Housing: "Doctor, I have four psychiatrists in the past 10 years and have tried everything., You tell me I'm depressed or bipolar. Again the drugs make me worse. Was I in therapy for six years and found that my parents parents were horrible, but I still feel the same way. Could you help me? "
John met with me for the first time because of problems he was having at work. His financial company had people like me in the past, you know, this bright and brilliant people who never seem to get their act together as they should be outstanding, but yourself. One third of the patients to whom it is finished with Adult ADHD and had never been diagnosed. Two of them even better on drugs, and you could not tolerate drugs, but found some relief from specialized goal-focused CBT for ADHD and coaching.
Housing: John is a 46-year-old single man in a relationship with a woman and was married twice. He has 3 children. He says he does not know what to do and his girlfriend of seven months will leave him if he does not get some help.
ADHD is overrepresented diagnosed, is not it? Well, in some places everyone is diagnosed with ADHD. However, more often than not, missed ADHD and the person designated as depression or bipolar disorder.
If someone tells me they are depressed, but any kind of treatment in the book, including several studies of various drugs and therapies have not worked, I start wondering if something else is going on. Many times, symptoms of ADHD than other diagnoses masquerade. People with ADHD often have "mood swings" and problems with mood regulation. This is not in the DSM-IV criteria, but if you have worked with hundreds of patients with ADHD, you know that ADHD causes mood swings. If someone with ADHD is sad or in a funk, they have a hard time shaking it. And when they are excited, they are really excited. This is one of the gifts and wonderful things about people with ADHD. They are passionate people, passionate about life and passion let other people know about it. If someone is not careful and do not get to spend the time to get to know the person, then you'd think the person has bipolar disorder. Yes, bipolar disorder and ADHD have a higher rate of occurring together, but more often that not people with ADHD, they have mood swings really say 'ADHD swings "not manic swings.
Many doctors have been taught that if someone presents with depression and ADHD, the first treatment of depression and then treat the ADHD. Well, this is only to think backwards. Very often, the patient feels depressed, frustrated, has lost interest in it very much, but that's because he has experienced an error after the other, or has gone from one job to the next. In my experience, the treatment of people when you begin to acquire the treatment of ADHD, the person, improve the ability to achieve their goals relationships, adherence to deadlines, remember to pick up the kids, avoid accidents the road, remember their tickets before leaving for the airport and feel much more competent, confident and happy.
Unfortunately, if patients for depression with antidepressants, or worse treated, treated with atypical antipsychotics for bipolar disorder and kept on these drugs for months or years, could not improve and their symptoms often worsen. I have never seen this data in the literature, but during my training at Massachusetts General Hospital, I was taught a very important PEARL. Never, never, never take away someone dopamine. Dopamine gives us joy, motivation, and allows us to pay attention. It is the piece of the puzzle people with ADHD may be missing that inhibits and blocks them to reach their potential. Guess what, antidepressants and antipsychotics do? Through a feedback loop, these drugs can reduce the function of dopamine in the frontal lobes and the limbic system. Not good for someone with ADHD.
Housing: John says he has never felt depressed. He has many friends and was very popular in high school, college and on his last four jobs. He is very kind, generous and creative, that's the rule, not the exception, people with ADHD. Of course he was very popular. He says he was always the "life of the party", and his teachers and coaches said he was an exuberant and courageous people, but they were always surprised that he never lived quite up to his role in the classroom or on the football field . He did not "git" the big picture or perform consistently.
More often than you imagine, adults with ADHD find themselves without a job and without a plan. Losing a job can have many causes, especially in this economic downward spiral. But without a plan is as easy with ADHD. People with ADHD are together through difficulties in visualizing the future together with the inability to put the pieces in order to get there.
According to Dr. Lev Mills, ADHD people come to a "full stop." Apart from difficulties with deciding what to do next, at one point, they lose all forward motion. It seems as if they never find a job. The "full stop" blocked forward movement. "Paradoxically, a person may also feel ADHD bombarded with a flood of ideas about where to turn, but each leads to a few weeks of the submission of applications and sends a few resumes and then they will find that something else is more interesting or promising . Having a some time at the point of paralysis sets it is almost impossible to move forward again. follows and depression.
"For a non-ADHD person, with a number of ... success in their work life, it may be useful to take this opportunity for some serious re-evaluation of life priorities .... But for an ADHD adult, on the edge of depression and possibly financial ruin is difficult to achieve this broader perspective and anxiety soon flood the view of the big picture. "
Once you lose your ride, you can not choose a career direction. You can easily be overwhelmed by the possibilities or depressed by the lack of opportunities. People with ADHD may find it difficult to make the first move when they reach the "full stop."
As for John, he was a good student up to 6 Class when the school was less structured and therefore more challenging. During his early years, his parents helped him structure his study and plan and schedule. They even interviewed him at night to help and focus to him. He attended a school in which the magnet teachers were very involved and valued his homework, calendar, provided a lot of "extra help" and enjoyed his enthusiasm. His coach in tennis and football enjoyed helping him, and for a while, did not mind, to encourage him, "Focus. Maintain your attention. Sure to stay alive." However, they observed that he often seemed to be in left field. He could not stay focused during practices or games themselves. He also had difficulty remembering the strategies that have been discussed before the game. When his classes become more difficult, and he was expected to be more "adult" and autonomous; hold was more difficult. He was no longer able to compensate for his lack of organizational planning, vision and concentration, inattention or incompetence. His grades began to suffer, he was not a model student, and began to Bs and Cs for the first time in his life. He did not want to "get" what was going on, and his teachers and parents were just as confused. He was frustrated and demoralized, but persevered and put all his energy put into doing well.
Since his parents were always involved, he was taught three times a week. His grades improved a little, but never again in ones.
The "you're just not trying" syndrome: Hundreds of people I have seen in treatment, are intelligent and very bright. You may have done very well at certain points in their lives, and no one could imagine that they have ADHD. Often, very organized and structured their parents or schools can as the person who used the "frontal lobe" or breaks in the early years. People with ADHD are great with structure. However, once the structure is gone, they have difficulties offering it for yourself. That is why when they get to school or college and have achieved their academic life, psychiatrists and others never entertained the possibility of ADHD. ADHD did not start as an adult. It starts in childhood. However, people with ADHD are often bad journalists and historians, and perhaps believe they have no problems with attention or focus, when in reality they did and their environment has helped them to compensate.
Housing: John did well in school for a while - in the early grades, when there is a lot of structure. His high intelligence helped compensate him. Decreases as the structure and increases the difficulty of his studies and material, he had more trouble keeping up.
When I dug a little deeper into his story, I began to suspect ADD, inattentive type. I asked him if he dreamed a lot, even in the years in which he did. He said yes. He admitted that he was only late for school every day there was competent and organized for its super mother who did not run a tight ship. He said that he often forgot his homework or lunch, but his mother come to the rescue and bring it to him.
His mother ran a tight ship not only for John but also for her husband. Often complained that her husband did not listen to them. On weekends, he would leave projects incomplete. At one point there were four half-finished projects in the garage. John's father sympathized with John because he behaved like his life. Luckily, he was in a career that make him jump from task to task and he did not need to focus for long periods of time allowed. He was a trader on Wall Street and thrived on the excitement and the ups and downs. He never finished college, even after 6 years and went to work on an entry-level position up to position worked pretty successful.
Family History: ADHD runs in families. Fortunately, John's mother was spared and was therefore in a position to get an organized and structured household upright. However, John's father ADHD symptoms, but had never been diagnosed. The state apparently do not affect its ability to achieve success in his career. Fortunately, he chose a career that was a good match for someone with ADHD. At 87 the heritability of ADHD is one of the highest of all families syndromes in psychiatry. Nevertheless, many people continue to feel in our culture and in the field of mental health, it is not a "real" syndrome and should not be treated as such.
Housing: I said that I was what John was a high suspicion of a diagnosis of ADHD, which has haunted him for most of his life. I was of the opinion that he is not about depression, bipolar or borderline personality disorder and that his symptoms could get much better. I assured him that he did not have a learning disability or dementia. People with ADHD have learning difficulties, but more often than not, they are very talented, gifted and intelligent. If ADHD recognized and treated appropriately, people with ADHD are free to bring their talents and gifts in the world to express.
John was very relieved and looked as if he had been given a new life. We discussed the possible treatments, including coaching, cognitive behavioral therapy and medication.
Treatment: The treatment of ADHD must be individualized, as each person is unique. But there are some general guidelines that are helpful to remember. People are complex, and their lives are complex. The treatment is not about writing a prescription and to see the patient once a year. The treatment is about a relationship and helps the person to move a comprehensive game plan with their lives, to reach their full potential.
Primarily, the relationship between you and the patient is to improve the basis for helping him if you prescribe medication once every three months, doing therapy or coaching.
Second, people with ADHD often have difficulty maintaining and focusing on relationships. Many experts believe that the connection one of the pillars to help someone improve. This must be part of the treatment.
Third, I believe that too often the treatment focus is on deficits or problems. This is how we are all educated, what is the problem? what is wrong and how we are, treatment providers, to address the person?. People come to us with so many gifts, talents and strengths. It is important to help the person recognize their strengths and show them what they have to overcome extraordinary challenges. The best gift we can give our patients is to show them their own power, the potential and the possibilities of what can be.
Housing: John returned after two weeks after he started the Adderall. For the first time in his life he felt like he was "out of the fog." He was not dizzy or anxious, he just felt "ok" in the present. He was hired at our meeting where we discussed and wrote goals for each area of his life for the next three months and five years. We addressed areas of work, community, spirituality, relationships and personal growth. I recommended weekly cognitive therapy to work with me on these goals, as well as meetings with ADHD coach.
A year later, we touched base on his performance. He had left his job for a promotion in a competitive business, and was engaged to his girlfriend. His mood was much better, he practiced, and we both smiled the progress he had made. It was not only exciting for him, but it was one of the reasons that I love my job, a relationship with people and helping them realize their potential and share them with the world. There is no greater gift....
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