I just found this thread, so my 2 cents is a bit late, but that has never stopped me before. Pardon length, I cut a lot out but it is a bit of a novel.
I have had the same issues and questions as the other posters have had. I was diagnosed with panic attacks and school phobia/agoraphobia at age 11. Had my first episode of clinical depression at 18 and then began having moods swings the other way at around 24. I had not been diagnosed with my ADHD at that time, but it was there, when you take the whole picture into account. My dad also clearly had it, and mine presents the same as his.
My mood swings were more like depression and hypomania, except on the upswing the mania part was never the kind that feels good and lets you get a lot done like most mania’s. It was more like a very agitated depression. I was on depakote for years, which helped with the anxiety and probably took the edge off, but my levels got toxic and I was switched to lithium. Again, more toxic levels. After a few yrs my psych NP pointed out that the dose I took wouldn’t affect a fly it was so low. I had been put on seroquel at a low dose for sleep a few yrs back. I have always had terrible insomnia. Lamotrigine was added as an antidepressant shortly after the lithium was started. It’s the only antidepressant that has no chance of causing mania in a bipolar person so was the safest bet. Since I was ok on the seroquel (low dose) and lamotrigine, we just upped the seroquel to the level that it works as a mood stabilizer and stopped the lithium.
I had started treating the ADHD around the time I went on lithium, and was on ritalin for most of that time. It was somewhat effective but not great. I switched to adderall and that turned out much better. Since I started treating my ADHD with a drug that was effective I have had no major mood swings. My psych NP said that she couldn’t really say I was definitely bipolar type 1 because she had known me for a while and realized I was ALWAYS this hyper. We agree that I have some sort of mood disorder. I need the lamotrigine- every time I’ve stopped it I’ve been in a funk and hating life within a week. I wouldn’t sleep without the seroquel, although I cut my dose in half.
I do have another bit of insight that is somewhat unique though. I am a psych RN and did a 2 yr contract at the local VA in the walk in clinic. I was doing the full psych evals on the vets who hadn’t been to that VA before and learned a LOT. What I found was that the doctors often couldn’t tell the difference at first glance because the mania and hyperactivity are so similar. They knew it and usually treated for bipolar first while taking the time to do neuropsych testing and do a more complete history. I developed a knack for asking the right questions to tell the difference or at least make a probable diagnosis. At the VA it isn’t a matter of having a job based entirely on your degree. An RN is allowed to formulate a diagnosis and recommend meds, the MD just has to sign off on it. They told me I had good diagnostic skills and it was fairly easy to find bipolar or ADHD quickly. The hard part is ruling out the other one. Some people really do have both.
So,knowing that I had ADHD and a mood disorder, they found an interesting use for me when they couldn’t tell what the current presentation was. I called it the petri dish method.They would ask me to talk to the patient in my office and then listen in after about 5 min.If we were both speaking fast and going all over the place in one way it was likely hypomania. If we were speaking what I referred to as Martian (it sounded like a different language almost and we were on the same frequency), it clarified the diagnosis of ADHD. It was amazing how I could connect in those 2 different ways and the diagnostic value of the time in the petri dish.
It is important though, to treat for bipolar first if there is any doubt at all. The outcomes are so serious if a bipolar episode goes untreated. It can ruin someones life a whole lot faster than the same amt of time being unmedicated for ADHD. When a person had both the moods were stabilized first and then stimulants were carefully added and titrated up.
In any of the speedy patients who needed an antidepressant we used lamotrigine because it wouldn’t trigger mania. If they seemed to be more ADHD than manic we would switch to wellbutrin for its slight benefit over lamotrigine for ADHD. The most important questions to ask are actually the historical ones. What age was the person when the first symptoms became an issue. If it was lifelong without any times with no symptoms, ADHD. If it started after age 15 or so and had times without impairment, bipolar.
I get really pissed when I find someone who has been heavily medicated for decades for bipolar and has not been screened for ADHD. My moods got better once the ADHD was treated and the stress of those symmptoms was less. I will not say I don’t have a mood disorder though, and am staying on the seroquel because I can’t sleep without it, and the lamotrigine bc I feel crappy without it. I suppose I could stop those meds and it would be clear pretty quick but the risks are too high. My life is crap when I can’t sleep anyway.
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