View Full Version : A little confused because of my pdoc

06-24-08, 05:25 AM
I was diagnosed with Adult ADD back in Jan and my pdoc gave me Dexedrine which I've been taking since (approx 50mg per day). He has told me on numerous occasions that I have an anger disorder - and has put me on epilim/valproate as a result with a view to doubling my dose. I did so at the end of Feb with some very bad results - I was constantly anxious and bawling my eyes out about things that really I shouldn't have as a grown adult :)

Every time I go back to my pdoc for a followup appointment he tells me my speech is still not clear and I mumble hence the Valproate/epilim isn't doing its job. He's since prescribed me Zyprexa because he thinks I am bipolar now, and I take all three drugs daily including the double-dose of the Valproate.

Really the doctor doesn't elaborate too much but is definitly certain of my anger and mood swings which I do agree in retrospect I have had for a long time with a long depressive background and history of mental illness in the family (grandmother on my dads side was diagnosed with schizophrenia in the 40s). I am once again feeling anxious on the combination of all 3 drugs and wonder if I should lower my dosage of the Valproate because I really don't feel like I'm improved.

At work I'm anxious throughout the day and my mood swings probably 3-4 times a day. At home I feel withdrawn and just not myself and find it hard to express myself (more so than ever before). Maybe it's an awareness of myself as a person and wanting to communicate but not knowing how, along with a huge lack of confidence that I'm not sure how to handle yet.

I'm also feeling the "mental fog" returning and finding it hard to read for extended periods of time.

Anyway - back on topic - should I trust this pdoc? He has a LOT of experience and is one of only a few doctors that realise the existancce of ADHD in my home city so I'm loathe to change to another psychiatrist. He's been practising since the 60s.

What can I do to boost my confidence, increase my ability to read/learn and feel better about myself?

06-24-08, 07:46 AM
"Anyway - back on topic - should I trust this pdoc? He has a LOT of experience and is one of only a few doctors that realise the existancce of ADHD in my home city so I'm loathe to change to another psychiatrist. He's been practising since the 60s."

One thing to keep in mind - if you have been in practice a long time with false assumptions or a rigid mind when it comes to making a diagnosis experience doesn't matter one bit.

Out of curiosity..and maybe in me BP fog I missed it...why did you post this here. Do you suspect Bipolar disorder. If so I will let you know forme xperience that I was misdiagnosed by 6 different PDocs/Therapists (and quite a few as just ADHD) before receiving the correct diagnosis...and EVEn after that one or two of the people I had seen really had no idea what to do with a BP person.

06-24-08, 09:20 AM
Your doc is adding MORE drugs b/c you are having side effects to the first drug (dexedrine).

50 mg is a LOT of dexedrine. Even 15 mg/day made me an anxious, tense, panicked upset mess.

-=Stimulants can also make Anger PRoblems worse.=-

To add a mood stabilizer or two (serious drugs) to that, and then an antipsychotic is questionable.

Polypharmacy practice like this scares me.

I don't think Bipolar can be diagnosed if you are on speed, BTW.

Diagnosis and assessment [esp of something as SERIOUS as Bipolar!] really ought to be made when you are off everything. Assessment while on psychotropic medications skews the picture.

(Just as they will not diagnose depression in someone who is using alcohol regularly or in binges. All these things affect mood states and presentation!)

06-25-08, 04:59 AM
Hmmm..Thanks for the feedback you too. Should I go look for a 2nd opinion? I am definitly certain I'm ADHD - no doubt about that - but was suspect when he started saying he was sure I had anger and bipolar issues. I've put on a few pound since starting the Zyprexa too so I'm not very happy about that! :)

At present, having only recently doubled my daily dose of valproate, I'm really really touchy and have really had to hold myself back. In the space of a brief conversatioin I can very easily be vibrantly happy one moment and then turn into an emotional wreck inside the next. In all my life while I've been quite withdrawn and lacked confidence I have never had such clear visions of giving up and suiciding, which I can (just) control and keep things in perspective. So I know the medication is doing something.. I guess at the moment I've been too scared to judge the experience of a psychiatrist with 40+ years experience :(

There is another pdoc near where I live who specialises in ADHD. I might see if I can make an appointment with him soon.

06-26-08, 08:04 AM
IMO ( of course everything I write is only my opinion) you need a second opinion, but from someone who is familar with Bipolar disorder. Most effective PDocs will tell you that when there is BP and ADHD (like me as well) you MUST treat the BP first. ADHD will not lead you too suicide, financial ruin, dangerous sexual habits, anger that will hurt osmeone or land you in jail etc. (okay it might help with substance abuse, but the BP would win that race as well).

06-27-08, 01:55 PM
I'm kind of surprised that the Zyprexa is not helping you. Zyprexa from what I know is one of the gold standards of treating bipolar disorder. Zyprexa is approved by the FDA for bipolar maintenance. However, we all respond to medication differently. If depakote and zyprexa are not helping you, I'd suggest speaking to the doctor about it as there are several other medications that can be used to treat bipolar mood swings, such as Lithium, Tegretol, Trileptal, and Lamictal.

07-09-08, 01:50 AM
Thanks for the advice all. To date, I havent noticed any benefit being on the Zyprexa. If anything I'm probably more BP than I was prior and I've put a few kgs on. Great. I've been given a referral to another pdoc to get a second opinion but again like you say it's hard to diagnose when I'm already medicated.

I still have another month to wait for either the referred pdoc or the next appointment at my current pdoc... And I dont know hwo to handle that month.

The mix of medications (dexedrine, valproate and zyprexa) Im on is affecting my life adversely. I'm constantly anxious now - either if something is at the forefront of my mind or if it's a dull throb deep in the pit of my stomach there is always something to worry about. I get viscious mood swings and hate my job even more than I used to despite being given opportunities to improve the rut I'm in!! I'm working at one of the world's largest IT networking companies and yet nearly ruining my chances of any career progression due to lack of enthusiasm, poor performance etc. And my lack of self esteem or confidence means it's near on impossible to go and make new friends, find new opportunities, and a role I can do that I will start enjoying.

Somedays I feel burnt out by what I'm doing other days I have to go to the bathroom and just cry because I feel like I am wasting my life away and don't understand why nobody can see the talent I have within but that I'm too shy/scared/unable to express. We work from a typical office environment with shoulder-high cubicles and an open plan environment yet today I'm sitting in one of the little sealed rooms near the lift with tears streaming down my face and like most times I don't really know why. Other times it could be something minor I take way too sensitively or just an unrealistic fear that I've let get ahead of myself.

The only thing holding me together really at the moment is my partner of a year and a half who understands as best she can but she really doesnt understand the feelings that go on inside me because I cant express them.

I've pleaded for an earlier appointment with either of these pdocs... what next??

07-09-08, 01:13 PM
Do you also have a therapist? Some one who you can talk to about all this. Someone who understands mental illness and can listen to you with out judging you.

Or if you don't have a therapist, do you have someone you trust that you can go to. It appears to me that you have a lot of emotions/thoughts/past experiences that need to be released. They have built up inside you for a long time and need a way out. Sometimes writing in a journal helps me, but the biggest thing is being able to just get it all out of my head. Once I say it or write it down, it feels like its no longer mine. But until that point everything in my head is like "my precious" it eats away at me from the inside but I don't seem to want to let it go.

*hugs* I feel for you, and I hope that you are able to get through this transition smoothly.

07-11-08, 06:26 PM
Zoie --

I totally agree with your assessment.

Boxdog -- like a pp said, I would doubt a pdoc who would put you on a stimulant before stabilizing you on a mood stabilizer or the combo of mood stabilizer/atypical antipsychotic (like Zyprexa or Risperdal). It's like a recipe for rapid cycling, which sounds like what you may be experiencing.

Vaproate can cause weight gain and with Zyprexa that's a double punch.

A good therapist never hurts. I've seen three in the last 11 years and have come away better from each. Writing has also helped me a lot.

07-27-08, 07:40 AM
Hi all, its me again (I changed my nickname on here). Thanks guys for your ideas and suggestions. I have yet to see the new pdoc (appointment is on Aug 4 - followed by another visit a few days later with the original guy. I'm going to see if this new guy can replicate the original ones' diagnosis. In the meantime the original pdoc got me back off zyprexa and I feel a little less foggy now but still anxious. I spoke to someone else in a different state and he says he was diagnosed through two pdocs working together along with "a CAT scan" (I think he meant one of those scans in Dr Amens' book). I'll see what the new pdoc suggests.

I've knocked back the valproate to 1 twice daily and also reduced the dex from 10 down to 7 daily in the meantime..

A couple of other things that have helped the anxiety slightly is being able to have more open communications with my partner and also trying to find my spirtual side a litle better. The latter is probably going to take a longer period of time - but it should help. My partner and I decided that the biggest cause of my anxiety (apart from the possible side effect of the dex) is my own self-esteem, which I'm trying to work through by listening to an audio book at the moment and just stop comparing myself to other people (mostly at work) all the time.

What I need to constantly remind myself because I always forget is.. so what if I'm not as smart, accomplished or fantastic as other people? THe good news is I have a job, I'm at a great company, and surrounded by people who would be happy to support me (I think) if I just had the confidence to open up with them more.

Still a hard thing to go by on a daily basis.. :(

07-27-08, 01:33 PM
If the diagnosis does turn out to be some type of mood disorder, it's not easy to live with. It's been 3 years and my pdoc and I are still searching for the right balance of medications that will help me get better. I seem to be in a good place right now with Abilify as a mood stabilizer and Cogentin to manage Abilify's side effects (I get akathesia (inner restlessness)). My pdoc sent me for a 2nd opinion after this long trial of medications and trying to find out what is causing my symptoms. The 2nd pdoc found that my anxiety and bipolar symptoms were being aggervated by my asperger's, so he is treating that with the Abilify as well. (One med for 2 problems).

Remember that there are other medications that can be tried if your current meds aren't cutting it. I've been on many medications. It never hurts to get that CAT scan and see if there is anything that can be derived from that. I had one done and was told it came back normal.

It will take some time and work on your part to help make things better. Do you see a therapist? My doctor is working on getting me one at the counceling center I go to. Seeing a therapist could help you channel your emotions.

The one main thing is to not give up. I'm sure in the end you will find the right set of medication and therapy that will work for you.

I wish you best of luck,