Posted by katekite on July 15, 2002, at 9:23:10
In reply to Re: What is going on with me? Long story...Kate, posted by Noelle on July 14, 2002, at 22:06:30
I guess my thinking is this (and this does not apply to major depression, just dysthymia and less urgent problems):
1. anti-depressants can screw up ADD testing by working in a stimulant way (especially prozac, wellbutrin, maybe remeron in high doses, maybe serzone in high doses) and all ADs will reduce the behavioral problems of ADD so can mask it to some degree. If someone is on antidepressants and tests not ADD, are they really not ADD or are the antidepressants just masking it? Since we all mostly get evaluated for ADD just once or twice in our lives, it ought to at least be a fair evaluation.
2. For someone who is not bipolar, stimulants can be extremely effective antidepressants. So if ADD and depression co-exist, one drug sometimes can effectively treat both. Better to find out first than to by trial and error add a stimulant to a cocktail years later.
3. In order to make a diagnosis of ADD you have to report concentration problems that go back to childhood. Very few people who are depressed will have been depressed from childhood, so this can be a good way to differentiate. Most people who report concentration problems from childhood have primary ADD, not primary depression. ADD is much more common in childhood than depression. As an adult, if the primary problem is treated, the secondary ones may get better on their own. Why not at least test for ADD first?
So that's my reasons. One could argue against that order of treatment by saying that there is a risk of addiction with stimulants and this is certianly true. But in people who test as ADD addiction to stimulants is very rare. Also for people who may be bipolar, stimulants have risks (although antidepressants have as much or more risk).
I don't feel that the 'test for ADD first rule' applies to people in a major depressive episode. If someone is dangerously suicidal then waiting weeks to get properly evaluated for ADD is dumb, they should try standard antidepressants because they can't afford to mess around.
Also, stimulant trials should not be used for ADD diagnosis. Because stimulants help most people a little and will help the concentration issues of depression. They should only be used after a diagnosis is made.
kate
poster:katekite
thread:112307
URL: http://www.dr-bob.org/babble/20020709/msgs/112403.html