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Getting Dx-ed Any Advice?


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Various people in my life have suggested at various times that I might have inattentive-type ADD.  Reasons?  Well, there was I guess the phenomenal absent-mindedness: I lock my keys in my car with it still running at least once a year, I've been known to walk into lampposts, I lose all manner of things--keys, glasses, pdas, my crutches, I forget appointments, holidays, what I'm doing at any given moment, etc, etc.  And There was my general messiness and lack of organization (piles and piles everywhere). There was my general "zoned out/off in my own little world" countenance.  There was my weird attention issues: when I am focused on something that does hold my attention, I become oblivious to all outside stimuli, to the point that as child I was tested for deafness b/c my parents and teachers were alarmed by the fact that when I was playing or reading I wouldn't hear them speak/yell at me at all.  And there was my general underachievement in school, life, etc., which had this odd characteristic: often the more easy a task was, the more likely I was to fail at it.  On tests I scored grades above my level, but I often got B's and C's because I couldn't make myself focus on finishing class busywork.  I couldn't hold a job as a store clerk in colleges, but ran an academic conference.  My grade average in high school was a B+, in college an A-, in grad school 4.0.  You know what I mean?

Anyway, I didn't want to have ADD, so I ignored this stuff until a year ago, when I read some Sari Solden books and was blown away by how much I related to it.  I've had life-long major depression, and the only  times I've ever felt in control of my ability to focus was when I was on a really stimulating AD: a tricyclic for a while in college and Wellbutrin for a while in grad school.  Meanwhile, SSRI's have never done anything for my depression, or for my ability to control my concentration. 

But when I went to my pdoc she went off on a rant about how there was no way anyone who could get Ph.D. could have ADD.  And she flatly refused to prescribe any stimulants.  My pdoc was generally very pro-serotonin; even before the whole ADD thing I was convinced my issues were more dopamine and norepinephrine related and I could never really get her to agree, but....anyway....

She finally agreed to let me try strattera, since the Wellbutrin had pooped out and we were trying to find something to replace it.  But I couldn't tolerate the side-fx and since then the whole thing's been tabled.  (and now I'm living in the UK and don't have health insurance or a pdoc)

I still feel really convinced that there's something to the ADD-thing, and it's interrelated with my depression.  Does that make sense?  How have other people gotten official dx's?

Shelley

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Various people in my life have suggested at various times that I might have inattentive-type ADD.  Reasons?  Well, there was I guess the phenomenal absent-mindedness.... There was my general "zoned out/off in my own little world" countenance.  There was my weird attention issues: when I am focused on something that does hold my attention, I become oblivious to all outside stimuli.... And there was my general underachievement in school, life, etc..... My grade average in high school was a B+, in college an A-, in grad school 4.0.  You know what I mean?

This is me, right down to the grades:  B+ in high school, A- in college, 4.0 in university.  (No grad school for quite some time yet, but you get the idea.)  Zoning out is definitely an issue, I've twice lost the keys to my workplace, and coworkers generally think I am exhibiting the aftereffects of some recreational drug. 

But when I went to my pdoc she went off on a rant about how there was no way anyone who could get Ph.D. could have ADD.
I don't have a PhD, but I still think she's wrong.  A common theme in inattentive ADD literature is that of mis- or non-diagnosis:  the more intelligent the sufferer, the less likely they were to be diagnosed, simply because bright people are more able to hide or compensate for their deficiencies.  But then, you've probably read this already.   

And she flatly refused to prescribe any stimulants.  My pdoc was generally very pro-serotonin.

Beware any practicioner with their own little pet hobbyhorse.  If they are incapable of recognizing multiple causes of illness and insist on only one narrow sliver of treatment options, by and large they cannot be far trusted.  It's like going to a GP who insists that every illness involving coughing is just a common cold, deliberately oblivious to bronchitis, pneumonia, emphysema, and certain varieties of asthma. 

I still feel really convinced that there's something to the ADD-thing, and it's interrelated with my depression.  Does that make sense?
Perfect sense.  Many ADDers suffer from depression, certainly at a higher rate than the general population.  Maybe there is some common neurological mechanism, or maybe ADDers become depressed from never being on the same page as others, always struggling to keep up in one area or another, frequently failing, but there is a link.  Perhaps someone else here is aware of an article which explains this more clearly. 

How have other people gotten official dx's?

Through perseverance and pressure tactics.  Well, not exactly.  When I was first assessed at the psych hospital, I said, right off the bat, "I think I have some form of bipolar disorder and inattentive ADD."  The panel agreed with my bipolar self-assessment, but declared I couldn't have ADD because I did too well in school.  Surely any attention problems were caused by the bipolar -- completely ignoring the academic difficulties I'd experienced since at least the first grade. 

Thus we proceeded with the treatment of my bipolar disorder for many months, my pdoc convinced my ADD symptoms would disappear with enough lithium, me insisting that, if anything, they were becoming worse.  Three months into this game, she finally agreed that I could be right and had me added to the neuropsych evaluation waiting list.  I'm still waiting. 

A couple of months later, my pdoc (a resident) left and I was turned over to the supervising practicioner.  This was right around the time I had to have medical certificates completed for school.  My disabilities office academic advisor said specifically that one psychiatric disorder would likely be disregarded by the evaluating government official, but that two stood a chance of getting me the financial aid I needed.  I related this to my current pdoc, who evidently decided there was enough evidence of ADD to accede to my request and write Bipolar Disorder/Adult Attention Deficit Disorder on the form. 

Am I happy with the thin basis on which my BP and ADD diagnoses were made?  No -- but it's led to helpful bipolar treatment so far, and may in the future help make my ADD more manageable.  I'll roll with that.

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Hey Shelley,

What you say sounds reasonable to me. I share many of your symptoms, tho usually if I leave the keys in the car it's not running. Also, in old days when cars didn't make noises at me, I used to leave the lights on. (Suggestion: carry an extra car key by itself in your wallet.)

Anyway, many of your experiences sound like mine, tho even in challenging courses I couldn't pay THAT much more attention, and where I went to school you really had to. My tdoc at first was sure I didn't have it when she heard the name of my alma mater, but then pdoc suggested it and that, together with the fact that it took an extra 10 years to graduate, convinced her. In my case I could get by paying attention less than half the time in public school because it was so trivial. Anyway, I didn't go looking for an ADD diagnosis, but when my depression lifted (Prozac) and I was still a space case, my pdoc decided I had it. It may help to write a note to your pdoc listing any and every relevant symptom and/or contributing factor you can think of all squashed in. Or maybe not in your case.

Generic stimulants can be pretty cheap, at least in the USA, altho a monthly visit to a pdoc isn't cheap.  They can also make life interesting, and not always in a good way. But for me, it's worth it.

Some people (including me, based on one experience) say Sudafed (pseudoephedrine, I think) is good for ADD, but I'm not at all sure I'd want to take it very often. Nasal congestion on rebound might not be too fun.

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