not sure if my lifelong history of mood swings (also major impulsivity and hyperactivity) is simply ADHD or I might be Bipolar as well. I recently read that ADHD adults can be very moody. I also notice that when I am in an extreme mood, either extremely happy/productive, or extremely upset, my physical hyperactivity is greatly increased-- I have horrible restless legs at these times.

Since I have been on Adderall, I find that my visible moodiness is fairly eliminated. I can be in the middle of having all sorts of mood swings, I take a pill, and 1 hr. later I am much better. I am calm and can sort through my emotions. I am not a zombie, I still feel everything, but I can sift through it and put it in perspective. However, I was on a spree of working on a poem for a few weeks, I abandoned it 2 weeks ago because I got "busy." I was being productive when I first started taking adderall, and now I am just "relaxing" and not doing anything again. I keep telling myself that I should let myself "relax" because this is the first time I've been able to, but I'm wondering if this fluctuation in motivational level could be due to something else. A few weeks ago, I was going to win the Pulitzer Prize for my poetry, now I am in one of the no specific life plan modes, just live life day to day until the next great inspiration comes along. I'm in a generally good mood, (except when the 6 dogs in my apt. cause a huge ruckus and stress me out, but I get over it). I notice that how well the adderall works varies from day to day, as far as focus and controlling hyperactivity. I skip it fairly often and my fiance can always tell-- I'm moody, talk fast, disorganized, etc, i.e. "normal" me.

Regardless, of whatever I get diagnosed with, I feel as if adderall is really improves my overall quality of life. However, I have only been taking it since the very end of April and I wonder if some "surprise" is awaiting me. I was hoping it would cure everything, but I've seen this motivational change already and I was wondering if this is "normal" for someone with ADHD or if it could be indicative of something else going on. I would greatly appreciate any insight anyone here has to offer.

Crazy~Feet
06-24-07, 01:28 PM
http://www.fortunecity.com/campus/psychology/781/dsm.htm

The definitions given below are from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994 (American Psychiatric Association, 1400 K Street NW, Suite 1101, Washington, DC 20005-2403 USA).

Bipolar I Disorder--Diagnostic Features (DSM-IV, p. 350)

The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. Often individuals have also had one or more Major Depressive Episodes. Episodes of Substance-Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. . . .




Bipolar II Disorder--Diagnostic Features (DSM-IV, p. 359)

The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode. Hypomanic Episodes should not be confused with the several days of euthymia that may follow remission of a Major Depressive Episode. Episodes of Substance- Induced Mood Disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Bipolar I Disorder. In addition, the episodes are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. . . .




Criteria for Major Depressive Episode (DSM-IV, p. 327)

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.


depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.

markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

insomnia or hypersomnia nearly every day

psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

fatigue or loss of energy nearly every day

feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.




Criteria for Manic Episode (DSM-IV, p. 332)

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:


inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode.

D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).

Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.




Criteria for Mixed Episode (DSM-IV, p. 335)

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).




Criteria for Hypomanic Episode (DSM-IV, p. 338)

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:


inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

(Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment {e.g., medication, electroconvulsive therapy, light therapy} should not count toward a diagnosis of Bipolar II Disorder.)....


--However...those of us on the ADDF Cycling Team have been told that use of SSRI class antidpressents can and do trigger hypomanic episodes in undiagnosed/diagnosed bipolar patients at times.--

************************************************** **********************

Crazy~Feet
06-24-07, 01:46 PM
Of course nobody here is qualified to diagnose any disorder...but I can offer this judging by my experience, and the experiences of others:

then freak out and either go to the dean's office crying hysterically or so high on life that I felt it was my great destiny to drop out so that I could become a famous writer This sounds like a typical bipolar cycle to me.

Serzone- felt a bit like a zombie, then became extremely suicidal, got paranoid, tried to seek mental help but thought the social worker was "stupid" and flipped out, also felt like everything had germs and was going to contaminate me-- just stopped taking it and eventually these things went away
Zoloft- took 1 dose 1X-- crazy mania, restless legs worse than I can describe, stayed up for 2 days, left class to go jogging-- absolutely miserable SSRI/SSNRI class antidepressents can easily trigger a manic/hypomanic episode in a person with bipolar disorder. This is something that many of us have learned while (incorrectly) diagnosed with chronic major depression.

Wellbutrin- took this to quit smoking, made me high as a kite, I was super productive and life was fun, but I was neither eating nor sleeping and had to go to the gym 2-3x per day, extremely sexual This is virtually the definition of a hypomanic episode.


However, I am still very moody. I can go from euphoric, to flipping out, enraged, to depressed to normal in an hour. This may qualify as rapid cycling:

"Ultradian cycling is characterized by more than four mood states within a year. Often these mood states occur within the space of a few weeks or even a single day. These oscillations, cycles, may last for several hours, a few days, or even weeks. While our current understanding looks to the presence of both states simultaneously, there are anecdotal cases where situational factors can produce distinct and separate periods of depression or mania/hypomania, switching back and forth."

This type of cycle may also be referred to as a mixed episode. We have a few bipolar members who have this feature here at ADDF.

Since I have been on Adderall, I find that my visible moodiness is fairly eliminated. I can be in the middle of having all sorts of mood swings, I take a pill, and 1 hr. later I am much better. I am calm and can sort through my emotions. I am not a zombie, I still feel everything, but I can sift through it and put it in perspective. However, I was on a spree of working on a poem for a few weeks, I abandoned it 2 weeks ago because I got "busy." I was being productive when I first started taking adderall, and now I am just "relaxing" and not doing anything again. I have the same response to Dexedrine, and a few others report similar responses to Adderall/Dexedrine. The fact that you later returned to this "busyness" (that can often be hypomania) would not be unusual if you are, indeed, bipolar.

Those of us who treat our bipolar disorders cannot expect to be free of all cycles forever. Even with the best meds combos possible for us, we may, can, and do, still cycle a few times a year.

There is a truly huge co-morbidity factor from those who have BP to ADHD. Most people with BP also have ADHD, in other words.

I hope that I have been somewhat helpful, although I have posted huge walls of text :o and I know how hard they can be on a person with ADHD. You feel free to ask questions and have a look around the Co-Ex conditions subforums. We have a great group of supportive members here with BP disorders, and we jokingly refer to ourselves as "The Cycling Team" or "The Cycle Club" :D. We share our stories, our information, our pains and our joys.

Best of luck to you, keep us posted and if you turn out to have BP of any type? There is always room for another member on the Cycling Team :).

adhdogwalker
06-26-07, 01:03 AM
Thank you Crazy Feet! I've been reading the forums a lot and doing lots of reading online. I actually mentioned some of this to my therapist today who I've been going to on and off for a number of years. She said my moodiness could be my ADHD coupled with my "brilliance." I don't feel this way (not today), but she also said that I was one of the most intelligent, gifted and creative people she's ever met and she thinks that I have a tremendous difficulty in harnessing and expressing it.

I had showed her some of my epic poem a few weeks back, but didn't tell her until today about the I was convinced that I'm going to win the Pulitzer Prize for it part. She also recalls the "I am going to be a dog clothes designer episode" from a few months back. There are many, many, other ones (all equally outlandish), but I can't remember them all now. Every time one of these episodes ends, she asks me how I'm progressing on whatever I'm doing and I tell her "Oh, I'm just taking a break. I'm so busy with work." But then I never pick it back up again. I usually have a huge irritable-frustrated period after these cycles, then am just tired and depressed for a bit. I notice that I tend to hide things from her as I have a tremendous respect for her and am generally not very open about my innermost thoughts.

When the conversation progressed, I told her about when I lived in Paris. I was supposed to study there, but I dropped out and wrote nearly 24 hours a day in my journals. I have a gigantic stack of them in my closet. This was one of the best periods of my life. I did nothing but that, then I would drink at night and go to sleep. I had no regular sleep schedule and lived in my imaginary world 24 hours a day. I used to take breaks and jog along the Seine and by the Eiffel Tower at 3 am. For some reason, I just stopped writing one day and did not write again for a long time. I ended up horribly depressed and moved back to NY to finish college, yet again. Anyhow, she didn't know about this episode and when I recounted it to her in detail, she just said "Oh."

There are a few others as well-- but I have freaked out for one reason or another and stopped going to see her a few times in the 8 years I've known her and she doesn't know about a good number of the extreme periods I've had in either direction as they've been at times when I wasn't seeing her. I've never told her about the time that I ended up at Bellevue (mental hospital in NYC) (long story).

Anyhow, she seemed to think that whether or not I'm Bipolar, it should be my choice if I take meds for it. When she asked me why I might not want to, I told her that I cherish the creative bursts, ie. hypomania, so much that I don't want to give it up. I just wish that I could maintain productivity when it does strike me and actually accomplish something.

I really feel as if the Adderall improves the quality of my life overall. It eliminates the extreme up and downs everyday, but does nothing for the underlying trends. If I am very hyper, it calms me. If I'm exhausted, it makes me only very slightly less (I was like this yesterday but still fell asleep 1 hr. after I took it). Furthermore, it seems to work well one day and then do absolutely nothing the next. When I take it, I can never predict when it's going to work and when it won't. Today, my thoughts were rather scattered and I had trouble organizing them. She said it should work everyday and I'm just not sure why it doesn't. I'm wondering if it's uneven because I am also. My theory of the moment- If what's happening in my brain chemically varies from day to day, then so might my response to Adderall.