Dodgy diagnosis? (long rant/post)

[tribalsushi]

Hi all,

I just had a bit of a dodgy diagnosis from a psychiatrist, and I want to just vent a little, and maybe get some advice.

I'll just warn you now, this is a VERY, VERY long post -- alot longer than I intended -- and it was more for my benefit, to get my feelings out -- but I'd be delighted if people had anything to share with me after reading it.

I've suspected that I've had ADHD for a few years (I'm 25). I've always quite been relatively bright, but I've done quite poorly at school since the time that I was about 7. I was always (and I mean always) losing or forgetting homework; letting my room get into a mess; I had a bad temper as a child; I used to talk and wander about alot in class, etc. I've also always had trouble falling asleep -- my internal monologue has always been very chatty -- though this has gotten better somewhat in the past three or four years.

As I got into high school, the hyperactive side of things died down a little -- less wandering around and the temper went away a bit -- but I was still hopelessly disorganised, rarely got work done on time, and had (and still have) a tendancy to start projects and never finish them. I always knew I could do well -- I would occasionally, due to fear of failing or genuine enthusiasm, excel in a subject for a term or two, before returning to mediocrity. I revisted my high school a few years ago, and commented how I had trouble getting things together at college -- he commented, "That's sort of the story of your life".

(I recently dug up some of my old school reports -- about half of my teachers commented 'well done!' for classes I never remember studying for, while the others commented 'fails to apply himself').

I was diagnosed with depression at about 17 years of age -- I had a bit of a crisis of sexuality which seemed to trigger something a bit deeper in my brain chemistry -- and have since then been prescribed a relatively medium dosage of a widely used SSRI by my family doctor. I've tried tapering off gradually in the past (under my doctor's guidance), but once the dosage passes a certain point, I tend to get depressed and aggressive. There is a history of depression in my family, so I've always supposed it's just an ongoing biological thing that's not caused by situational factors.

At college, I switched concentrations four times, deferred twice, failed several units, though only once through lack of ability (I never was very good at maths); all the other times due to persistent general failure to do ongoing study (despite interest in the subject), and took an extra two years to complete my degree. I could sometimes excel at subjects -- again, either through genuine (though usually short-lived) enthusiasm, a combination of periodic enthusiasm and the fact that I found the course material easy, or through well-timed short bursts of study (I once wrote up a summary of a 1000 page corporate law textbook in two weeks over summer, did not go to a single class during semester, immersed myself in the material for two days beore the exam, and got 80% for the whole class. To this day, I can't remember the first thing about corporate law.).

At university, I immersed myself in extracurricular activities. At one point, I had a full study load, was working 25 hours a week, held a position on the student representative council, volunteered at a homeless shelter, and went to Mass four times a week. I found this stimulation quite natural in many ways, though due to my hectic lifestyle I wasn't eating or sleeping properly, and would burn out to some extent, so I would cut off various activities.

My shame at the spottiness of my academic history from college made me decide -- before I had even graduated -- to take up another undergraduate degree by distance once I'd finished this one (I was also working full-time). I figured my first undergraduate degree was completely useless, and noone would hire me, given how hit-and-miss my grades were. This new degree actually started before I graduated, so at one point I was working full-time, studying for my final exams at one college while starting another degree (by distance) at another college. But after the first semester of this new degree, despite the genuine interest in the topic matter, I was too disorganised to do more than intermittent reading of the course material, and I failed to complete any further units.

I have a tendancy to plan and make a start on grand projects -- learning another language (the only subject I have ever maintained a real ongoing interest in was Japanese), starting a new fitness program, fixing up the garden, and so on and so forth. These projects always go along swimmingly for two to five weeks, before petering out. I have only had a few interests in my lifetime that have lasted for more than a few months.

I also find it immensely difficult to get the daily mundane tasks done -- doing the dishes, cooking dinner, doing my laundry, paying the bills. To this day, I mainly eat out or live off of TV dinners, and wash and hang out my work clothes the night before (or even worse -- pick up yesterday's clothes off the floor, quickly iron them and wear them to work).

I can, occasionally, hyperfocus on some things -- more than once, I've had a colleague knock on my office door to let me know it was time to go home, when I'd realised I'd been playing around with a spreadsheet for four and a half hours without a break.

The Internet is another great source of hyperfocus for me, especially Wikipedia -- the endlessly interlinked articles provide an enormous source of stimulation, while accommodating my impulsivity. You start reading an article -- you see a link to an interesting keyword -- you open the article about that keyword -- you see another interesting keyword, etc ... At one point not too long ago, I had no fewer than 73 Wikipedia articles open in my browser, and spent 13 hours reading Wikipedia continuously, eating in front of the computer and with only short toilet breaks.

(Unfortunately, I don't actually absorb that much in-depth knowledge from the articles on Wikipedia. It seems to be more the massive inflow of information that stimulates me, and I come away with a very surface level of knowledge, if I really remember anything at all.)

I bear quite a large guilt complex due to all of this. I've always been fairly bright, and have been able to grasp new ideas and learn new materials very rapidly -- when I'm inclined to. Try as I may to 'get things together' -- to somehow have a functional life, with proper discipline at work/school, with my weekly chores done, apply myself to a fitness program, and get into a relationship without getting bored -- things just don't happen, and I don't know why. I can't focus on anything for any period of time (with some exceptions), and I feel like I'm massively underperforming, given my potential. I've often put it down to a moral failing, to a lack of 'industry', 'hard work' or 'character'. I find it very uplifting in many ways to read books about people who have worked hard and made something of themselves -- mainly because I want to be like them, because I feel like I have that capability -- but in the end they always remind me of how little I've achieved and how far short I've fallen of my potential.

So when I started to read more about adult ADHD, and especially when I read 'Driven to Distraction', I figured I should get screened. Given my background above, I think it is very possible that I have some form of ADHD, though maybe not a particularly severe kind. I don't want to self-diagnose, as that can be very dangerous; in any case, it's something I want to have looked at by a medical professional.

I contacted the local ADHD support group; they recommended a certain psychiatrist (let's call him Dr X). I approached my doctor; he seemed somewhat sceptical about Dr X -- mentioned something about a tendancy to overdiagnose ADHD -- and referred me to different psychiatrist (let's call him Dr Y).

I didn't get around to calling up Dr Y until a few months later; I booked an appointment, but I would have to wait a further two months before I could see him. Not too long after, I was talking to a colleague, and he revealed to me that he had recently been diagnosed with ADHD -- though he had some reservations about the whole thing. His psychiatrist turned out to be Dr X. He said that he was a bit uncomfortable with this doctor, for a few reasons:

• The doctor diagnosed this person's entire extended family with ADHD, even though there were some members he doubted actually had ADHD
• The doctor offered a prescription for Dexedrine, but did not really offer any advice about taking it -- eg contraindications etc. There was a nominal dosage on the prescription, but he said just "take them whenever you feel like it."
• The doctor also carried out Eye Movement Desensitization and Reprocessing -- see http://en.wikipedia.org/wiki/EMDR for more info -- on all of his family members, apparently because it was obvious to Dr X that they were suffering from unprocessed traumatic memories, a mild form of PTSD (though none of the family members had presented as such).

All of this sounded a bit odd. However I asked around amongst a few friends and colleagues, and some reported that they themselves (or knew someone who) had gotten the same treatment from Dr X -- almost instant diagnosis of ADHD, a quick session of EMDR to treat apparent PTSD, and quite indiscriminate handing out of a prescription.

I was starting to get more and more impatient with having to wait for my appointment with Dr Y.

I'm quite embarrassed about this part, because I know it is illegal, though I think it was worth it in the end -- I managed to get my hands on a few tablets of Dexedrine. I tried them out at work one day, and I found them very effective -- I was able to concentrate alot better on my work, I jumped from task to task less, and my internal monologue was less chatty.

It was at this point that I decided I would contact Dr X and see if I could get an appointment earlier than the one I had with Dr Y. I figured I would get my medication and I could start living my life -- seeing as the Dexedrine had been so effective.

Well, this I did -- I called Dr X's offices, and got an appointment within a week. I attended, and had a bit of an interesting experience:

• I took with me my referral to Dr Y, on which my doctor had (wisely) written down the details of the SSRI that I am taking. The first thing Dr X said when he saw it was "Oh God, you're on [insert SSRI name here]? I'll have to get you off that." I later remarked that I had been on them for several years and I felt that they had worked; he retorted that "Well you wouldn't know if they didn't work, would you?". He never asked if I'd tried going off them or tapering down the dosage.
• There was an almost instant assumption that I had ADHD. One of the first things I commented on was the fact that I had taken a while to make an appointment, and Dr X said "Well of course, you have ADD."
• Dr X took down my basic details, and started to go through a bit of a family history. One of his first questions he asked, and I quote: "So which of your parents has ADD?" (Note: noone in my immediate family has been diagnosed with ADHD). Dr X also 'diagnosed' one of my siblings based purely on that sibling's current job.
• Dr X never asked me about my childhood, my academic performance, my personal life, etc. I volunteered some very limited information about poor academic performance and disorganisation (this was also on my referral, but there were no details and there was no more than two lines or so).
• Dr X never went through any of the criteria in the DSM-IV or other diagnostic manuals (at least not in any explicit manner).
• Dr X then started asking leading questions about any 'traumatic memories' I had:
  • Dr X held out his arms, asked me to look closely at his eyes and tell me whether his arms were shaking. Of course, a person's arms shake slightly after being held out for more than 15-20 seconds, so after 15 seconds or so I commented yes, your hands are shaking. I indicated with my hands how they were shaking (about half an inch up and down). He stated that this was evidence that I had some unprocessed traumatic memories.
    • I had not mentioned any trauma, or any symptoms resembling PTSD (eg persistent re-experience of a traumatic event)
  • After a few repeated promptings from Dr X for any traumatic incidents I may have experienced, I related a rather unremarkable (and in retrospect humorous) bullying incident I had experienced in grade school.
    • Again, this was not a particularly traumatic memory, and I only raised it because I couldn't think of anything else. Like most people, I've had my ups and downs in life, but I've never had anything particularly traumatic happen to me (car crashes, watching someone get killed, etc.), or even any particularly unpleasant or regrettable experiences that I didn't get over after a month or two at most. As far as I know, I don't have any memories that are still particularly distressing -- not even any from the worst periods of my depression.
  • He then carried out a brief (five minute) session of Eye Movement Desensitization and Reprocessing, until I stated that I couldn't really remember the particular bullying incident.
• Dr X then said he would have to write me a script for some Dexedrine. I was given a two months' supply, with a quick run-through of a fact sheet on Dexedrine (I didn't get a copy).
• Dr X also gave me a 'fact sheet' on ADD. I don't have it with me (I left it at work), but I read it briefly on the bus. It struck me as rather suspect -- it suggested that around about 20% of the world population has ADD in some form, and that symptoms can emerge at any age, and that they can readily be treated with ADD meds.
  • These claims are questionable because:
    • As far as I know, the general consensus is that ADHD affects around 3% to 7% of the population.
    • Symptoms don't develop after childhood, except possibly in the case of brain injury.
    • Not all cases of ADHD can be treated with medication. Some people have adverse reactions; some people don't get any benefit out of medication. Newer medications, like Strattera, might offer hope for some of these people. Medication alone isn't always a fully effective treatment either. It's disingenuous to suggest that ADHD can be 'readily' treated with medication.
  • I didn't read into it that deeply -- and I left it at work, so I can't say for sure -- but I remember it stating that 'ADD' isn't a disorder, and suggest another name for ADD, using the same initials.
  • There were no references or sources listed on the fact sheet (that I saw -- once again, I didn't read it exhaustively).

So I paid my bill and went and got my script filled. So now I have a few months' supply of a controlled substance after a very odd 1 hour session with a psychiatrist.

Maybe if I hadn't heard about the process from other people -- the almost instant diagnosis, the EMDR, etc -- and hadn't read up about ADHD in general, I wouldn't be so sceptical. However the whole experience seems incredibly dodgy to me.

I would have expected the following:

• Psychiatrist asks why I have asked to be screened for ADHD; I describe symptoms (eg disorganisation, poor academic and work performance).
• Psychiatrist administers diagnostic questionnaire or goes through detailed questioning process
  • Psychiatrist also makes sure that symptoms first presented in childhood
• Psychiatrist compares answers against DSM-IV or other suitable criteria
• Psychiatrist possibly asks for supporting evidence -- school reports, asks to speak to parent or family friend who
• Psychiatrist possibly checks for co-morbid conditions or other medical problems that could cause similar symptoms (thyroid problems etc.)
• Psychiatrist makes diagnosis, discusses treatment options (counselling and therapy, medications, alternative treatments), and possibly suggests another medical professional if I would like a second opinion
• Psychiatrist and I discuss and agree on treatment process.

Maybe this is a bit too idealistic -- medical professionals are very pressed for time, and other people have written on here about relatively fast diagnoses they've had -- but I thought the psychiatrist would at least ask some details about my symptoms before diagnosing me. I gave maybe 30 seconds of background and description of my symptoms -- without being prompted Dr X, and only because I thought he should know. Dr X himself never asked about my symptoms except tangentially (eg asking which family members of mine had ADHD)

The whole EMDR thing seems completely out of left field for me. I didn't present with any symptoms of PTSD or similar conditions; I didn't volunteer that any traumatic conditions had occurred. A questionable 'test' was administered -- try holding your arms out for 30 seconds without them shaking up and down a little bit -- before engaging on a treatment that might have some scientific merit but which was, in my opinion, completely unnecessary.

But the thing that I'm p*ssed about most is the fact that Dr X completely discounted the SSRIs I'm taking. SSRIs, used properly, are generally accepted in the medical community as safe and effective. I've been on these medications for 7 years, and I am not exaggerating when I say that they probably saved my life. I was suicidally depressed for about nine months before starting on them; while they are no 'silver bullet', and I still battle the occasional bout of depression, they have immensely improved my quality of life. While I understand that some co-morbid conditions can have the same underlying cause, and so treating one can fix the other -- so if my depression was caused by my ADHD, treating the ADHD would fix the depression -- Dr X did absolutely no investigation into the possibility that they are two separate co-morbid conditions with different causes. Remember, this was the FIRST thing Dr X said to me, before asking me any questions.

I feel like the whole diagnosis I've received is a sham. I think I might have ADHD, and I think there's a real possibility that diagnosis and treatment could improve my quality of life -- but I feel that this particular diagnosis from this particular doctor isn't the way to go.

I will go and see Dr Y and see what happens. I am scared that he will refuse to diagnose me with ADHD, which leaves me at a bit of a deadend -- I identify quite strongly with alot of stories I've read of adults with ADHD, and I have tried Dexedrine with some success. Once again, I don't want to self-diagnose, but I'm starting to conclude that my quality of life would be improved with some ADHD medication, behavioural therapy and some coaching.

I don't want to go back to see Dr X -- I get a creepy feeling from the whole thing, and the only reason I would go back is for more medication. I don't want to have to go through a medical professional who I don't trust, but if he is the only 'gatekeeper' I have access to, I might have to. The town I live in isn't too big; there might be other psychiatrists I can see, or I can go to a larger city nearby, but the organisational hoops I've jumped through are enough of a challenge already.

Well this is a very, VERY long post -- my apologies for you poor people who had to read it . Which brings me to another point -- the only way I've been able to write something like this is by taking the Dexedrine I was prescribed by Dr X -- which I am inclined to keep taking, but given the dodgy diagnosis I received, it almost feels like cheating. I've noticed the feeling is a bit more 'muted' compared to the first time I took them, but there is a definitely noticeable difference. Part of me thinks that, even if I don't get diagnosed with ADHD by Dr Y, and I don't go back to Dr X, that by getting my hands on some Dexedrine, I've gotten lucky and might be able to get some order into my life, even if only for a month or two. It's early days though, and time will tell, I suppose.

I feel in many ways like I'm really alone -- the only people I know face-to-face who have been 'diagnosed' with ADHD have been diagnosed by Dr X, and people I speak to are generally incredulous when I say I think I might have ADHD, because in many ways I seem somewhat together. After all, the general public perception is that ADHD is something that kids who have had too much red cordial have, and it's not something that adults have, least of all adults who have actually gone to college or have a job.

Though in many ways I seem "with it", the people who know me best know my life is pretty chaotic in alot of ways -- though they mightn't realise the full extent of it because I'm pretty careful to try to hide my failings and my shame. I still feel in many ways that maybe I'm just trying to avoid responsibility for failures in my life by trying to hide behind ADHD, and I just need to "suck it up" and start working harder (despite all the times I've failed in the past), but in reading about adult ADHD I can see a glimmer of hope, which gives me some comfort -- even if it proves to be a false glimmer.

Most of this post was a rant -- I wanted to get everything out, from my background to how I got to where I am right now -- but if anyone has any advice I'd be more than happy to listen. I am more than content, though, to be able to vent to a community that (hopefully) can relate to my story a bit.

Can anyone relate to my background? Is it possible that I have ADHD, or am I just lazy (or something else)? Has anyone else had an experience with a doctor like this? And if so, did you go back? And finally -- do I keep taking the Dexedrine I've been prescribed by Dr X??

Cheers -- and thanks for reading
-tribalsushi