![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Mr. Scott on January 29, 2002, at 20:25:02
Can people tell me what it's like to have bipolar II disorder with or without rapid cycling or mixed states?I've read the text book descriptions but what actually happens during a true blue hypomania or mixed state. How does one feel and act? What is going on inside the mind and how does it become clear that a mood stabilizer is necessary?
The reason I ask, is because as a child I was hyperactive by all accounts (a True Deviant bordering on sociopath). When I first felt depressed at 16 I used tricyclics which made me so anxious and crazed that I convinced myself I was Gay (which is fine but I'm straight!) I however forced myself to take them, and as I raised the dose of Sinequan and added Xanax, I got better and made a transition in to a non-deviant non-sociopath citizen, convincing myself all the while things would get better. However, I developed a drug problem in highschool, that carried over and intensified in College. In my last semester or thereabouts my drug use escalated (cocaine, heroin)and I dropped out. I actually had to declare bankruptcy because of the money I had spent on drugs and subsequent hospitalizations. At one point "I was chasing imaginary people around outside my house in my underwear from doing so much cocaine!" The police got involved... And finally, After this all went down and I was finally getting clean and straightening out (Still occasionally binge on booze 6-7 drinks couple times a month) I was given the combo of Prozac and Wellbutrin which I firmly believe caused a Severe agitation that drove me to attempt suicide. My mood was changing hourly until I became so agitated I just started thinking evil thoughts and then I decided this would never end and I should die.
Well that was almost 6 years ago, and since then I have never really been totally free of depression or anxiety. Although I did return to school to graduate and have become fairly successful and independent despite my shitty mood.
I have been off the illicit drugs for nearly 6 years, but in my life I have pretty much never been able to tolerate an AD without a benzo. And obviously it hasn't worked as well as I'd hoped it would or I wouldn't be lamenting on this now.
Sorry for rambling, and back to my original question about describing bipolar stuff. As the diagnosis has become more inclusive I am trying to do some research on what it actually is and what experience people actually have with it outside of textbook descriptions.
The BP II and mixed stuff is most interesting to me.Your feedback is appreciated.
Posted by 3 Beer Effect on January 29, 2002, at 23:13:31
In reply to At least you might get a kick out of this, posted by Mr. Scott on January 29, 2002, at 20:25:02
It is hard to tell the difference between Adult ADHD & Bipolar II, they share many similar symptoms. I am having the same problem, I don't know which of these is my problem (I also cannot tolerate even SSRI antidepressants w/o a benzo b/c of insomnia).
The thing is, with your background of drug & alcohol use, Doctors will probably not give you the medicine to help w/ ADHD because most of them are Schedule II abuse prone stimulants like Ritalin, Dexedrine (d-amphetamine) or Adderall.
It is safer for them to give you "dumb drug" mood stabilizers like Depakote or Lithium that make you want to sleep all day.The only real way to tell is to take the comprehensive tests for ADHD or get a SPECT scan done.
Posted by Mr. Scott on January 29, 2002, at 23:26:22
In reply to Adult ADHD Bipolar II are commonly confused, posted by 3 Beer Effect on January 29, 2002, at 23:13:31
3Beers,
Spect scan...Now thats a new idea I haven't yet pursued. I don't suppose it's likely to get reimbursed by insurance...How much does such a thing cost?
Scott
It is hard to tell the difference between Adult ADHD & Bipolar II, they share many similar symptoms. I am having the same problem, I don't know which of these is my problem (I also cannot tolerate even SSRI antidepressants w/o a benzo b/c of insomnia).
>
> The thing is, with your background of drug & alcohol use, Doctors will probably not give you the medicine to help w/ ADHD because most of them are Schedule II abuse prone stimulants like Ritalin, Dexedrine (d-amphetamine) or Adderall.
> It is safer for them to give you "dumb drug" mood stabilizers like Depakote or Lithium that make you want to sleep all day.
>
> The only real way to tell is to take the comprehensive tests for ADHD or get a SPECT scan done.
Posted by 3 Beer Effect on January 30, 2002, at 2:19:01
In reply to Re: Adult ADHD Bipolar II are commonly confused » 3 Beer Effect, posted by Mr. Scott on January 29, 2002, at 23:26:22
> I think I read somewhere that SPECT scans are around $1500. They have to inject some kind of green dye that crosses into your brain in order for the scan to be effective. Insurance might pay for the scan if your psychiatrist deems that it is necessary to treat you, but somehow I would think HMOs would object to spending that kind of money unless it was life threatening, or even if it was life threatening for that matter!
3 Beers.
>
> Spect scan...Now thats a new idea I haven't yet pursued. I don't suppose it's likely to get reimbursed by insurance...How much does such a thing cost?
>
> Scott
>
>
Posted by IsoM on January 30, 2002, at 2:34:31
In reply to SPECT scans are around $1500 I think, posted by 3 Beer Effect on January 30, 2002, at 2:19:01
Just stepping into your conversation, if you don't mind, with a question.
Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
Posted by MB on January 30, 2002, at 4:11:43
In reply to Bipolar II and ADHD Differences? » 3 Beer Effect, posted by IsoM on January 30, 2002, at 2:34:31
> Just stepping into your conversation, if you don't mind, with a question.
>
> Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
Also, can't a person have both, or are they mutually exclusive?
Posted by Ritch on January 30, 2002, at 10:07:57
In reply to Bipolar II and ADHD Differences? » 3 Beer Effect, posted by IsoM on January 30, 2002, at 2:34:31
> Just stepping into your conversation, if you don't mind, with a question.
>
> Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.Hi IsoM,
The fuzziness with the diagnosis is that BP-II's do not experience psychotic mania. Also people with ADHD have mood swings, irritability, impulsiveness, restlessness, distractability as part of their symptom complex. When BP-II's are hypomanic or depressed they can have great trouble focusing and concentrating (distractability). Also, there are "inattentive" ADHD people that are depressed (couch-potatoes). There is just a lot of overlap with the symptoms. I was dx'ed as BP for about 20 years, then it got switched to ADHD. Then it got switched to social phobia/panic. Now, it is all three. I have a nephew who looks and acts a lot like me and he is ADHD and is on Ritalin and doing fine. The real test is to give someone who is BP-II a low dose of a stimulant and see what happens (IMO). Give it a week or so and see how they are doing. If they are quiet and focused and sleeping normally, you could consider ADHD in addition to or instead of BP-II. If they get hypomanic and develop chronic insomnia and their distractability gets *worse* one might rule out ADHD. I would like to get to the bottom of it for sure. I still think I have both.
Mitch
Posted by IsoM on January 30, 2002, at 13:08:56
In reply to Re: Bipolar II and ADHD Differences? » IsoM, posted by Ritch on January 30, 2002, at 10:07:57
Posted by petters on January 30, 2002, at 16:13:03
In reply to Re: Bipolar II and ADHD Differences? » IsoM, posted by Ritch on January 30, 2002, at 10:07:57
> > Just stepping into your conversation, if you don't mind, with a question.
> >
> > Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
>
> Hi IsoM,
>
> The fuzziness with the diagnosis is that BP-II's do not experience psychotic mania. Also people with ADHD have mood swings, irritability, impulsiveness, restlessness, distractability as part of their symptom complex. When BP-II's are hypomanic or depressed they can have great trouble focusing and concentrating (distractability). Also, there are "inattentive" ADHD people that are depressed (couch-potatoes). There is just a lot of overlap with the symptoms. I was dx'ed as BP for about 20 years, then it got switched to ADHD. Then it got switched to social phobia/panic. Now, it is all three. I have a nephew who looks and acts a lot like me and he is ADHD and is on Ritalin and doing fine. The real test is to give someone who is BP-II a low dose of a stimulant and see what happens (IMO). Give it a week or so and see how they are doing. If they are quiet and focused and sleeping normally, you could consider ADHD in addition to or instead of BP-II. If they get hypomanic and develop chronic insomnia and their distractability gets *worse* one might rule out ADHD. I would like to get to the bottom of it for sure. I still think I have both.
>
> MitchHi Mitch...
Have you ever tried Effexor for ADHD, or perhapes for bipolar depression? New studies show promising result regarding ADHD and Effexor.
Sincerely...//Petters
Posted by Ritch on January 30, 2002, at 23:46:21
In reply to Re: Bipolar II and ADHD Differences?, posted by petters on January 30, 2002, at 16:13:03
> > > Just stepping into your conversation, if you don't mind, with a question.
> > >
> > > Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
> >
> > Hi IsoM,
> >
> > The fuzziness with the diagnosis is that BP-II's do not experience psychotic mania. Also people with ADHD have mood swings, irritability, impulsiveness, restlessness, distractability as part of their symptom complex. When BP-II's are hypomanic or depressed they can have great trouble focusing and concentrating (distractability). Also, there are "inattentive" ADHD people that are depressed (couch-potatoes). There is just a lot of overlap with the symptoms. I was dx'ed as BP for about 20 years, then it got switched to ADHD. Then it got switched to social phobia/panic. Now, it is all three. I have a nephew who looks and acts a lot like me and he is ADHD and is on Ritalin and doing fine. The real test is to give someone who is BP-II a low dose of a stimulant and see what happens (IMO). Give it a week or so and see how they are doing. If they are quiet and focused and sleeping normally, you could consider ADHD in addition to or instead of BP-II. If they get hypomanic and develop chronic insomnia and their distractability gets *worse* one might rule out ADHD. I would like to get to the bottom of it for sure. I still think I have both.
> >
> > Mitch
>
> Hi Mitch...
>
> Have you ever tried Effexor for ADHD, or perhapes for bipolar depression? New studies show promising result regarding ADHD and Effexor.
>
> Sincerely...//Petters
Hi Petters,Yes, I have tried Effexor and it did help somewhat with attentiveness. But, the Effexor aggravated my bipolar cycling and caused hostility. Adderall had an anticycling effect, but made me anxious...
Mitch
Posted by petters on January 31, 2002, at 1:49:53
In reply to Re: Bipolar II and ADHD Differences? » petters, posted by Ritch on January 30, 2002, at 23:46:21
> > > > Just stepping into your conversation, if you don't mind, with a question.
> > > >
> > > > Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
> > >
> > > Hi IsoM,
> > >
> > > The fuzziness with the diagnosis is that BP-II's do not experience psychotic mania. Also people with ADHD have mood swings, irritability, impulsiveness, restlessness, distractability as part of their symptom complex. When BP-II's are hypomanic or depressed they can have great trouble focusing and concentrating (distractability). Also, there are "inattentive" ADHD people that are depressed (couch-potatoes). There is just a lot of overlap with the symptoms. I was dx'ed as BP for about 20 years, then it got switched to ADHD. Then it got switched to social phobia/panic. Now, it is all three. I have a nephew who looks and acts a lot like me and he is ADHD and is on Ritalin and doing fine. The real test is to give someone who is BP-II a low dose of a stimulant and see what happens (IMO). Give it a week or so and see how they are doing. If they are quiet and focused and sleeping normally, you could consider ADHD in addition to or instead of BP-II. If they get hypomanic and develop chronic insomnia and their distractability gets *worse* one might rule out ADHD. I would like to get to the bottom of it for sure. I still think I have both.
> > >
> > > Mitch
> >
> > Hi Mitch...
> >
> > Have you ever tried Effexor for ADHD, or perhapes for bipolar depression? New studies show promising result regarding ADHD and Effexor.
> >
> > Sincerely...//Petters
>
>
> Hi Petters,
>
> Yes, I have tried Effexor and it did help somewhat with attentiveness. But, the Effexor aggravated my bipolar cycling and caused hostility. Adderall had an anticycling effect, but made me anxious...
>
> MitchHi Mitch...
Have you ever consider adding a moodstabilizer like Lamictal or even better for your anxiety, Neurontin. What I try to say if you have some sign of bipolar it will be very correct using this stratergi. Some researcher means that ADHD symptom is in fact a form of bipolar disorder and nearly allways need treatment with moodstabilizer.
Sorry for my bad spelling. Not from U.S
Sincerely...//Petters
Posted by Peter on January 31, 2002, at 2:18:24
In reply to Re: Bipolar II and ADHD Differences?, posted by petters on January 31, 2002, at 1:49:53
This is certainly an interesting post that relates significantly to that with which I myself have been grappling. At the onset of my pdoc sessions about 5 years ago, I was diagnosed with hypomania, possible ADD, and varying degrees of anxiety (generalized, social, etc.). My doctor prescribed me numerous drug combos over about 5 years, covering the spectrum of SSRI's, mood stabilizers, benzos, dopamine agonists, stimulants, and beta-blockers. My last cocktail consisted of adderal, depakote, klonopin, and Atenolol. The adderal helped me with attention/focus difficulties, impulsivity, and lack of drive and motivation, and the depakote was helping to curtail manic episodes. The klonopin decreased anxiety, and the atenolol kept my heart rate low and steady. But, as often occurs during med trials, what started off seemingly flawless became a mess; evidently, the adderall, as it accumulated in my system over a few weeks, caused increasing, unmanageable amounts of anxiety. So, I decided, along with my pdoc, to reduce everything and start with a clean slate. I came off the adderall, the atenolol, & reduced the depakote to almost nothing (but I kept the klonopin at a fairly steady low dose). Things seemed to be going well, and I even thought for awhile that I'd be able to deal with myself and my life without meds, when I began to experience terrible episodes of a whole jumble of symptoms that seemed to overlap into areas of ADD, hypomania, and anxiety. So now my doctor has prescribed me Neurontin (to add to my klonopin) with the intent that it could possibly deal with my wide spectrum of symptoms better than depakote, especially, those of anxiety and episodic depression. Who knows? Maybe it was my hypomania, not ADD, that rendered me unable to concentrate and relax. Later down the line, depending on how the neurontin helps me, I might have a small amount of pstim and/or SSRI added. Sorry for the length of this thread, but I thought I'd give a personal testimony reflecting the frequent difficulties of distinguishing between bipolar II and ADD, and the problems that can arise treating a comorbid case conventionally, especially when there's anxiety involved that a stimulant or SSRI can exacerbate. So much of it is trial and error. BTW, does anyone with similar diagnoses have positive experience with neurontin as an aid to episodic hypomania, anxiety, and underlying ADD? if the addition of a stimulant becomes necessary due to difficult ADD symptoms, is neurontin a better mood stabilizer to combine with a stimulant than depakote for those with anxiety? Thanks.
Posted by Ritch on January 31, 2002, at 9:59:14
In reply to Re: Bipolar II and ADHD Differences?, posted by petters on January 31, 2002, at 1:49:53
> Hi Mitch...
>
> Have you ever consider adding a moodstabilizer like Lamictal or even better for your anxiety, Neurontin. What I try to say if you have some sign of bipolar it will be very correct using this stratergi. Some researcher means that ADHD symptom is in fact a form of bipolar disorder and nearly allways need treatment with moodstabilizer.
>
> Sorry for my bad spelling. Not from U.S
>
> Sincerely...//PettersHi Petters,
Yes, I am taking Neurontin and Klonopin now. It is interesting that you mentioned ADHD as a form of bipolar disorder. It would even be interesting if bipolar disorder was a form of ADHD....
Mitch
Posted by Ritch on January 31, 2002, at 10:17:09
In reply to Re: Bipolar II and ADHD Differences?, posted by Peter on January 31, 2002, at 2:18:24
> This is certainly an interesting post that relates significantly to that with which I myself have been grappling. At the onset of my pdoc sessions about 5 years ago, I was diagnosed with hypomania, possible ADD, and varying degrees of anxiety (generalized, social, etc.). My doctor prescribed me numerous drug combos over about 5 years, covering the spectrum of SSRI's, mood stabilizers, benzos, dopamine agonists, stimulants, and beta-blockers. My last cocktail consisted of adderal, depakote, klonopin, and Atenolol. The adderal helped me with attention/focus difficulties, impulsivity, and lack of drive and motivation, and the depakote was helping to curtail manic episodes. The klonopin decreased anxiety, and the atenolol kept my heart rate low and steady. But, as often occurs during med trials, what started off seemingly flawless became a mess; evidently, the adderall, as it accumulated in my system over a few weeks, caused increasing, unmanageable amounts of anxiety. So, I decided, along with my pdoc, to reduce everything and start with a clean slate. I came off the adderall, the atenolol, & reduced the depakote to almost nothing (but I kept the klonopin at a fairly steady low dose). Things seemed to be going well, and I even thought for awhile that I'd be able to deal with myself and my life without meds, when I began to experience terrible episodes of a whole jumble of symptoms that seemed to overlap into areas of ADD, hypomania, and anxiety. So now my doctor has prescribed me Neurontin (to add to my klonopin) with the intent that it could possibly deal with my wide spectrum of symptoms better than depakote, especially, those of anxiety and episodic depression. Who knows? Maybe it was my hypomania, not ADD, that rendered me unable to concentrate and relax. Later down the line, depending on how the neurontin helps me, I might have a small amount of pstim and/or SSRI added. Sorry for the length of this thread, but I thought I'd give a personal testimony reflecting the frequent difficulties of distinguishing between bipolar II and ADD, and the problems that can arise treating a comorbid case conventionally, especially when there's anxiety involved that a stimulant or SSRI can exacerbate. So much of it is trial and error. BTW, does anyone with similar diagnoses have positive experience with neurontin as an aid to episodic hypomania, anxiety, and underlying ADD? if the addition of a stimulant becomes necessary due to difficult ADD symptoms, is neurontin a better mood stabilizer to combine with a stimulant than depakote for those with anxiety? Thanks.
Peter,Wow, your story is almost exactamente to my own. Yes, hypomania can be distracting enough to create focus troubles, too-I believe that. The trouble I have is I go into these seasonal depressions and the most prominent feature is daytime fatigue, hypersomnia, severe attentional problems with total lack of interest in everything (everything is BORING). *Nothing* has worked with *complete* success for these particular symptoms than a stimulant. In other words, during my depressive episodes IF I can focus (due to a pstim, i.e.) and not feel sleepy all day I am *not* depressed. I have never had such a striking remission from a depressive state. But, the anxiety does start "creeping up" and after a few weeks on 5mg of Adderall I got panicky and had to stop it. BTW, I am still taking Neurontin and Neurontin was the only med I was taking with the Adderall at the time and I still panicked. I seem to need a little bit of SSRI and clonazepam to prevent panic from recurring. I am not sure how it would go if I had those thrown in the mix (would I still have to stop the Adderall again?). Neurontin *does* seem to help with all three things you mentioned-anxiety, hypomania, and ADD. It just doesn't seem to work well by itself for everybody. Also, at higher doses you can get cognitive blunting from it (I did above 900mg/day).
Mitch
Posted by manowar on January 31, 2002, at 20:36:32
In reply to SPECT scans are around $1500 I think, posted by 3 Beer Effect on January 30, 2002, at 2:19:01
I went to the Amen clinic in CA in August. If they suspect that you may have ADD type problems- they like to take two scans: one when you're brain is at rest and one when you're concentrating. The scans have to be at least a day apart. The radioisotope they use for the scan takes about a day to leave the system.
BTW: They don't inject a dye at all. They inject a radioisotope (nuclear medicine)
It cost me $2,700 for:
1) The two scans
2) A history taken
3) A two-hour appointment with a psychiatrist
4) Dr. Amen personally reads every scan
5) A thorough ten-page write up that includes my history, complaints, evaluation, diagnosis, recommendations and treatment plan.
6) He also called my pdoc (whom I've since dumped) and set him strait!It was the best money I ever spent. I guess since the scans proved that I was truly ill, my insurance paid $2,300 for it.
Isn't it funny that insurance companies treat ADD as a brain based illness, but depression as some sort of psychological problem? My insurance would not pay for psychiatry. That's why I now see a pediatrician that specializes in ADD (Yes, he also treats adults too...)
I'll take one pediatrician over a dozen psychiatrists!
--Tim
> > I think I read somewhere that SPECT scans are around $1500. They have to inject some kind of green dye that crosses into your brain in order for the scan to be effective. Insurance might pay for the scan if your psychiatrist deems that it is necessary to treat you, but somehow I would think HMOs would object to spending that kind of money unless it was life threatening, or even if it was life threatening for that matter!
>
> 3 Beers.
> >
> > Spect scan...Now thats a new idea I haven't yet pursued. I don't suppose it's likely to get reimbursed by insurance...How much does such a thing cost?
> >
> > Scott
> >
> >
Posted by Mr. Scott on January 31, 2002, at 20:59:10
In reply to Re: Bipolar II and ADHD Differences?, posted by Peter on January 31, 2002, at 2:18:24
> This is certainly an interesting post that relates significantly to that with which I myself have been grappling. At the onset of my pdoc sessions about 5 years ago, I was diagnosed with hypomania, possible ADD, and varying degrees of anxiety (generalized, social, etc.). My doctor prescribed me numerous drug combos over about 5 years, covering the spectrum of SSRI's, mood stabilizers, benzos, dopamine agonists, stimulants, and beta-blockers. My last cocktail consisted of adderal, depakote, klonopin, and Atenolol. The adderal helped me with attention/focus difficulties, impulsivity, and lack of drive and motivation, and the depakote was helping to curtail manic episodes. The klonopin decreased anxiety, and the atenolol kept my heart rate low and steady. But, as often occurs during med trials, what started off seemingly flawless became a mess; evidently, the adderall, as it accumulated in my system over a few weeks, caused increasing, unmanageable amounts of anxiety. So, I decided, along with my pdoc, to reduce everything and start with a clean slate. I came off the adderall, the atenolol, & reduced the depakote to almost nothing (but I kept the klonopin at a fairly steady low dose). Things seemed to be going well, and I even thought for awhile that I'd be able to deal with myself and my life without meds, when I began to experience terrible episodes of a whole jumble of symptoms that seemed to overlap into areas of ADD, hypomania, and anxiety. So now my doctor has prescribed me Neurontin (to add to my klonopin) with the intent that it could possibly deal with my wide spectrum of symptoms better than depakote, especially, those of anxiety and episodic depression. Who knows? Maybe it was my hypomania, not ADD, that rendered me unable to concentrate and relax. Later down the line, depending on how the neurontin helps me, I might have a small amount of pstim and/or SSRI added. Sorry for the length of this thread, but I thought I'd give a personal testimony reflecting the frequent difficulties of distinguishing between bipolar II and ADD, and the problems that can arise treating a comorbid case conventionally, especially when there's anxiety involved that a stimulant or SSRI can exacerbate. So much of it is trial and error. BTW, does anyone with similar diagnoses have positive experience with neurontin as an aid to episodic hypomania, anxiety, and underlying ADD? if the addition of a stimulant becomes necessary due to difficult ADD symptoms, is neurontin a better mood stabilizer to combine with a stimulant than depakote for those with anxiety? Thanks.
Your story IS my story in terms of treatment approach and failure. I'm beginning to see this a lot here on this board and am beginning to formulate a hypothesis that many of us here share some common element that makes us unable for some reason to respond to meds the way most people do. Is it a missed bipolar component that makes Stimulants and AD intolerable? Is it a seizure disorder that makes makes them intolerable? Maybe what we have isn't so unique as what we don't have...The ability to tolerate the right meds because of some other neurological problem.
Scott
Posted by OldSchool on January 31, 2002, at 21:32:49
In reply to Re: Bipolar II and ADHD Differences? » IsoM, posted by Ritch on January 30, 2002, at 10:07:57
> > Just stepping into your conversation, if you don't mind, with a question.
> >
> > Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
>
> Hi IsoM,
>
> The fuzziness with the diagnosis is that BP-II's do not experience psychotic mania. Also people with ADHD have mood swings, irritability, impulsiveness, restlessness, distractability as part of their symptom complex. When BP-II's are hypomanic or depressed they can have great trouble focusing and concentrating (distractability). Also, there are "inattentive" ADHD people that are depressed (couch-potatoes). There is just a lot of overlap with the symptoms. I was dx'ed as BP for about 20 years, then it got switched to ADHD. Then it got switched to social phobia/panic. Now, it is all three. I have a nephew who looks and acts a lot like me and he is ADHD and is on Ritalin and doing fine. The real test is to give someone who is BP-II a low dose of a stimulant and see what happens (IMO). Give it a week or so and see how they are doing. If they are quiet and focused and sleeping normally, you could consider ADHD in addition to or instead of BP-II. If they get hypomanic and develop chronic insomnia and their distractability gets *worse* one might rule out ADHD. I would like to get to the bottom of it for sure. I still think I have both.
>
> MitchWow, this is super confusing and complicated. Im skeptical any psychiatrist no matter how well trained could diagnose in this subjective manner and be correct the majority of the time. I think it would be much easier and better if you could just get a brain scan, ie; SPECT.
Bring on the brain scans. I am waiting for it to hit clinical psychiatry.
Old School
Posted by Ritch on February 1, 2002, at 1:01:38
In reply to Re: Bipolar II and ADHD Differences?, posted by OldSchool on January 31, 2002, at 21:32:49
> > > Just stepping into your conversation, if you don't mind, with a question.
> > >
> > > Why is it so hard to differentiate between bipolar II & ADHD? I'm not disputing anyone's comment about it but truly don't understand why the difference can't be seen. Is it that some people have very clear-cut differences & others don't? For myself, it's as different as a horse from a zebra. Please educate me.
> >
> > Hi IsoM,
> >
> > The fuzziness with the diagnosis is that BP-II's do not experience psychotic mania. Also people with ADHD have mood swings, irritability, impulsiveness, restlessness, distractability as part of their symptom complex. When BP-II's are hypomanic or depressed they can have great trouble focusing and concentrating (distractability). Also, there are "inattentive" ADHD people that are depressed (couch-potatoes). There is just a lot of overlap with the symptoms. I was dx'ed as BP for about 20 years, then it got switched to ADHD. Then it got switched to social phobia/panic. Now, it is all three. I have a nephew who looks and acts a lot like me and he is ADHD and is on Ritalin and doing fine. The real test is to give someone who is BP-II a low dose of a stimulant and see what happens (IMO). Give it a week or so and see how they are doing. If they are quiet and focused and sleeping normally, you could consider ADHD in addition to or instead of BP-II. If they get hypomanic and develop chronic insomnia and their distractability gets *worse* one might rule out ADHD. I would like to get to the bottom of it for sure. I still think I have both.
> >
> > Mitch
>
> Wow, this is super confusing and complicated. Im skeptical any psychiatrist no matter how well trained could diagnose in this subjective manner and be correct the majority of the time. I think it would be much easier and better if you could just get a brain scan, ie; SPECT.
>
> Bring on the brain scans. I am waiting for it to hit clinical psychiatry.
>
> Old School
Hi O.S,I did have that BEAM comprehensive EEG "mapping" done a couple of years ago by a behavioural neurologist (it was very experimental at the time). At the time, it was so weird I thought it was a bunch of quackery. He told me that I had left frontal hypofunctionality, a "flat spot" that could be a head injury (I lost consciousness when I was a kid in a bike accident-hitting my head on concrete), but no obvious seizure activity he could pinpoint. He wanted to do a sleep-deprived 24-hr. and then an MRI. I was real skeptical and didn't go for it-he retired while I was seeing him. I wonder what those might have turned up now..
Mitch
Posted by IsoM on February 3, 2002, at 15:33:41
In reply to Re: Bipolar II and ADHD Differences? » OldSchool, posted by Ritch on February 1, 2002, at 1:01:38
Mitch, I can probably do a search for good sites that explain the differences/similarities of bipolar II & ADHD, but if you know any that are good, could you post them? It would save me wading through lots of different sites trying to find the good ones. I'm curious to learn more.
Thanks :)
Posted by Ritch on February 3, 2002, at 23:26:44
In reply to Mitch, Know Any Bipolar II and ADHD Sites to Read? » Ritch, posted by IsoM on February 3, 2002, at 15:33:41
> Mitch, I can probably do a search for good sites that explain the differences/similarities of bipolar II & ADHD, but if you know any that are good, could you post them? It would save me wading through lots of different sites trying to find the good ones. I'm curious to learn more.
> Thanks :)
Hi IsoM,I don't have a lot to offer as far as *sites* go with information. I've just been diagnosed with both and I fulfill the diagnostic requirements of both. I haven't gotten a lot of really *useful* information that gets much better than what I read here about individual experiences. There are all sorts of studies out there you can find abstracts on that are occasionally insightful. But, unfortunately, they are generalizations put out based on usually small groups of people. If you are unfortunate enough to not "fit nicely" into a simple diagnostic category, that stuff is really not going to be of much help (abstracts,etc.). Basically, what I know and believe about my problems is based on subjective personal experience with different medications (trial and error if you will), and what other *individuals* share about their experiences. You might start by simply reading the DSM-IV diagnostic criteria for bipolar II and ADHD and see what you think. There is one site I happen to have bookmarked about adults with ADHD
http://www.addult.org/
and it is somewhat interesting.hope this is of some help,
Mitch
Posted by Ritch on February 4, 2002, at 11:23:17
In reply to Mitch, Know Any Bipolar II and ADHD Sites to Read? » Ritch, posted by IsoM on February 3, 2002, at 15:33:41
> Mitch, I can probably do a search for good sites that explain the differences/similarities of bipolar II & ADHD, but if you know any that are good, could you post them? It would save me wading through lots of different sites trying to find the good ones. I'm curious to learn more.
> Thanks :)
IsoM,I am going to paste in this 50 tips article. It mentions meds just once, but this is something I read and it rang so many bells about my own behavior, perhaps it would be insightful for others. In it the M.D.'s mention the need to "exclude similar and related disorders" such as manic-depression, OCD, etc. Well, if it is a similar and related disorder-could it all be a part of the same thing??
Mitch
=============================================
You may download and reproduce this article, link to it, or include on your website, but only if you include the following statement at the top of the article and so that it is visible to all readers.
"This educational material is made available, courtesy of Darryl Peterson and Attention Deficit Disorder Resources, a non-profit organization based in Tacoma, whose purpose is to help people with Attention Deficit Disorder achieve their full potential. We have numerous materials as well as a quarterly newsletter for sale. Our address is ASW, P.O. Box 7804, Tacoma, WA. 98406-0804. Tel 253-759-5085, e-mail: addadhd@home.com < mailto: addadhd@home.com >and web site: www.addult.org < http://www.addult.org >
The Management of
Adult Attention Deficit Disorder
by Edward M. Hallowell, M.D. and John J. Ratey, M.D.
The treatment of ADD begins with hope. Most people who discover they have ADD, whether they be children or adults, have suffered a great deal of pain. The emotional experience of ADD is filled with embarrassment, humiliation, and self castigation. By the time the diagnosis is made, many people with ADD have lost confidence in themselves. Many have been misunderstood repeatedly. Many have consulted with numerous specialists, only to find no real help. As a result, many have lost hope.
The most important step at the beginning of treatment is to instill hope once again. Individuals with ADD may have forgotten what is good about themselves. They may have lost, long ago, any sense of the possibility of things working out. They are often locked in a kind of tenacious holding pattern, bringing all theory, considerable resiliency, and ingenuity just to keeping their heads above water. It is a tragic loss, the giving up on life too soon. But many people with ADD have seen no other way than repeated failures. To hope, for them, is only to risk getting knocked down once more.
And yet, their capacity to hope and to dream is immense. More than most people, individuals with ADD have visionary imaginations. They think big thoughts and dream big dreams. They can take the smallest opportunity and imagine turning it into a major break. They can take a chance encounter and turn it into a grand evening out. They thrive on dreams, and they need organizing methods to make sense of things and keep them on track.
But like most dreamers, they go limp when the dream collapses. Usually, by the time the diagnosis of ADD has been made, this collapse has happened often enough to leave them wary of hoping again. The little child would rather stay silent than risk being taunted once again. The adult would rather keep his mouth shut than risk flubbing things up once more. The treatment, then, must begin with hope.
We break down the treatment of ADD into five basis areas:
1. Diagnosis
2. Education
3. Structure, support, and coaching
4. Various forms of psychotherapy
5. Medication
In this article we will outline some general principles that apply both to children and adults concerning the non-medication aspects of the treatment of ADD. One way to organize the non-medication treatment of ADD is through practical suggestions.FIFTY TIPS
INSIGHT AND EDUCATION:
1. Be sure of the diagnosis. Make sure you're working with a professional who really understands ADD and has excluded related or similar conditions such as anxiety states, agitated depression, hyperthyroidism, manic depressive illness, or obsessive compulsive disorder.
2. Educate yourself. Perhaps the single most powerful treatment for ADD is understanding ADD in the first place. Read books. Talk with professionals. Talk with other adults who have ADD. You'll be able to design your own treatment to your own version of ADD.
3. Coaching. It is useful for you to have a coach, for some person near to you to keep after you in a supportive way. Your coach can help you get organized, stay on task, give you encouragement, or remind you to get back to work. Friend, colleague, or therapist (it is possible, but risky for your coach to be your spouse), a coach is someone to stay on you to get things done, exhort you as coaches do, keep tabs on you, and in general be in your corner, on your side. A coach can be tremendously helpful in treating ADD.
4. Encouragement. ADD adults need lots of encouragement. This is in part due to their having many self-doubts that have accumulated over the years. But it goes beyond that. More than the average person, the ADD adult withers without encouragement and positively thrives when given it. The ADD adult will often work for another person in a way he won't work for himself. This is not "bad," it just is. It should be recognized and taken advantage of.
5. Realize what ADD is NOT, i.e., conflict with mother, etc.
6. Educate and involve others. Just as it is key for you to understand ADD, it is equally, if not more important, for those around you to understand it--family, friends, people at work or at school. Once they get the concept they will be able to understandyou much better andto help you out as well. It is particularly helpful if your boss can be aware of the kinds of structures that help people with ADD.
7. Give up guilt over high-stimulus seeking behavior. Understand that you are drawn to high stimuli. Try to choose them wisely, rather than brooding over the "bad" ones.
8. Listen to feedback from trusted others. Adults (and children, too) with ADD are notoriously poor self observers. They use a lot of what can appear to be denial.
9. Consider joining or starting a support group. Much of the most useful information about ADD has not yet found its way into books but remains stored in the minds of the people who have ADD. In groups this information can come out. Plus, groups are really helpful in giving the kind of support that is so badly needed.
10. Try to get rid of the negativity that may have infested your system if you have lived for years without knowing what you had was ADD. A good psychotherapist may help in this regard. Learn to break the tapes of negativity that can play relentlessly in the ADD mind.
11. Don't feel chained to conventional careers or conventional ways of coping. Give yourself permission to be yourself. Give up trying to be the person you always thought you should be -- the model student or the organized executive, for example--and let yourself be who you are.
12. Remember that what you have is a neurological condition. It is genetically transmitted. It is caused by biology, by how your brain is wired. It is NOT a disease of the will, nor a moral failing. It is NOT caused by a weakness in character, nor by a failure to mature. It's cure is not to be found in the power of the will, nor in punishment, nor in sacrifice, nor in pain. ALWAYS REMEMBER THIS. Try as they might, many people with ADD have great trouble accepting the syndrome as being rooted in biology rather than weakness of character.
13. Try to help others with ADD. You'll learn a lot about the condition in the process, as well as feel good to boot.PERFORMANCE MANAGEMENT:
14. External structure. Structure is the hallmark of the non-pharmacological treatment of the ADD child. It can be like the walls of the bobsled slide, keeping the speedball sled from careening off the track. Make frequent use of:
1) notes to self
2) color coding
3) rituals
4) lists
5) reminders
6) files
15. Color coding. Mentioned above, color coding deserves emphasis. Many people with ADD are visually oriented. Take advantage of this by making things memorable with color: files, memoranda, texts, schedules, etc. Virtually anything in the black and white of type can be made more memorable, arresting, and therefore attention-getting with color.
16. Use pizzazz. In keeping with #15, try to make your environment as peppy as you want it to be without letting it boil over.
17. Set up your environment to reward rather than deflate. To understand what a deflating environment is, all most adult ADDers need do is think back to school. Now that you have the freedom of adulthood, try to set things up so that you will not constantly be reminded of your limitations.
18. Acknowledge and anticipate the inevitable collapse of x% of projects undertaken, relationships entered into obligations incurred.
19. Embrace challenges. ADD people thrive with many challenges. As long as you know they won't all pan out, as long as you don't get too perfectionistic and fussy, you'll
get a lot done and stay out of trouble.
20. Make deadlines. Think of deadlines as motivational devices rather than echoes of doom. If it helps, call them lifelines, instead of deadlines. In any case, make them and stick to them.
21. Break down large tasks into small ones. Attach deadlines to the small parts. Then, like magic, the large task will get done. This is one of the simplest and most powerful of all structuring devices. Often a large task will feel overwhelming to the person with ADD. The mere thought of trying to perform the task makes one turn away. On the other hand, if the large task is broken down into small parts, each component may feel quite manageable.
22. Prioritize. Avoid procrastination. When things get busy, the adult ADD person loses perspective: paying an unpaid parking ticket can feel as pressing as putting out the fire that just got started in the wastebasket. Prioritize. Take a deep breath. Put first things first. Procrastination is one of the hallmarks of adult ADD. You have to really discipline yourself to watch out for it and avoid it.
23. Accept fear of things going too well, Accept edginess when things are too easy, when there's no conflict. Don't gum things up, just to make them more stimulating.
24. Notice how and where you work best: in a noisy room, on the train, wrapped in three blankets, listening to music, whatever. Children and adults with ADD can do their best under rather odd conditions. Let yourself work under whatever conditions are best for you.
25. Know that it is O.K. to do two things at once: carry on a conversation and knit, or take a shower and do your best thinking, or jog and plan a business meeting. Often people with ADD need to be doing several things at once in order to get anything done at all.
26. Do what you're good at. Again, if it seems easy, that is O.K. There is no rule that says you can only do what you're bad at.
27. Leave time between engagements to gather your thoughts. Transitions are difficult for ADDers, and mini-breaks can help ease the transition.
28. Keep a notepad in your car, by your bed, and in your pocketbook or jacket. You never know when a good idea will hit you, or you'll want to remember something else.
29. Read with a pen in hand, not only for marginal notes or underlining, but for the inevitable cascade of "other" thoughts that will occur to you.MOOD MANAGEMENT:
30. Have structured "blow-out" time. Set aside some time in every week for just letting go. Whatever you like to do -- blasting yourself with loud music, taking a trip to the race track, having a feast -- pick some kind of activity from time to time where you can let loose in a safe way.
31. Recharge your batteries. Related to #30 most adults with ADD need feeling guilty about it. One guilt-free way to conceptualize it is to call it time to recharge your batteries. Take a nap, watch TV, meditate. Some-thing calm, restful, at ease.
32. Choose "good," helpful addictions such as exercise. Many adults with ADD have an addictive or compulsive personality such that they are always hooked on something. Try to make this something positive.
33. Understand mood changes and ways to manage these. Know that your moods will change willy-nilly, independent of what's going on in the external world. Don't waste your time ferreting out the reason why or looking for someone to blame. Focus rather on learning to tolerate a bad mood, knowing that it will pass, and learning strategies to make it pass sooner. Changing sets, i.e. getting involved with some new activity (preferably interactive) such as a conversation with a friend or a tennis game or reading a book will often help.
34. Related to #33, recognize the following cycle which is very common among adults with ADD:
a. Something "startles" your psychological system, a change or transition, a disappointment or even a success. The precipitant may be quite trivia. b. This "startle" is followed by a mini-panic with a sudden loss of perspective, the world being set topsy-turvy. c. You try to deal with this panic by falling into a mode of obsessing and ruminating over one or another aspect of the situation. This can last for hours, days, even months.
35. Plan scenarios to deal with the inevitable blahs. Have a list of friends to call. Have a few videos that always engross you and get your mind off things. Have ready access to exercise. Have a punching bag or pillow handy if there's extra angry energy. Rehearse a few pep talks you can give yourself, like, ‘’You've been here before. These are the ADD blues. They will soon pass. You are OK."
36. Expect depression after success. People with ADD commonly complain of feeling depressed, paradoxically, after a big success. This is because the high stimulus of the chase or the challenge or the preparation is over. The deed is done. Win or lose, the adult with ADD misses the conflict, the high stimulus, and feels depressed.
37. Learn symbols, slogans, sayings as shorthand ways of labeling and quickly putting into perspective slip ups, mistakes, or mood swings. When you turn left instead of right and take your family on a 20-minute detour, it is better to be able to say, "There goes my ADD again," than to have a 6-hour fight over your unconscious desire to sabotage the whole trip. These are not excuses. You still have to take responsibility for your actions. It is just good to know where your actions are coming from and where they're not.
38. Use "time-outs" as with children. When you are upset or over stimulated, take a time-out. Go away. Calm down.
39. Learn how to advocate for yourself. Adults with ADD are so used to being criticized, they are often unnecessarily defensive in putting their own case forward. Learn to get off the defensive.
40. Avoid premature closure of a project, a conflict, a deal, or a conversation. Don't "cut to the chase'' too soon, even though you're itching to.
41. Try to let the successful moment last and be remembered, become sustaining over time. You'll have to consciously and deliberately train yourself to do this because you'll just as soon forget.
42. Remember that ADD usually includes a tendency to over focus or hyper focus at times. This hyper focusing can be used constructively or destructively. Be aware of its destructive use: a tendency to obsess or ruminate over some imagined problem without being able to let it go.
43. Exercise vigorously and regularly. You should schedule this into Your life and stick with it. Exercise is positively one of the best treatments for ADD. It helps work off excess energy and aggression in a positive way, it allows for noise-reduction within the mind, it stimulates the hormonal and neurochemical system in a most therapeutic way, and it soothes and calms the body. When you add all that to the well-known health bene- fits of exercise, you can see how important exercise is. Make it something fun so you can stick with it over the long haul, i.e. the rest of you life.INTERPERSONAL LIFE:
44. Make a good choice in a significant other. Obviously this is good advice for anyone. But it is striking how the adult with ADD can thrive or flounder depending on the choice of mate.
45. Learn to joke with yourself and others about your various symptoms, from forgetfulness, to getting lost all the time, to being tactless or impulsive, whatever. If you canbe relaxed about it all to have a sense of humor, others will forgive you much more.
46. Schedule activities with friends. Adhere to these schedules faithfully. It is crucial for you to keep connected to other people.
47. Find and join groups where you are liked, appreciated, understood, enjoyed. People with ADD take great strength from group support.
48. Reverse of #47. Don't stay too long where you aren't understood or appreciated. Just as people with ADD gain a great deal from supportive groups, they are particularly drained and by negative groups.
49. Pay compliments. Notice other people. In general, get social training, as from your coach.
50. Set social deadlines. Without deadlines and dates your social life can atrophy. Just as you will be helped by structuring your business week, so too you will benefit from keeping your social calendar organized. This will help you stay in touch with friends and get the kind of social support you need.
Posted by manowar on February 4, 2002, at 23:28:28
In reply to Re: 50 tips for managing ADHD » IsoM, posted by Ritch on February 4, 2002, at 11:23:17
Posted by IsoM on February 6, 2002, at 3:13:24
In reply to Re: 50 tips for managing ADHD » IsoM, posted by Ritch on February 4, 2002, at 11:23:17
Thanks Mitch, I copied it into a Word document & modified th spacing to make it easier to read for me (got Irlen syndome too which makes reading some matierial hard - monitor screens are okay for brief bits but anything long, I print out.)
I recognise the names of the authors. I took out dozens of ADHD books when I first found out my problems. Socially, I'm not really handicapped in that area but orgnaisation is my weakest point > I'd LOVE to have a on-going coach with me but that's not practical. I have a couple of Ativan in my tonight to try to muffle the extreme pain of a toothache (must be abscessed) plus some codeine so I'm making more mistakes & corrections than actually simply typing.
Will tell you tomorrow what I read on the print out from you - thanks again.
Posted by petters on February 6, 2002, at 15:11:07
In reply to Re: 50 tips for managing ADHD » IsoM, posted by Ritch on February 4, 2002, at 11:23:17
> > Mitch, I can probably do a search for good sites that explain the differences/similarities of bipolar II & ADHD, but if you know any that are good, could you post them? It would save me wading through lots of different sites trying to find the good ones. I'm curious to learn more.
> > Thanks :)
>
>
> IsoM,
>
> I am going to paste in this 50 tips article. It mentions meds just once, but this is something I read and it rang so many bells about my own behavior, perhaps it would be insightful for others. In it the M.D.'s mention the need to "exclude similar and related disorders" such as manic-depression, OCD, etc. Well, if it is a similar and related disorder-could it all be a part of the same thing??
>
> Mitch
>
>
> =============================================
>
>
> You may download and reproduce this article, link to it, or include on your website, but only if you include the following statement at the top of the article and so that it is visible to all readers.
> "This educational material is made available, courtesy of Darryl Peterson and Attention Deficit Disorder Resources, a non-profit organization based in Tacoma, whose purpose is to help people with Attention Deficit Disorder achieve their full potential. We have numerous materials as well as a quarterly newsletter for sale. Our address is ASW, P.O. Box 7804, Tacoma, WA. 98406-0804. Tel 253-759-5085, e-mail: addadhd@home.com < mailto: addadhd@home.com >and web site: www.addult.org < http://www.addult.org >
> The Management of
> Adult Attention Deficit Disorder
> by Edward M. Hallowell, M.D. and John J. Ratey, M.D.
> The treatment of ADD begins with hope. Most people who discover they have ADD, whether they be children or adults, have suffered a great deal of pain. The emotional experience of ADD is filled with embarrassment, humiliation, and self castigation. By the time the diagnosis is made, many people with ADD have lost confidence in themselves. Many have been misunderstood repeatedly. Many have consulted with numerous specialists, only to find no real help. As a result, many have lost hope.
> The most important step at the beginning of treatment is to instill hope once again. Individuals with ADD may have forgotten what is good about themselves. They may have lost, long ago, any sense of the possibility of things working out. They are often locked in a kind of tenacious holding pattern, bringing all theory, considerable resiliency, and ingenuity just to keeping their heads above water. It is a tragic loss, the giving up on life too soon. But many people with ADD have seen no other way than repeated failures. To hope, for them, is only to risk getting knocked down once more.
> And yet, their capacity to hope and to dream is immense. More than most people, individuals with ADD have visionary imaginations. They think big thoughts and dream big dreams. They can take the smallest opportunity and imagine turning it into a major break. They can take a chance encounter and turn it into a grand evening out. They thrive on dreams, and they need organizing methods to make sense of things and keep them on track.
> But like most dreamers, they go limp when the dream collapses. Usually, by the time the diagnosis of ADD has been made, this collapse has happened often enough to leave them wary of hoping again. The little child would rather stay silent than risk being taunted once again. The adult would rather keep his mouth shut than risk flubbing things up once more. The treatment, then, must begin with hope.
> We break down the treatment of ADD into five basis areas:
> 1. Diagnosis
> 2. Education
> 3. Structure, support, and coaching
> 4. Various forms of psychotherapy
> 5. Medication
> In this article we will outline some general principles that apply both to children and adults concerning the non-medication aspects of the treatment of ADD. One way to organize the non-medication treatment of ADD is through practical suggestions.
>
> FIFTY TIPS
>
>
>
> INSIGHT AND EDUCATION:
> 1. Be sure of the diagnosis. Make sure you're working with a professional who really understands ADD and has excluded related or similar conditions such as anxiety states, agitated depression, hyperthyroidism, manic depressive illness, or obsessive compulsive disorder.
> 2. Educate yourself. Perhaps the single most powerful treatment for ADD is understanding ADD in the first place. Read books. Talk with professionals. Talk with other adults who have ADD. You'll be able to design your own treatment to your own version of ADD.
> 3. Coaching. It is useful for you to have a coach, for some person near to you to keep after you in a supportive way. Your coach can help you get organized, stay on task, give you encouragement, or remind you to get back to work. Friend, colleague, or therapist (it is possible, but risky for your coach to be your spouse), a coach is someone to stay on you to get things done, exhort you as coaches do, keep tabs on you, and in general be in your corner, on your side. A coach can be tremendously helpful in treating ADD.
> 4. Encouragement. ADD adults need lots of encouragement. This is in part due to their having many self-doubts that have accumulated over the years. But it goes beyond that. More than the average person, the ADD adult withers without encouragement and positively thrives when given it. The ADD adult will often work for another person in a way he won't work for himself. This is not "bad," it just is. It should be recognized and taken advantage of.
> 5. Realize what ADD is NOT, i.e., conflict with mother, etc.
> 6. Educate and involve others. Just as it is key for you to understand ADD, it is equally, if not more important, for those around you to understand it--family, friends, people at work or at school. Once they get the concept they will be able to understandyou much better andto help you out as well. It is particularly helpful if your boss can be aware of the kinds of structures that help people with ADD.
> 7. Give up guilt over high-stimulus seeking behavior. Understand that you are drawn to high stimuli. Try to choose them wisely, rather than brooding over the "bad" ones.
> 8. Listen to feedback from trusted others. Adults (and children, too) with ADD are notoriously poor self observers. They use a lot of what can appear to be denial.
> 9. Consider joining or starting a support group. Much of the most useful information about ADD has not yet found its way into books but remains stored in the minds of the people who have ADD. In groups this information can come out. Plus, groups are really helpful in giving the kind of support that is so badly needed.
> 10. Try to get rid of the negativity that may have infested your system if you have lived for years without knowing what you had was ADD. A good psychotherapist may help in this regard. Learn to break the tapes of negativity that can play relentlessly in the ADD mind.
> 11. Don't feel chained to conventional careers or conventional ways of coping. Give yourself permission to be yourself. Give up trying to be the person you always thought you should be -- the model student or the organized executive, for example--and let yourself be who you are.
> 12. Remember that what you have is a neurological condition. It is genetically transmitted. It is caused by biology, by how your brain is wired. It is NOT a disease of the will, nor a moral failing. It is NOT caused by a weakness in character, nor by a failure to mature. It's cure is not to be found in the power of the will, nor in punishment, nor in sacrifice, nor in pain. ALWAYS REMEMBER THIS. Try as they might, many people with ADD have great trouble accepting the syndrome as being rooted in biology rather than weakness of character.
> 13. Try to help others with ADD. You'll learn a lot about the condition in the process, as well as feel good to boot.
>
> PERFORMANCE MANAGEMENT:
> 14. External structure. Structure is the hallmark of the non-pharmacological treatment of the ADD child. It can be like the walls of the bobsled slide, keeping the speedball sled from careening off the track. Make frequent use of:
> 1) notes to self
> 2) color coding
> 3) rituals
> 4) lists
> 5) reminders
> 6) files
>
> 15. Color coding. Mentioned above, color coding deserves emphasis. Many people with ADD are visually oriented. Take advantage of this by making things memorable with color: files, memoranda, texts, schedules, etc. Virtually anything in the black and white of type can be made more memorable, arresting, and therefore attention-getting with color.
> 16. Use pizzazz. In keeping with #15, try to make your environment as peppy as you want it to be without letting it boil over.
> 17. Set up your environment to reward rather than deflate. To understand what a deflating environment is, all most adult ADDers need do is think back to school. Now that you have the freedom of adulthood, try to set things up so that you will not constantly be reminded of your limitations.
> 18. Acknowledge and anticipate the inevitable collapse of x% of projects undertaken, relationships entered into obligations incurred.
> 19. Embrace challenges. ADD people thrive with many challenges. As long as you know they won't all pan out, as long as you don't get too perfectionistic and fussy, you'll
> get a lot done and stay out of trouble.
> 20. Make deadlines. Think of deadlines as motivational devices rather than echoes of doom. If it helps, call them lifelines, instead of deadlines. In any case, make them and stick to them.
> 21. Break down large tasks into small ones. Attach deadlines to the small parts. Then, like magic, the large task will get done. This is one of the simplest and most powerful of all structuring devices. Often a large task will feel overwhelming to the person with ADD. The mere thought of trying to perform the task makes one turn away. On the other hand, if the large task is broken down into small parts, each component may feel quite manageable.
> 22. Prioritize. Avoid procrastination. When things get busy, the adult ADD person loses perspective: paying an unpaid parking ticket can feel as pressing as putting out the fire that just got started in the wastebasket. Prioritize. Take a deep breath. Put first things first. Procrastination is one of the hallmarks of adult ADD. You have to really discipline yourself to watch out for it and avoid it.
> 23. Accept fear of things going too well, Accept edginess when things are too easy, when there's no conflict. Don't gum things up, just to make them more stimulating.
> 24. Notice how and where you work best: in a noisy room, on the train, wrapped in three blankets, listening to music, whatever. Children and adults with ADD can do their best under rather odd conditions. Let yourself work under whatever conditions are best for you.
> 25. Know that it is O.K. to do two things at once: carry on a conversation and knit, or take a shower and do your best thinking, or jog and plan a business meeting. Often people with ADD need to be doing several things at once in order to get anything done at all.
> 26. Do what you're good at. Again, if it seems easy, that is O.K. There is no rule that says you can only do what you're bad at.
> 27. Leave time between engagements to gather your thoughts. Transitions are difficult for ADDers, and mini-breaks can help ease the transition.
> 28. Keep a notepad in your car, by your bed, and in your pocketbook or jacket. You never know when a good idea will hit you, or you'll want to remember something else.
> 29. Read with a pen in hand, not only for marginal notes or underlining, but for the inevitable cascade of "other" thoughts that will occur to you.
>
> MOOD MANAGEMENT:
> 30. Have structured "blow-out" time. Set aside some time in every week for just letting go. Whatever you like to do -- blasting yourself with loud music, taking a trip to the race track, having a feast -- pick some kind of activity from time to time where you can let loose in a safe way.
> 31. Recharge your batteries. Related to #30 most adults with ADD need feeling guilty about it. One guilt-free way to conceptualize it is to call it time to recharge your batteries. Take a nap, watch TV, meditate. Some-thing calm, restful, at ease.
> 32. Choose "good," helpful addictions such as exercise. Many adults with ADD have an addictive or compulsive personality such that they are always hooked on something. Try to make this something positive.
> 33. Understand mood changes and ways to manage these. Know that your moods will change willy-nilly, independent of what's going on in the external world. Don't waste your time ferreting out the reason why or looking for someone to blame. Focus rather on learning to tolerate a bad mood, knowing that it will pass, and learning strategies to make it pass sooner. Changing sets, i.e. getting involved with some new activity (preferably interactive) such as a conversation with a friend or a tennis game or reading a book will often help.
> 34. Related to #33, recognize the following cycle which is very common among adults with ADD:
> a. Something "startles" your psychological system, a change or transition, a disappointment or even a success. The precipitant may be quite trivia. b. This "startle" is followed by a mini-panic with a sudden loss of perspective, the world being set topsy-turvy. c. You try to deal with this panic by falling into a mode of obsessing and ruminating over one or another aspect of the situation. This can last for hours, days, even months.
> 35. Plan scenarios to deal with the inevitable blahs. Have a list of friends to call. Have a few videos that always engross you and get your mind off things. Have ready access to exercise. Have a punching bag or pillow handy if there's extra angry energy. Rehearse a few pep talks you can give yourself, like, ‘’You've been here before. These are the ADD blues. They will soon pass. You are OK."
> 36. Expect depression after success. People with ADD commonly complain of feeling depressed, paradoxically, after a big success. This is because the high stimulus of the chase or the challenge or the preparation is over. The deed is done. Win or lose, the adult with ADD misses the conflict, the high stimulus, and feels depressed.
> 37. Learn symbols, slogans, sayings as shorthand ways of labeling and quickly putting into perspective slip ups, mistakes, or mood swings. When you turn left instead of right and take your family on a 20-minute detour, it is better to be able to say, "There goes my ADD again," than to have a 6-hour fight over your unconscious desire to sabotage the whole trip. These are not excuses. You still have to take responsibility for your actions. It is just good to know where your actions are coming from and where they're not.
> 38. Use "time-outs" as with children. When you are upset or over stimulated, take a time-out. Go away. Calm down.
> 39. Learn how to advocate for yourself. Adults with ADD are so used to being criticized, they are often unnecessarily defensive in putting their own case forward. Learn to get off the defensive.
> 40. Avoid premature closure of a project, a conflict, a deal, or a conversation. Don't "cut to the chase'' too soon, even though you're itching to.
> 41. Try to let the successful moment last and be remembered, become sustaining over time. You'll have to consciously and deliberately train yourself to do this because you'll just as soon forget.
> 42. Remember that ADD usually includes a tendency to over focus or hyper focus at times. This hyper focusing can be used constructively or destructively. Be aware of its destructive use: a tendency to obsess or ruminate over some imagined problem without being able to let it go.
> 43. Exercise vigorously and regularly. You should schedule this into Your life and stick with it. Exercise is positively one of the best treatments for ADD. It helps work off excess energy and aggression in a positive way, it allows for noise-reduction within the mind, it stimulates the hormonal and neurochemical system in a most therapeutic way, and it soothes and calms the body. When you add all that to the well-known health bene- fits of exercise, you can see how important exercise is. Make it something fun so you can stick with it over the long haul, i.e. the rest of you life.
>
> INTERPERSONAL LIFE:
> 44. Make a good choice in a significant other. Obviously this is good advice for anyone. But it is striking how the adult with ADD can thrive or flounder depending on the choice of mate.
> 45. Learn to joke with yourself and others about your various symptoms, from forgetfulness, to getting lost all the time, to being tactless or impulsive, whatever. If you canbe relaxed about it all to have a sense of humor, others will forgive you much more.
> 46. Schedule activities with friends. Adhere to these schedules faithfully. It is crucial for you to keep connected to other people.
> 47. Find and join groups where you are liked, appreciated, understood, enjoyed. People with ADD take great strength from group support.
> 48. Reverse of #47. Don't stay too long where you aren't understood or appreciated. Just as people with ADD gain a great deal from supportive groups, they are particularly drained and by negative groups.
> 49. Pay compliments. Notice other people. In general, get social training, as from your coach.
> 50. Set social deadlines. Without deadlines and dates your social life can atrophy. Just as you will be helped by structuring your business week, so too you will benefit from keeping your social calendar organized. This will help you stay in touch with friends and get the kind of social support you need.Hi Ritch...
Very interesting information. Could you please, if possible explain the relationship regarding ADD and Bipolar II.
Sincerely...//Petters
Posted by anniebananie on February 6, 2002, at 22:49:20
In reply to Re: 50 tips for managing ADHD » IsoM, posted by Ritch on February 4, 2002, at 11:23:17
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.