Therapy/Treatment options | ADHD Information

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Hello everyone.  In a prior post, I gave some background about my life’s patterns, and sort of generally asked “Could much of this be due to my ADHD?”  Now I’d like to talk briefly about my ongoing search for treatment, and ask for some needed feedback, if anyone is so inclined.

In 1996 I began to seek medical and therapeutic treatment for clinical depression.  I have undergone several types of therapy and several antidepressants, or combinations of antidepressants, ever since.  In this time period I have also been through a 4 ½ year relationship, now ended, a dozen temporary jobs, and one full-time position with benefits which lasted for 2 ½ years (running a children’s residential camping program).  In these years I have known some extremely effective and rewarding periods but have continually returned to varying degrees of depression, from mild to severe.  These depressive periods have followed my life circumstances quite closely, yet also have compounded my difficulties.  Throughout, I have not managed to achieve any long term stability, nor even a manageable level of financial solvency (I have only briefly ever had a “prudent reserve” of money for unexpected occurrences).  For two years I have gone to “Al-Anon” support groups to address the possible effects of my father’s drinking, my parents’ divorce, and ultimately the unmanageability in my life.

Last spring, I began seeing a new psychiatrist.  She gave me a written test for bipolar disorder, but the symptoms did not seem to apply to my experience.  Yes, I’d had some happier, more effective periods, but no real mania.  She weened me off of very high levels of two antidepressants, and introduced another--Wellbutrin 300mg.  She also gave me a sleep aid to curb some anxiety, but it left me fairly useless in the morning.  My condition seemed to improve somewhat on the Wellbutrin, but ultimately I hit a pretty serious depression again, shortly after the place I worked went out of business.  My psychiatrist suggested that I change therapies from cognitive-behavioral, which I had been receiving, to psychoanalytic psychotherapy.  She also prescribed an anti-convulsant which is approved as a mood stabilizer.  She said that depression which has responded briefly to several different antidepressants, but continually returns might respond more consistently to a mood stabilizer.  The week-and-a-half that I was on it was the most hellish of any response I have had to medicine.  I experienced profound lethargy.  I felt “drugged” in the popular sense of the term, and had continuous low-grade headaches. 

Finally, she speculated that ADHD may lie at the heart of my difficulties.  She prescribed Strattera at 100mg/day and another antidepressant (Lexipro 15mg).  Currently, on two antidepressants and Strattera, I have returned to a somewhat consistent degree of stability emotionally.  Nonetheless, the job I have been at since September ended last week, as it was only a temporary position to begin with. 

Now listen closely:  I have a bachelor’s degree.  I have a very high IQ.  I have a strong work ethic, and try to do well whatever I do.  I have never quit a job, and never been fired.  Furthermore, I have usually been quite liked (if I don’t mind saying so myself) by almost everyone I have worked with, and have often been praised for my hard work or ingenuity.  I am not “sort of a hippie” as a friend once joked with me.  I am quite frustrated to be once again unemployed, financially strained, and without health insurance for the last year-and-a-half.  Unless I begin working again soon, I will not be able to pay my rent.  As crazy as it sounds, however, I feel a world better than I did the last six weeks on the job, where I was given a spreadsheet of an acquired company’s entire inventory to enter into a database.  I seem to deal better with the prospect of financial ruin than with the mind-numbing detailed minutae of my former position.

Though I have been through the process countless times, I am mystified as to why finding work continues to feel like shooting at sea-monkeys in the ocean (to coin a phrase), and why the prospect of becoming insured seems out of my control, ultimately up to the powers that be wherever I might become employed.  This does not even address larger issues:  Security.  Relationship.  Dare I say marriage?  Perhaps children?  Do I hear job fulfillment?  Meaning and direction in life?

I am very discouraged.  I am also very conflicted at this point in my therapy.  I’m not looking for a scapegoat, or a magic bullet.  Nonetheless, after extensive research on the internet (over the last week or so), I find I can identify wholesale with the hundreds of personal stories I have read of adults with ADHD.  I also learned that the condition itself is somewhat debated, and as it manifests in adulthood is not yet well understood by many professionals.

I spoke with my therapist about her ability to address ADHD specifically.  She was more inclined to attribute the events of my adult life to unconscious self-defeating and self-punishing behavior, and she believes that I am very “intellectually defended” around my feelings, and can benefit from ongoing psychotherapy.  I don’t dispute the last part of this, the benefit of psychotherapy.  Obviously I’ve experienced large setbacks in relationship and career and despite my best efforts continue to live on the edge of poverty.  And obviously this has often been painful and caused periods of depression.  Nonetheless, I currently believe all of the self-knowledge and awareness of my feelings in the world won’t help me unless I can gain the tools and understanding I need to overcome the challenges specific to Adult ADHD.

I am looking for help.  Right now, finding the next job is my immediate challenge.  Beyond that, my next obstacle is finding the right type of treatment or the right professional(s).  Another is paying for treatment and perhaps medicine.  Ultimately, I would love to work my way into a career/lifestyle/understanding that is sustainable and meaningful.  The first challenge I will handle, because I have to.  Any solid, practical advice on the rest would be greatly appreciated.

Peace

Hey tactilejones, how's it going? Thanks for your
reply to "do I need a higher dose?".   I went to see my
doctor today. I've slipped into one of those really
depressed states, the kind where I can feel it coming
on and I say to myself "No, please don't go there
again" and the kind where I feel almost paralyzed
and stuck. Along with this really depressed state
came the anxiety. It got so bad today that I had to
leave work early because I felt like the painting "The
Scream". I know its crazy or wait, maybe I am.
Anyway, the doctor increased my Lexapro to
30mg/day and she gave me a script for klonopin (I
haven't been on that one for a while so things must
be bad"). The wellbutrin and the ritalin doses are the
same. God, I feel like a walking pharmacy. Sorry
about all that, I just had to vent to someone who
might understand what I was talking about. Anyway,
thanks again for your reply. Even though you are
afraid of addiction I think you should try the ritalin.
Yes, I am one of those people who can honestly say
that it "saved my life". I've been on it for six years and
it has made a world of difference. I know for a fact
that had I not been on ritalin, I would have never
gone back to school to get another degree. I can
actually focus and think for once. You owe it to
yourself to give it a try. I want to type more, but I need
to refer to some of your other posts because I can
really identify with a lot that you have written and
there are some other things that I would like to
discuss. OK with you? Hope so! Until then, take
care.