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Re: Atomoxetine (Straterra) - bi polar

Posted by comorbid? on May 24, 2003, at 20:24:24

In reply to Atomoxetine (Straterra) - bi polar » comorbid?, posted by paulk on May 23, 2003, at 10:44:29

> I think the bi-polar diagnose is a fad diagnose and unfortunately, ends up removing most of your treatment options. Deciding if a patient is hyperactive or manic is a VERY subjective determination that will get you either a bipolar or a quite different ADD diagnose.
> The fix is to go to a new doctor and tell him you want his to diagnose you BEFORE he has access to your old records.
> You will most likely get a new diagnose, and if it is non bi-polar you should be able to try stimulants. (In fact I would bet if you go to 5 different doctors, you will get 5 different diagnoses!)
> Your best hope to get good treatment is to be very proactive with your doctor.

paulk -

Thanks for your input and advice. I must say, my initial self-diagnosis, based on what i ferreted out on the web, was ADHD, inattention subtype, and i wanted stimulant treatment. BUT, i had additional symptoms that were not covered by the ADHD symptom cluster: Depression and hypomania on a seasonal cycle (as well as on shorter cycles), pronounced mood lability of long duration, strong correlation between light exposure and mood, ultra-ultra-rapid (ultradian) mood cycling, and so on. These are all hallmarks of childhood-onset BPD, and after my doc told me he thought i might be bipolar, i looked into it and found that my symptoms were MUCH better characterized by bipolar type 2 than by ADHD.

AN interesting thing: Childhood-onset bipolar disorder is very frequently _misdiagnosed_ as ADHD. I would suggest that any parent who has a child with an "intractable" case of ADHD consider the possiblity of COBPD or "early onset BPD," especially if there is a family history of mood disorders. This is 180 degrees different from your assertion about "fad diagnoses."

To further respond to your suggestions: My current doctor had no medical history to refer to, other than what i told him about my self-diagnosis and my history of winter depression and summer up-mood, with agitation and extreme mood swings in spring and fall (which had been ignored by my previous docs). My case history was unavailable to him, due to difficulties in obtaining the documents and my privacy concerns. This doc has wide experience in dealing with ADHD and numerous other disorders that interfere with studying, because he works in a university mental health setting. He doesn't have any predispostion to one diagnosis or another (which is what i think you're suggesting). And his diagnosis is in complete accord with my symptom cluster, more so than that of any doc i've had previously.

If you look back at my first post, you'll see that my psychometric assessment, which was performed independently by another doctor in the university system (who did not communicate with my current doc) was ADHD _inattention subtype_ with FEATURES of hyperactivity, and that my slight hyperactivity was not my reason for seeking treatment, nor was it the most salient part of my symptom cluster. I have never fit into the hyperactivity model very well; i'm a distracted daydreamer, rather than a disrupter. Always have been, from early childhood.

You may also see from my earlier post that i AM proactive with my doc. We have a very open relationship, and he respects my self-awareness and asks me to consider things rather than telling me what to do (he even suggests that I look up references for various drugs to see what I think about them!). Since i agree with his diagnosis and am doing well with my current treatment (though not finished titrating, and still having some concentration issues that we’re working on), i think it would be ill-advised, even foolish, for me to seek another doctor at this time.

Finally, it bears mentioning that there are NUMEROUS treatment options for both ADHD and bipolar disorder, and a well-informed doc will know about them. My doctor has included the possibilty of stimulants in my case, having decided that my degree of self-awareness and my honesty and openness with him reduce the risk of unwanted complications “snowballing”... Strattera is appealing, because it is not a controlled substance like the amphetamines and appears to be less likely to induce mania. But frankly, i'd rather continue my current course of treatment, because stimulants simply will not address my various problems with long term mood lability (ADHD is often associated with SHORT-TERM mood swings). My doc even suggested the possibility of using stimulants on an occasional basis, for times when i need extra concentration, but i'm not very interested in this option, because i've abused stimulants in the past and am familiar with how they affect my mood when i discontinue them (depression).

Thank you for your opinions, but really i think you need to take a closer look at things before making the type of statements you made. Mental illness is complicated, highly variable, and poorly understood; jumping to snap conclusions is not the way to deal with it.





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