January 13, 2019 at 10:49 am #106596
So I finally got an appointment with a Psychiatrist and got there and it turned out to be his nurse practitioner.
In 20 minutes she decided to disregard my previous hyperactivity diagnosis from my youth, and instead diagnosed me as bi-polar.
She has put me on trileptal.
Not sure what to think but I’m taking the meds because I need help and will try whatever they tell me.
The trileptal seems to make me feel like I’m in a haze, but I’ve only been on it a couple of days. By 7pm I’m so exhausted I can hardly stay awake.
Not sure here… any advice would be appreciated.
January 14, 2019 at 7:41 am #106614
Do you have a previous ADHD diagnosis that this person has disregarded, or a separate ‘hyperactivity’ diagnosis? I know you said it above, but I need to be clear on this point. If you have a previous ADHD diagnosis, you need to INSIST that you see the ACTUAL SPECIALIST about going forward with this, to get the appropriate diagnosis and medical treatment. Despite what a lot of non-specialists think, ADHD CAN and DOES persist into adulthood (I’m 27 and I’m only just getting diagnosed as ADHD).
How long have you been taking these meds exactly? I don’t know anything about Bipolar meds, but at least in the case of ADHD meds, if you feel any serious side-effects (lethargy, haziness, etc) then you’re on the wrong meds, and need to try different ones. If you think there MAY be some truth in the Bipolar diagnosis, keep going on your meds for roughly a couple of weeks. If the side-effects persist, and your other symptoms- the ones you want treatment for (you’ve not mentioned what they are)- don’t improve, talk to them about it. If you DON’T think you’re bipolar, I’d argue that you should stop taking the meds immediately, have a word with your GP or family doctor, and demand to see the ACTUAL specialist, as I suggested above. Alternatively, keep taking the meds, but STILL talk to your GP about it. The specialist, if they uphold the Bipolar diagnosis, may refuse to discuss anything else with you or try to diagnose you for something else before you’ve taken one course of these meds. It’s a real shitty way of going about things, but that’s the way some of them work.
On what grounds did the nurse practitioner dismiss your previous diagnosis? If it was on the grounds of ‘That doesn’t carry on into adulthood’ (assuming your previous diagnosis was actually ADHD), then you absolutely HAVE to stop the meds now, and demand to see the specialist, because that simply isn’t true.
If you want to volunteer more information, or have additional questions, please feel free to respond, and I’ll respond as soon as I’m able, though I can’t guarantee that that will be immediate. I wish you the best of luck, going forward.
January 14, 2019 at 9:47 am #106627
Thank you for your response.
Yes, I was diagnosed by psychiatrist and doctor as hyperactive disorder when I was a kid (5th grade).
Back then (1977) they were hesitant to put me on meds because I excelled in school. Shortly after that school took a nose dive sadly. I get bored quickly.
My symptoms are that my thoughts go extremely fast. It is hard for me to focus on one thing for long, unless I obsess on that one thing. When it is very bad, I cannot even watch an entire television program or movie without fast forwarding through large chunks of it. At the worst I cannot even listen to an entire song on the radio in the car, I will bounce around from song to song even on songs I like. Seems like a small thing I know but it represents the feeling I have that I cannot even slow down enough to absorb things I enjoy.
At the worst I feel like I am a piano wire strung so tight I may break, and vibrating at a very high pitch.
I function at a very high level when I am like that and that will go on for months and then eventually I come apart an crash under anxiety of not handling my life and work appropriately. I run at a high pace, but still only accomplish just enough to get by. I rarely can finish complex projects entirely without missing something, which is a problem for me because I’m a Network Engineer.
As far as the bi-polar meds… I do feel in a haze all the time since I started taking them even though they appear to “stabilize” my mood as they are supposed too… I feel like I am walking through mud all the time now.
I guess I will need to find and talk to a GP here and try to get a Psychiatrist to talk to. I’m frustrated because I can’t seem to get a call back from Psychiatrists and the one office I did landed me talking to this Nurse Practitioner that seemed to ignore my previous diagnosis.
She confused me too, because she said if my mind is moving too fast, that ADHD medication will make that worse. I thought that if you don’t have a hyperactive mind, that adhd meds sped you up, but that if you are like us with adhd it actually slows us down to a more normal speed…
Not sure what to do at this point… I guess I will find a doctor and start there… and continue looking for a psychiatrist.
January 14, 2019 at 10:16 am #106635
Correct me if I’m wrong, but it sounds like you’re living in the UK, but come from somewhere abroad, would that be right?
That’s largely irrelevant anyway, but it’s always good to have information.
I completely understand your frustrations. To be honest, a lot of my motivation for seeking ADHD treatment (I’m hopefully starting meds on Monday) was to simply improve various quality of life issues. I don’t have a drug problem, nor issues with addictive behaviour, and I can hold down a job and relationships with (relatively) little difficulty. However, ADHD costs me a lot in different areas of my life, and I just want to be able to enjoy my life and live out my potential, something it doesn’t feel like I’ve ever been able to do up until this point. Simple things like ‘being able to listen to a song all the way through’ or ‘read a book to the end without getting bored’ aren’t minor goals- they’re things that being unable to do diminishes your quality of life, and you’re right to try to push for that.
Bear in mind that I’m not a medical professional, or anything even remotely related to that- I just spend a lot of my time reading stuff. It sounds to me like the reason she’s put you on Bipolar medication is due to your whole thing about ‘crashing’ after a certain period of months, which I’ll admit, does sound similar to bipolar disorder, at least, relatively stable bipolar disorder (instead of peaking and crashing every few days, it’s after a few months), but ADHD can often be comorbid with other things, including fatigue issues. By any chance, do your crashes happen to coincide with the winter months? Or do they just tend to come whenever they feel like it? It wouldn’t surprise me to hear that you have ADHD and Seasonal Affective Disorder (like me). I get so tired during the winter months that I can barely move, and I snap at all and sundry.
It might help you going forward if we discussed a little bit about what ADHD actually is, and how medications help with it. ADHD symptoms are caused when your brain doesn’t make enough Dopamine. Dopamine is the reward chemical in your brain. Not having enough essentially turns your brain into a ‘dopamine-seeking-missile’, and instead of being able to focus on whatever you need to do, your ADHD will pull your focus towards the thing that gives you the biggest kick of dopamine with the least effort. This leads a lot of people to binge eat, be sexually promiscuous, abuse drugs and alcohol, or play video games. ADHD medications work by either telling your brain to make more dopamine, or by telling it to hold on to the dopamine it makes, and thus ‘normalises’ the level of Dopamine in your brain, letting you focus on whatever you NEED to focus on, rather than whatever your brain WANTS to focus on. They don’t ‘slow you down’, as you put it, but they just make it EASIER to prioritise. So, for a hyperactive child, instead of the child starting to climb the book case and not thinking ‘maybe I shouldn’t do that’ until they’re halfway to the top, they’ll maybe think about it straight after thinking “I bet the room looks great from the top of the book case”. It gives you a millisecond between ‘impulse’ and ‘response’, a millisecond to think ‘Now, hold on, is this really the best thing I can do right now?’. It LOOKS like you’ve slowed down, but actually, it’s just given you more time.
As a general rule, yes, if you don’t have ADHD, ADHD medications may make whatever symptoms you have worse. Conversely, if you HAVE ADHD, antidepressants and Bipolar meds can make it worse, too. I would argue that the negative responses you’re feeling outweigh any benefits you may see, and that you should go back and have a word with your doctor. Incidentally, Trileptal is not a ‘first-line’ medication for Bipolar disorder- it’s actually an epilepsy medication sometimes used to ‘calm’ the manic episodes associated with bipolar. It’s used for it, but it’s not the medication’s ‘intended purpose’, if you get me.
There’s a lady on here who’s also seen a Nurse Practitioner, and that person was told that ADHD is a physical condition caused by people moving around too much, or that people who experience it can’t stop moving (I don’t remember which), and she told the NP she was wrong, and hasn’t heard back from them since. I STRONGLY recommend chasing them up on it.
Let us know how you get on. Hopefully your GP will be able to straighten things out for you.
February 18, 2019 at 11:59 am #109485
I preface this with this is a personal opinion (not a medical opinion). I am a psych NP in training and also a person with a long time diagnosis of ADHD. I think as you described it in this chat board, I too would have more likely been led to a bipolar diagosis. In fact, Bipolar symptoms can be misdiagnosed as ADHD in children because it is not diagnosed until people are older. That said, if you feel you’ve been given the wrong diagnosis, I would recommend you get neuropsych testing with a psychologist (not a psychiatrist or NP). They can do a more thorough evaluation and look at your working memory and executive functioning. It’s a difficult diagnosis to determine for paychiatrist and NPs, they are not trained on the neuropsych testing but rely on self report and functioning (seems like you are high functioning as a network engineer, though I totally understand that it may not feel that way to you). Again, as you described it, it’s understandable that you were given that diagnosis, and stimulant medications would probably exacerbate bipolar symptoms. At any rate, a second opinion would either change this outcome or give you more reassurance.
January 14, 2019 at 10:44 am #106638
If you don’t feel heard by your clinician, it’s time to find a new one. Especially when your not even given enough time to share what’s concerning you.
ADDitude Community Moderator, Parenting ADHD Trainer & Author, Mom to teen w/ ADHD, LDs, and autism
January 14, 2019 at 8:35 pm #106707
Thank you for your responses.
I feel like the trileptal just slows me down. So much so that I do not take it in the morning or I would struggle all day.
I was very hyper as a child. Ran everywhere. Talked a mile a minute. Just wound tighter than a ten day clock.
I’m going to give this trileptal thing until the end of the week and call the clinic I’m dealing with and ask to talk to the Psychiatrist.
To answer a couple of the questions:
I live in Las Vegas.
I had not thought about it but my crashes do come in the winter months. Last year was in the fall, and this year right at the new year.
I really struggle to focus, and it’s hard to tell if I am gaining anything from the trileptal, because it slows me down, so I am able to concentrate a little longer, but I feel like my brain is stuck in mud if that makes any sense.
Yeah I will talk to them again. I would at least like to try ADHD medication, as I was diagnosed with hyperactivity (highly) when I was young, and I think I’ve had that all my life and never been treated.
I want to be able to function at my best, not feel like I am struggling through a haze.
Thanks again for the info. Much appreciated. It was hard to take this step and seek help, so it really means a lot to get some feedback from others.
January 14, 2019 at 9:21 pm #106708
Sean, Las Vegas is a problematic place for medical care, including challenging chronic disorders such as ADHD. Most people are from elsewhere and return home after short stays. That said, there is hope.
By all means, you must bypass undertrained personnel like the nurse who “evaluated” you. I recommend that you also look for an additional psychiatrist – or better yet, neuropsychiatrist – as a backup in case the first psychiatrist does not work out. I’m sorry that I don’t have any names for you.
February 11, 2019 at 8:31 am #109036
Just an update. I found a good doctor. He listened to me and seemed to understand that I have been struggling with this for many years.
He prescribed Adderall… 5mg twice a day for the first 7 days, then 10mg twice a day for 7 days, then seeing me again to assess.
Right out of the gate I am amazed. I never really realize how different it can be to not feel like an race horse want to burst through gates all the time, because I have never known anything different.
My mind is calm now. First big difference I noticed is my ability to get some things done around the house. Next thing I noticed was the change in my driving… I am so much calmer, and in no hurry.
I was hopeful that medication would help me, but skeptical, I have never really trusted psychology or medicine, and I don’t like taking pills. Man I am glad I took a chance to get some help.
Only side effects for me seem to be feeling a bit warm, and a little thirsty.
Very hopeful now that I have found a doctor that seems to understand how I am feeling and why I need help.
If anyone else in Las Vegas needs a good doctor, let me know and I will advise.
February 11, 2019 at 8:36 am #109037
It’s an INSANE difference, isn’t it?! I had no idea meds could help so much, either. I’m so happy for you ^^
I’m glad you finally got someone who listens to you 🙂 Have a great everything going forward 🙂
February 11, 2019 at 8:41 am #109038
Thank you! Yeah I only wish attitudes towards ADHD and medication would have been different when I was younger. I then could have gotten help before I was 51 years old. Better late than never though 🙂 Take care and all the best to you, and thanks again for your earlier responses, they helped keep me from getting discouraged and giving up.
February 11, 2019 at 8:50 am #109039
Any time 🙂 We’re all in this together 😉
February 11, 2019 at 3:54 pm #109099
I literally just had this exact same issue come up. I’ve been prescribed abilify and am majorly apprehensive about accepting the diagnosis as bipolar or taking these new medications after a half hour skype session with someone who’s never met me. Like yes, I do have periods of hyperactivity that get better or worse as time goes on, but I’m literally always hyperactive. There was not a single day in my life where I was not exhibbiting ADHD symptoms. Unless I’m always some degree of Hypomanic this diagnosis makes no sense to me.There’s a chance I’ll totally toss the meds if I don’t like how I feel on them.
February 18, 2019 at 3:47 pm #109522
I’m sorry, that NP is an idiot and should be reported.
Stimulant medication does not speed up racing thoughts in a ADHD brain. It creates clarity, focus, and control of attention. I don’t know what it does to a non=ADHD brain.
I can’t imagine any licensed medical practitioner diagnosing an incredibly complex disorder like bipolar, with no previous history, in a 20-minute meeting.
That’s horrible. You definitely need a second opinion, and I would seriously consider lodging a complaint with the practice and with whatever licensing board governs her. That’s ridiculous.
Even if you had bipolar instead of or alongside ADHD, 20 minutes? That’s …just… no freaking way. Totally irresponsible.
February 18, 2019 at 3:56 pm #109526
Thanks for the segway for my story. I had a family crisis, crying & went for counseling, suggesting that ADHD could be a major contributor to the family problems. Also NP, short interview, short quiz, “Bam” I’m bipolar. What they never explained was (1) I was only tested for Bi-polar & (2) what “periods” of highs or lows meant. Through much research & reading I found out a major difference between the two: ADHD fluctuates rapidly(short periods) BASED on events, Bi-polar is usually Long periods (weeks/months) of unexplained highs & lows with no apparent connection to causation. Again note that ADHD & many other diagnoses co-exist. Just hope that this helps others understand what you’re going thru & get the correct (ADHD for me) diagnosis & treatment, even if you’re over 60!
February 18, 2019 at 4:01 pm #109527
Tanumen: Oh, I’m so glad I didn’t write sooner- I didn’t know there were Psych NPs! I was going to write that NPs shouldn’t be allowed to deal with “brain stuff”, but clearly I would’ve been wrong.
I was hospitalized for 6 weeks due to a rare and exhausting physical condition. They brought in an 80-year-old shrink to chat with me, but because of the exhaustion I fell asleep mid-session and was very drowsy otherwise. For that I was labelled as depressed and put on meds by an NP (who seemed to hate me and I will never schedule another visit with her) that made me balloon to my heaviest weight ever. But I had never felt more positive before! Hey, I survived! My life is a do-over!
It is really hard to be a do-over when you are 60 pounds overweight through no fault of your own and can’t walk.
I just got the wrong NP.
February 23, 2019 at 6:11 pm #109911
I’m 62 and have been diagnosed with everything from Bipolar 2 to Generalized Anxiety to Borderline Personality Disorder to Major Depressive Disorder — you get the picture. I can only speak from my experiences and observations. I’ve been seeing psychiatrists/psychologists/therapists etc. since I was 17.
If you made an appointment with a psychiatrist, then you have the right to see that psychiatrist. Period. Especially for an initial evaluation or a diagnosis. Seeing a nurse-practitioner or RN or physician’s assistant is just fine most of the time – for a meds checkup, or a routine visit, or getting questions answered. But sometimes you need the expertise that only comes with that degree and experience.
Call the office – if you still want to deal with this doctor – and stand up for yourself. Nicely but firmly. You didn’t ask to see a nurse-practitioner, you asked to see a psychiatrist, a doctor. If you feel you’ve been diagnosed improperly, please don’t just let it go (I’ve done that many times and been sorry). Even professionals like doctors and nurses fall into the trap of “get them in & get them out.” Especially since most of us with brain conditions feel like we’re a big pain in the ass, and we’re not worth fighting for. But we are. You are. Insist you get the attention you deserve, and that you feel comfortable with the diagnosis you get, and the meds you’re prescribed. If you can’t get that from this doctor, find another.
February 23, 2019 at 6:37 pm #109915
Wow, this is a response to artbug91’s response to the original post but I wanted to chime in and just say as a newly diagnosed individual who is now learning to deal with mental health professionals I really needed to read what you said when you stated
Even professionals like doctors and nurses fall into the trap of “get them in & get them out.” Especially since most of us with brain conditions feel like we’re a big pain in the ass, and we’re not worth fighting for. But we are. You are. Insist you get the attention you deserve
Thanks for taking the time to write that, needed to hear it.
February 23, 2019 at 9:13 pm #109918
Sorry I have not responded to many of the comments here. I could not find the thread even though I posted it. Most forums have a search, and a subscribed threads, or threads I have posted links history so I can get back to the thread I posted but I could not find any of that here.
Anyway, I am very sad to hear that there are other people that are being mis-diagnosed in the same manner I was. It is criminal it really is. I am very thankful that Trileptal didn’t spin me out and lead me into disaster. The brain is a fragile id and shouldn’t be flippantly jollied around with.
I hope that all of you get the proper mental health care that you deserve.
The second half of my story is that I found a good Psychiatrist and he has me on Adderall and it is working fantastic for me. I never realize how fast my mind was going until medication slowed it down, and now I understand that there is no fix for ADHD (as I experience it) other than the proper medication.
It is so hard to explain how I (we ADHD people) experience the world, all I can say is I spent 51 years feeling like I needed to go, and there were always things in my way, like a race horse biting at the bit to burst out of the gate and run. Now that I am on Adderall, for the first time I feel in sych with the world around me to a better extent.
I still talk a bit to much, but find I grow weary of long conversation quicker than I used.
I quickly realized as well, that medication is only part of the equation. I need to change my habit. 51 years of habits do not change because of a pill. good news is now, I have the clarity to focus on goals like breaking old habits, and finishing tasks. It really has been an astonishing experience for me and a real eye opener.
Last thing I will say, because I’m new to treatment is that I found that Addrall as prescribed 10mg in the morning and 10mg in the afternoon, did not quite work for me. When it starts to wear off I get very loopy and it can be very harsh when you don’t see it coming. During that initial feeling of it wearing off, if it’s during the day, at work, I need to take a bit more.
So I now take 5mg at 5am when I get up for work, 5mg at 9am, 5mg at 2pm and 5mg at 6pm.
Works perfectly for me and I fall asleep soundly between 9pm and 10pm every night.
Point is if you do get on meds, make sure you talk with your doctor about adjustments to dosages and timing. My doc said that my dosing schedule is fine especially if it works for me, which it does.
I wish there very best to you all and appreciate the input and hope that those that are being given bad diagnosis like I was, get the proper attention and medication very soon.
Peace and clam to one and all.
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