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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by CarolAnn on November 29, 1999, at 14:32:34
Is there such a thing as atypical ADD? I've always thought of people w/ADD as being hyperactive, so I've never really considered it as anything I would be diagnosed with. But even though I am the complete opposite of hyperactive(hyper-exaustive?) I do have some unaccounted for "symptoms" of something that may or may *not* be related to depression. My brain is too fogged over(new med.) to list things right now, so if anyone has any idea of what I'm talking about, and could list the behaviors that would indicate an atypical ADD(or a typical case), I would very much appreciate it. Thank you!CarolAnn
Posted by Noa on November 29, 1999, at 16:13:42
In reply to Atypical ADD?, posted by CarolAnn on November 29, 1999, at 14:32:34
A controversial topic in the world of ADD theory, but the current diagnostic criteria delineate three types:
1.ADHD, Predominantly Hyperactive-Impulsive Type
2.ADHD, Predominantly Innattentive
3.ADHD, Combined TypeThere is also an ADHD, Not Otherwise Specified, for those who don't meet the full criteria for any of the above.
One of the main controversies is whether ADD, ADHD, whatever, is primarily an attention deficit, or an impulse control/behavioral inhibition deficit. There are other ways to look at it too, including "executive function" deficit (difficulty initiating, planning, organizing, holding things in working memory, etc.)and as a problem in regulation of alertness and arousal.
Many girls have been overlooked because they present more frequenlty with the predominantly innattentive type of ADHD. Some people with ADHD have too little energy, have difficulty staying alert to complete tasks, can't muster up initative, etc.
Another problem with all of this, is that some of these symptoms, whether the more well know, classic ones, like hyperactivity, or short attention span, can also sometimes be caused by anxiety or depression, etc.
So, to answer your question: In the 1960's and 70's, what you are describing would be considered "atypcial" as the disorder was conceived of as "hyperkinetic disorder of childhood". Beginning in the eighties, the idea of calling it an attention deficit disorder came about; I think it was called ADD in the DSM III, published in 1980. Then, with DSMIII-R,(1987??)it became ADD/H, with specification if it was with or without hyperactivity. The discussion went back and forth and round and round. For DSM IV (1994), it became ADHD, with the different types. It is still such a young diagnosis, and will probably change again for the next DSM published, as will the criteria (I hear they will get more specific with age-related criteria, to reflect how the disorder looks different at different ages). I think as the research develops, we will see several different disorders emerge, based on knowledge of different malfunctioning brain processes.
Posted by JESSICA on November 29, 1999, at 16:45:38
In reply to Atypical ADD?, posted by CarolAnn on November 29, 1999, at 14:32:34
yes, it's ADD without hyperactivity. Also known as hypo-active, as in hard to get off the couch. It feels very much like depression, and continues on to contribute further to depression. Mostly women have this type of ADD, and no one really seems to recognize it. And these women generally just continue on trying to treat depression that just doesn't go away. Jessica.
Posted by saint james on November 29, 1999, at 21:03:12
In reply to Atypical ADD?, posted by CarolAnn on November 29, 1999, at 14:32:34
> Is there such a thing as atypical ADD? I've always thought of people w/ADD as being hyperactive, so I've never really considered it as anything I would be diagnosed with. But even though I am the complete opposite of hyperactive(hyper-exaustive?) I do have some unaccounted for "symptoms" of something that may or may *not* be related to depression. My brain is too fogged over(new med.) to list things right now, so if anyone has any idea of what I'm talking about, and could list the behaviors that would indicate an atypical ADD(or a typical case), I would very much appreciate it. Thank you!CarolAnn
James here....
Most adult's with ADD are not really hyperactive anymore. You may be describing inattentive ADD, where brain fog is very common, it seems this type is more common in women. I am more "standard" ADD (really there is no such thing) where my mind goes very fast, running all the possibilities. I have my little body twitches, too, but they are not really called hyperactivity. Inattentive type tends be very clam, placid. I would not call this type atypical, it is ez'er to ID ADD in boys because we act out more, with girls and the tendinisty toward inattentive type, it is ez'er to miss ADD.
No 2 ADD'ers are alike, either.j
Posted by CraigF on November 29, 1999, at 21:23:44
In reply to Re: Atypical ADD?, posted by saint james on November 29, 1999, at 21:03:12
So how is this inattentive ADD best treated? I'm never sure whether my cloudy, inability to focus (especially when speaking to others) is anxiety or some type of ADD related. I'm not a woman (an anxious momma's boy, maybe) but I'm betting its a little of both and plan to add Wellbutrin to my mix with the hopes its quasi-amphetamine effect will help (and blow away the Serzone fog).
Any experiences with Wellbutrin and this?
Posted by Noa on November 29, 1999, at 21:31:02
In reply to treatment for inattentive ADD?, posted by CraigF on November 29, 1999, at 21:23:44
I have known some people with ADD who have been helped by wellbutrin. Also, ritalin. But as always, response to medication is very individual. And, as you mention, it is VERY hard to distinguish between ADD and other things, like anxiety. I suspect it is more helpful to think in terms of process or symptoms, rather than discrete diagnostic categories, which are intellectual constructs to help us think about what is really going on in our brains. Until we can look inside each of our brains and really assess what is going on, these constructs are helpful. So, if you have "cloudy brain" plus anxiety, and both are helped by wellbutrin, what the diagnosis is becomes less important. If you are not helped by wellbutrin, thinking the diagnosis through, which would include a thorough review of your history, might help to guide you and your doc to the next logical step to try, but the truth is there may be one or two meds that your doc would have you try anyway, regardless of the diagnosis.
Posted by saint james on November 29, 1999, at 21:48:45
In reply to treatment for inattentive ADD?, posted by CraigF on November 29, 1999, at 21:23:44
> So I'm not a woman (an anxious momma's boy, maybe) but I'm betting its a little of both and plan to add Wellbutrin to my mix with the hopes its quasi-amphetamine effect will help (and blow away the Serzone fog).
>James here...
The women/inattentive add is a general thing, my brother is inattentive ADD. Your best bet is AD's + stims, stims make the most difference. In inattentive they bring focus, clarity, or an edge to thinking process. I personally prefer Dexadrine to any other stims.
j
Posted by saint james on November 29, 1999, at 21:55:27
In reply to Re: treatment for inattentive ADD?, posted by Noa on November 29, 1999, at 21:31:02
> I have known some people with ADD who have been helped by wellbutrin. Also, ritalin. But as always, response to medication is very individual. And, as you mention, it is VERY hard to distinguish between ADD and other things, like anxiety. I suspect it is more helpful to think in terms of process or symptoms, rather than discrete diagnostic categories, which are intellectual constructs to help us think about what is really going on in our brains. Until we can look inside each of our brains and really assess what is going on, these constructs are helpful. So, if you have "cloudy brain" plus anxiety, and both are helped by wellbutrin, what the diagnosis is becomes less important. If you are not helped by wellbutrin, thinking the diagnosis through, which would include a thorough review of your history, might help to guide you and your doc to the next logical step to try, but the truth is there may be one or two meds that your doc would have you try anyway, regardless of the diagnosis.
James here....
I agree that getting a Dx of ADD is important. When I describe ADD, many say "I have that" and it is true that everyone has ADD moments. ADD is about distractibility more than the norm, so it is a grey area. Some ADD;ers have neurological signs, I am right handed and left eyed. Also you have ADD for life so look for problems in primary/secondary school.
j
Posted by PL on December 2, 1999, at 10:48:37
In reply to Atypical ADD?, posted by CarolAnn on November 29, 1999, at 14:32:34
I am a female who had perfect grades until 4th grade. At that point I had a hard time paying attention although I do not feel I was hiper (but I did have outbursts occationally.) I remember I would look at the teacher, here her, but my mind would be thinking about something else so I never got what she said. Today, I find this true many times when in a conversation with someone, I miss words or even sentences when my mind, I think, thinks "This is boring, lets think about someting else." Its like I lose control. The same thing happens when I read. I can read a whole paragraph and realise I was actually thinking about someting else and have to reread it. Even if it is someting I'm interested in, my mind has a mind of its' own, it seems.
Currently I'm taking 200 mg Wellbutrin 2 x day, plus 15 mg BuSpar 2 x day, and 20 mg Celexa a day. The Wellbutrin has helped, but not enough. My Psy Doc does not want me to go to stimulants because of the need to increase dosages after a while to get the same effect. I have a feeling that reboxetine will be useful for me and will be the first in line when it is released.
Posted by CarolAnn on December 2, 1999, at 17:13:25
In reply to Re: Atypical ADD?, posted by PL on December 2, 1999, at 10:48:37
>>in a conversation with someone, I miss words or even sentences when my mind, I think, thinks "This is boring, lets think about someting else." Its like I lose control. The same thing happens when I read. I can read a whole paragraph and realise I was actually thinking about someting else and have to reread it. Even if it is someting I'm interested in, my mind has a mind of its' own, it seems.
> >PL thanx for your input. It's interesting that I was very similar to you in my childhood. Also, when I read fiction, I have always been able to so completely lose myself, that people have to call me several times to bring out to hear them.
Anyway, I've never actually been diagnosed with ADD, so will talk to my Dr. next appt. I am on the same amount of Wellbutrin as you and getting no results at all with it! Going to ask Dr. about Vivactil or some other "activating" antidepressant. Thanx again!CarolAnn
Posted by Curious on December 2, 1999, at 22:25:42
In reply to Re: Atypical ADD?, posted by PL on December 2, 1999, at 10:48:37
> Currently I'm taking 200 mg Wellbutrin 2 x day, plus 15 mg BuSpar 2 x day, and 20 mg Celexa a day.
PL - I'm on a similar regimen, except for the buspar. What does it do for you? Does it augment
the Wellbutrin? Do you take it at a specific time?
Does this combo give you any gastrointestinal problems, such as acid reflux or diarrhea?
Thanks for any info
Posted by Renee on December 5, 1999, at 9:13:22
In reply to Some questions For PL (but everyone is welcome!), posted by Curious on December 2, 1999, at 22:25:42
> > Currently I'm taking 200 mg Wellbutrin 2 x day, plus 15 mg BuSpar 2 x day, and 20 mg Celexa a day.
>
> PL - I'm on a similar regimen, except for the buspar. What does it do for you? Does it augment
> the Wellbutrin? Do you take it at a specific time?
> Does this combo give you any gastrointestinal problems, such as acid reflux or diarrhea?
> Thanks for any infoI am a 40yr old F with ADD and/or depression. I've tried several stims alone and in combination with Wellbutrin. Currently I am taking 150 Well. , 75 effexor, and 10 mg ADDerall (Adderall I take twice a day. The ADs make me less upset about the ADD symptoms, but don't change them. I didn't think the stims helped at all, but since I've been cut back from 30mg a dose to 10, I am having more trouble with foorgetfulness and orginization than I was before. My blood pressure is up since stzrting the effexor. I also had a sinus infection when I sttarted it and Had a horrible headache off and on for two weeks. I'm not sure how much of that was the effexor and how much sinus. My son also "has" ADD without the H. I think my psychiatrist thinks I'm also anxious and that's why he went for the effexor. I understand it was recently approved to be prescribed for anxiety. ADD, Depression, Anxiety---Which came first the chicken or the egg? Has anyone had success with treatment for similar problems? Have any of you tried cognitive behavior therapy along with your meds? How did tit go? I am reading a great book about cognitive behavior therapy ideas to try on your own called Feeling Good by David Burns. I think it is helping with the anxiety adn depression. I highly recommend it!
Posted by Zeke on December 8, 1999, at 3:21:44
In reply to Re: Atypical ADD?, posted by PL on December 2, 1999, at 10:48:37
PL said:
> The same thing happens when I read. I can read a whole paragraph and realise I was actually thinking about someting else and have to reread it. Even if it is someting I'm interested in, my mind has a mind of its' own, it seems.
I can really identify with this. It's like the reading becomes mechanical, like doing something with your hands, and meanwhile you're thought veer off on their own.
Now I recently came across an article about ADD posted at the ABCNews site that addressed this:
Many [people with ADHD] also have trouble with
reading, because when they read a new paragraph,
they may have already forgotten the previous
one. As they get older, most people with ADHD
have difficulty simultaneously listening to a
lecture, taking notes and making sense of what
they're hearing.The study was based on PET scans of ADDers (and non ADDers) and was reported at last week's meeting of the Society for Neuroscience.
see: The Mental Images of ADHD
http://abcnews.go.com/sections/living/dailynews/adhdbrain1027.html
PL also said> My Psy Doc does not want me to go to stimulants because of the need to increase dosages after a while to get the same effect.
If you have ADD, then your doctor IS WRONG about the tolerance issue. After some initial adjustment, a fixed dosage should continue to help with the ADD.
Now I suspect that your doc sees just depression, and ergo the tolerance issue. (not that its necessarily true for that either.) Another good possibility is that he's afraid/uninformed about stimulants (and haven't we all known several such docs). He may also have an ancient view of ADD such as 'you grow out of it' or 'stimulants don't work in adults' or 'rule out ALL other possibilities' (you'll likely be old or buried before that happens).
By considering your comments and his, it sounds like he hasn't treated Adult ADD patients (or many)? Ask him!!!
So has he diagnosed you with ADD too? Has he tried (checklists of symptoms, history, certain neuropsych tests)?
Why not get a second opinion (evaluation) from someone familiar with adult ADD? Go for it. (A 2nd opinion is proper and ethical. And YOU pick the doc. Be sure to ask questions about whether he/she treats many with adult ADD. Also GENTLY ask about whether they are opposed to stimulants. Else you may end up with your doc's twin or someone trying to build up a psychotherapy business.) Your local chaptr of CHADD may be able to provide some references.
If you have ADD, the stimulants are usually the treatment of choice. Further they are generally safer than antidepressants -- have fewer side effects -- and this is important when you're taking several different meds. Its possible that go from 3 meds to two -- a stimulant and an antidepressant. Response to stimulants is immediate or rapid, compared to the weeks and months of antidepressants. Abuse among ADDers is rare.
Sorry to go on like this but I'm annoyed at his "need to increase dosages" statement about stimulants. I wasted too much time and money because docs afraid and uninformed. (Take a look at this URL, a chapter on stimulants from a psychopharmacology textbook: http://www.appi.org/books/schatze/as08.html)
Posted by PL on December 9, 1999, at 15:21:33
In reply to Re: Atypical ADD?, posted by PL on December 2, 1999, at 10:48:37
Thank you all for your responses! I just saw my doc on Monday, and he changed my script by my request. I am on 20 mg celexa a day, no buspar, and wellbutrin 200 mg 3 times a day. (Yes he advised me that that is above the max dose, but I know that wellbutrin does have an increased effect at higher doses.) As far as the buspar goes, it never had any effect on me, so side effect, but no effects, so thats why we canned it. The celexa helps but I feel get no benefit above the 20 mg.
So far so good. I never had the usual side effects people complain about when they start wellbutrin. (Like not being able to sleep, jitteriness, etc.) But since I increased the dosage I have only gotten about 3 hours sleep a night, but I'm not really complaining. I don't feel tired during the day, so I don't call that insomnia. I have a little jitteriness, but again no complaints. I think I am finally at a therapeutic dose. (I have a high tolerance, it seems, for most drugs.)
As far as the increased seizure risk, I am willing to take my chances. Nothing like that runs in my family, so I think I'll be ok.
Thanks again for your input. I will check out those sights and if this dosen't work I'll presure my doc for stims.
Take Care All,
PL
Posted by PL on December 9, 1999, at 18:02:19
In reply to Re: Atypical ADD?, posted by PL on December 9, 1999, at 15:21:33
Yes, and I have more to add. First of all, I guess you all noticed my spelling impediance. That may be part of the problem, or it may be that my left brain works faster than my right brain. (Hope I have that right, I have a tendency to be dislecsick....yeah) Anyhooo, I also feel, well besides depression, another.. depends on the time. Yeah, when I'm at work or at home. BTY the depression is the main momb... sorry lost track.. had to go set the meat in the mico for dinner. Real Life. Sucks. Can I say that here? Sorry if not.
See You In Space,
PL
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