Posted by bmwfan07 on December 8, 2010, at 14:45:25
The past four-plus months have been pretty tumultuous, after I impulsively quit my job to start a business that I ended up never actually starting.
I'd always had motivation, attention, and impulsive/hyperactive issues, so you can imagine what I then discovered about myself--that I had ADHD. I've also had OCD, social phobia, and maybe GAD for the better part of my life--I'm 21 now. I have, until now, however, never had clinical depression.
My OCD kicked into major high gear after I left my job (stress has been said to exacerbate the former) and I started getting horrible aggressive intrusive thoughts and became convinced (quite literally) that I was a psychopath. I didn't know about the potency of OCD at the time!
A month or so later, my GP prescribed Adderall to see if it would help me focus and apply said focus to finding a new job. I started out at 5mg twice per day. However, I noticed that by the third day, I woke up feeling quite depressed and moody. I interpreted my dad's normal morning routine as a severe slight (because he didn't simply acknowledge me) and then felt suicidal. The remainder of the day was dominated by feelings of depression, apathy, anhedonia, etc., but strangely also by some seeming hypomanic features, or else perhaps it was simply euthymia combined with depression as the onset of depression isn't typically instantaneous, because I was seemingly "over"-excited about seeing my friend at night. This prompted myself to overanalyze my behavior, and I became convinced I was having a mixed episode, which led to a panic attack (OCD surely played a role here).
Suffice it to say, I ceased taking Adderall and am to this day really not sure what happened, other than to say I'm pretty confident Adderall destabilized my already somewhat fragile (situationally, I believe) emotional state, and since then I haven't been my normal self. Specifically, I've been having bouts of atypical depression. Unfortunately, my memory seems pathologically (but chronically) awful, so I'm not able to recall exactly the course it's taken, but I had a few weeks of feeling very anergic, lethargic, exhausted, sleepy, depressed, mostly anhedonic, and had diurnal worsening at night--i.e. atypical depression. Then, and I can't remember "why," I felt better, though not completely, for about a week, after which I felt the cloud descending back on me over the course of a few days. Unfortunately, my 21st birthday occurred on the last of these days and I felt so bad because I was incapable of enjoying one of what I believed to be my most important birthdays. The depression after a few weeks then lifted somewhat for a few days to a week at a time and then came back but has definitely been there to varying extents for the past two-plus months--since I took the Adderall. I've noticed that it's predictably better on the day I see my psychologist and ADHD life coach, indicating that mood reactivity described in atypical depression.
I've only heard of Adderall doing this in the context of bipolar disorder, and I know atypical depression is more common in bipolar disorder, so I'm quite concerned that this is my actual condition. In fact, my obsessing over whether I might have bipolar disorder for the past couple of months (first it was Asperger's, then borderline personality disorder...then finally the correct self-, and then professional, diagnosis of ADHD), ironically probably caused a lot of this in some inexplicable way.
I've never had a hypomanic or mixed episode to my knowledge, but perhaps I really did have a mixed episode that day on Adderall (I don't really recall racing thoughts or extreme hand-wringing agitation, though, just a lot of anxiety *about* the possibility of having a mixed episode).
So. My question given my history--sorry for the novel!--is what you all recommend I start with to get out of this funk. I'm somewhat pessimistic given my extensive reading of bipolar and atypical depression and how chronic, often treatment-resistant, and awful, both (or are they the same, in actuality?) conditions are.
My p-doc wanted to prescribe Lexapro originally, but I've somewhat lost confidence in her (trust in the "pros" is an issue for me, for some reason...always has been...most likely because I've witnessed their ignorance and malpractice firsthand) because she didn't even probe (or particularly care, when prompted) about any atypical symptomatology or too much about bipolar (although she did ask), which might better indicate treatment with MAOIs. I'm mainly concerned about a) the SSRI not helping, b) the SSRI inducing a (hypo)manic or mixed episode, c) the SSRI "pooping out" after 6-12 months, as it seems to do with so many atypical or bipolar depressives, and d) the SSRI kindling or altering the course of bipolar, as I've read it can potentially do.
At the same time, I really want to feel better. I manage emotionally during the day, but my mood takes a steep dive at around 6pm every single night and I start having hopeless, suicidal, and other negative ruminations as well as a pervasively awful mood. I'm traveling over Christmas next week and I know it's gonna blow feeling like death for a large portion of it, but it's something I've already committed to.
So, any recommendations for what to start with given all of the above? Thanks in advance!