Dysthymia and Social Phobia or ADD Inattentive

[JDog]

Ok, I've been diagnosed by two different psychologists - one diagnosed me with dysthymia and some moderate social phobia, while the other diagnosed me with ADD inattentive type. Now, it's not clear to me if the ADD inattentive type is the cause of my depression and anxiety around others, or if my depression causes the symptoms of ADD. I'm not sure it really matters anyway.

I've gone the CBT route and have definitely benefited from it, but I feel that it hasn't been able to help everything so I decided to try prescription drugs to fill that gap. I was prescribed Paxil, and it worked pretty well, except for the weight gain, which is why I stopped it. I've tried Ritalin but didn't like how it made me felt. Currently, I'm taking Adderall, but I'm uncomfortable about its neuro toxicity, and am wondering if I should even be taking ADD medication if I just have dysthymia.

My question is if anyone has any good ideas of a prescription(s) that could help me. Is there anything new out there I should consider?

 

[David Baxter PhD]

There are several alternatives for medication but to some extent (though not entirely) it depends on the accuracy of the diagnoses.

Individuals with ADHD, especiall if it has gone untreated during the school years, often do end up with secondary depression and/or social anxiety. On the other hand, the symptoms of either depression/dysthymia or anxiety disorders include impaired concentration and memory.

Do you know what the diagnoses were based on? i.e., did you have any psych testing or was it just based on clinical interviews?

What are your concerns about Adderall based on?

 

[JDog]

I'm not necessarily looking for an alternative to medications, as I've already looked into that quite a bit. I'm looking for alternative medications to the ones which I've already taken.

I spent 2 years doing counseling with a grad student at my colleges psych clinic. I think the counselor was pretty sensible and had a good head on her shoulders. She was the one who "diagnosed" me with dysthemia and social phobia. She didn't think I had ADD even though through my research, I found I had a lot of the symptoms. I think she was just uninformed about the different types of ADD which are out there because she thought it was necessary that I have hyperactivity. Perhaps it's just a school of thought in which some psychologists don't recognize anything but ADHD.

A couple years later, since my problems weren't going away, I went to see a psychiatrist at a veterans hospital (I'm prior service). After telling him my probelems he asked me if I ever considered that I may have ADD. I exclaimed to him, YES I HAVE. So he told me to go get what is a comprehensive psudoeducational evaluation (the official name of the evaluation). I can't quite remember, but I think I paid around $500, so it was definitely indepth., and also took 2 days to complete She diagnosed me with: ADHD, Inattentive Type, and a math learning disorder.

My symptoms have been poor working memory, poor long-term memory, poor hearing (but my hearing was tested and it was found just fine), difficulty tracking conversations, general deperession (dysthemia I guess), trouble following directions, trouble comprehending what I hear, difficulty focusing attention, making careless mistakes, and below average grades in school.

As far as the adderall, let me get back to you on that.

There are several alternatives for medication but to some extent (though not entirely) it depends on the accuracy of the diagnoses.

Individuals with ADHD, especiall if it has gone untreated during the school years, often do end up with secondary depression and/or social anxiety. On the other hand, the symptoms of either depression/dysthymia or anxiety disorders include impaired concentration and memory.

Do you know what the diagnoses were based on? i.e., did you have any psych testing or was it just based on clinical interviews?

What are your concerns about Adderall based on?

 

[David Baxter PhD]

All right. It seems that the ADHD Inattentive Type is credible and evidence based, then. The fact that you got a different diagnosis from an inexperienced graduate student isn't all that surprising... she may well have been a nice person with a good head on her shoulders but as a graduate student she definitely lacked experience in diagnosis. Indeed, since she was not a licensed psychologist, in Canada she would not legally have been allowed to diagnose.

That doesn't mean, however, that you cannot have both ADHD and social anxiety and/or dysthymia/depression.

 

[JDog]

The only thing I know about adderall's possible toxicity is from:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

I don't know if ADHD is your field of specialty, but could you make any suggestions on a type of medication I should look into considering the problems I listed?

 

[David Baxter PhD]

I didn't find anything specific to neurotoxicity there. I do recall a year or so ago some concerns about the newer medications to treat ADHD, however, and this led to the suspension of one of those medications by Health Canada - that medication was later reinstated, if I recall correctly (Concerta?).

I think if this medication was prescribed by your physician, you should probably be guided by his/her advice (if you think you have reason not to trust that doctor, you should find one you do trust).

For individuals correctly diagnosed with ADHD, Adderall is probably a good medication to be on but it won't necessarily manage all of your symptoms if there is anxiety or depression present as well.

I would suggest two things:

1. Have a talk to your doctor about the depression and anxiety you feel. Does the Adderall have any effect on these symptoms? Does it make it better or worse? It may be helpful to look at adding in or changing medications depending on the answers to those questions. There are many choices now.

2. I believe you mentioned that you had two years of counseling with a graduate student which included CBT, but she didn't believe that ADHD was a problem. Perhaps, it might be worth trying again with another therapist now that the ADHD has been diagnosed.

 

[JDog]

I'm glad I thought of checking back on this forum to see if you responded. The reason I didn't check earlier is because I never received a reply notification e-mail, like I did for your last posts. And all this time I thought you didn't want to talk to me. Haha.

Well, perhaps that wasn't the right link to pubmed I gave you. If my memory serves me correctly, the test it detailed showed a potential neurotoxicity in rats. I'll be glad to find that study if you're interested.

I believe the drug that was temporarily banned in Canada was actually Adderall. A source: http://en.wikipedia.org/wiki/Adderall

I've been on Adderall for about two months now, but as of late, it doesn't seem as though it's working like it used to. I've read about people going on "drug hollidays," but didn't think it would be something I'd have to do so soon after starting it.

In response to your suggestions, I have spoke with my doc. about the depression, etc. last time I saw him 2 mo. ago, but he wanted me to see how I did on my new adderall perscription. I'm almost confident he'll suggest perscribing me another anti depressent. I really don't want to go on another one because of all the side-effects they have. By the way, I have been on Wellbutrin for the past year or so. I'm not so sure I notice anything from it, but I take it because my doc says it's a good idea.

What do you think of modafinal (provigil) in place of adderall? From what I gather, it's not a traditional stimulant (which is good, I think), does everything adderall does, and has nearly no side-effects unlike adderall. I know it's marketed as a perscription for narcolepsy, but that doesn't change its value.

As far as more therapy goes, I guess it wouldn't be a bad thing, but I'm not so sure I need anymore. Additionally, I could see how it could create more internal dialogue like I used to be plagued with, which is one thing I really don't need.

 

[JDog]

By the way, for what it's worth, I don't have the H in ADHD.

 

[David Baxter PhD]

What do you think of modafinal (provigil) in place of adderall? From what I gather, it's not a traditional stimulant (which is good, I think), does everything adderall does, and has nearly no side-effects unlike adderall. I know it's marketed as a prescription for narcolepsy, but that doesn't change its value.

I'm afraid I have no knowledge of the use of that medication for ADHD. Best to discuss this with your physician.

By the way, for what it's worth, I don't have the H in ADHD.

That doesn't necessarily mean that stimulants or newer medications such as Adderall can't be helpful. It's also often the case that ADHD individuals themselves don't notice much difference on medication - but those around them see a clear difference in behavior and focus.

 

[Retired]

Information on PROVIGIL (modafinil) is available in this Psychlinks posting.

 

[JDog]

Thanks for the link TSOW.

I think I have finally been able to pigeon hole the exact type of ADD I struggle with: Sluggish Cognitive Tempo (SCT). It's a descriptive term which is used to better identify ADD Inattentive type.

For years I've been trying to pinpoint and catagorize the cognitive difficulties my father, his brother, his brothers sons, and I have delt with in our lives. If you're interested, this article accurately describes my problems:

http://en.wikipedia.org/wiki/Sluggish_cognitive_tempo