Expert: Ivan Goldberg, M.D. - 12/1/2008

Question
Hi, Dr. Goldberg.
I am 23 years old and was diagnosed with A.D.D. my freshman year of college. Since then, I have been diagnosed with what seems to be the "DSM Code of the week" more specifically, Dysthymia, Cyclothymia, random mood Disorders, etc. Thus, I have been given several SSRI's to try (to no alas, other than icky side effects)and have been prescribed every A.D.D. Drug out there, only to become resistant and have my  original baseline be more tolerable/functional than a day on 60+mgs of Adderall.
One psychiatrist suggested a mood stabilizer (I am apt to think I am more Bi Polar than Cyclothymic at this point, but am also dealing with a lot of stress, and the loss of a parent, the ADD Symptoms that seem to have taken over my life, etc...) but I am afraid of the effects. It is a scary thought (in my opinion) to take an anti-convulsant when you are extremely sensitive to medications (horrid side effects from Wellbutrin, Lexapro, Concerta, etc. I do NOT seem to tolerate medications very well at all! I was given Seroquel to sleep, and slept for 28 hours on 1/16th of a  100 mg.pill!!!!)
Being a social worker, I am perhaps over-cautious with my opinions on medications, but seem lost. My mood is ALL OVER THE PLACE, and so is my life. I can't find my keys, I forget things within seconds (even mid-sentence)and am barely functional at this point. I can't attend to anything, and am sad and irritable more days than not. I am not sure what to do at this point.I also think that it is hard to decipher what is stress, what is grief, what is ADD, what is BiPolar.. and which symptom relates to what!!!! I do not want to be given the "drug of the week" or passed off as a "treatment resistant case." There has to be SOMETHING for someone with ADD and Cyclothymia, right? Are anti-convulsants really the answer??? I am so afraid of even the idea!
Any help or suggestions would be so appreciated. I refuse to believe that I have to live like this... I don't accept that answer for my clients that are struggling, and I don't want to for myself now, either.
Thank you so much for taking time out to help.
Sincerely, Kathrine

Answer
Hi Kathrine . . .

The relationship between ADD and bipolar disorder is not well understood. In some people what looks like ADD is really the earliest manifestation of bipolar disorder. In other, ADD and bipolar disorder are both present (comorbid to use the technical lingo). Calling a disorder 'cyclothymia" is usually just another way of saying that someone has "soft bipolar" disorder or that they are someplace on the "bipolar spectrum."

It would seem that the first ting you need is a solid diagnosis. You might print out the bipolar screening questionnaire at:
http://www.psycom.net/depression.central.bipolar-screening.html
and take the completed questionnaire with you when you seek a second opinion. Such a second opinion should be with a psychiatrist with greater than average excellence in diagnosing and treating people with mood disorders. You can find a list of such psychiatrists at:
http://www.psycom.net/depression.central.psychiatrists.html

If it is decided that you do have a disorder in the bipolar spectrum treatment with a mood stabilizer, rather than an antidepressant, would initially make sense. I usually start people with stories similar to yours on either Lamictal, or Trileptal.

Best regards . . .

Ivan
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