CBT for Depression: Mood and Thought Diary

Last week I started therapy for my depression and ADD.  If therapy for ADD sounds strange, allow me to say that it's always been a huge factor in my depression.  When you grow up with any sort of neurological difference, your self-esteem is systematically crushed into a pulp; you're told that you're not "really" trying, that you don't care enough to learn, that you could do so much better if you just "worked up to your full potential".

It's that last one that really got to me.  I was told repeatedly by my parents and teachers that I was "too smart" to be sucking in school as much as I was.  I didn't feel like I was smart at all.  If I was so damn smart, why was school so hard?  Why couldn't I remember a word the teacher said?  Why couldn't I finish my assignments?  Why wouldn't they all realize that I was just plain dumb and leave me alone?

Growing up like that plants a lot of negative thoughts in your head.  The thought and mood diary that my therapist assigned me to do last week has really brought that out into the light.  I learned that sometimes my thoughts precede my mood, and sometimes my mood precedes my thoughts, but that whatever the situation holy crap am I a negative person!

Alaska, ADHD, and the Hunter-Farmer Hypothesis

Lately I've been neglecting the blogs I used to read, so I wandered over to Gina Pera's ADHD Roller Coaster to see what I've been missing.  I found an interesting guest post about the prevalence of ADD traits in Alaska.  After the author was first diagnosed, she started to notice that an unusually high number of her friends and relatives also had ADHD traits.  So she checked with them, and lo and behold, many of them had been diagnosed with ADD.

She makes the point that Alaska is tailor-made for people with ADHD.  There's plenty of dangerous, adventurous work to do for those of us who loathe the thought of traditional desk jobs (and I should say here and now that I used to harbor a fantasy of moving to Alaska to become a bush pilot).  To me, though, the most interesting part is when she describes walking through the woods with her sons.

When her sons are outside, suddenly their "distractibility" turns into "noticing things":

They are attuned to every detail of their surroundings, noticing each chirping bird fluttering softly in the brush and each animal track on the ground. Given the high probability of us running across a bear during our excursions, I find their hyper-awareness to be quite a relief. In a school setting it gets them in trouble; in a wilderness setting it could save their lives.

Now, I'm generally not one of those people who feels that ADD is some sort of gift, that people with ADD are somehow "more creative" than others.  I've known too many creative people who don't have ADHD, and they're a lot better off than I am -- they can follow through on their creative projects, and actually get around to putting them out into the world.

There is, however, one area where I do feel ADD confers a gift: when I'm outside, I notice a lot of things my non-ADHD compaions don't.  Quite simply, I'm "distracted" by every bird flying overhead, every rustling in the grass, every mark I see the ground.  I notice foxes and rabbits and quail and coyotes.  I see hawks diving for their dinners.  I spot whale spouts offshore.  Sometimes, my companions luck out and I can show them what I see.  Often, though, they miss out -- the wildlife has vanished by the time I point it out to them.  When I'm outside, I'm not "disordered", I'm "observant".  In this one area, ADD means I have an advantage that others don't.

Starting Therapy (hopefully)

I've probably needed therapy for several months now.  It's not something I could have handled in the months following my psychotic episode, but I definitely could have used it when I learned that my relationship is cracked to its very foundations.

I didn't seek counseling at that time because I felt I couldn't afford it.  We needed couples counseling, and I knew I'd need to see my doctor for med checks pretty often once winter really swung into high gear.  My pdoc isn't in network, so that would ultimately cost a few thousand dollars.

Since the death of my cat, I've felt overwhelmed by feelings of sadness and hopelessness.  I've lost a lot of motivation.  Though I know I don't really want to die, at times I felt ... well, kind of like I wanted to die.  It's clear that I need help.  But I can't afford to spend a few hundred dollars a month.  Not after spending a few thousand on vet bills last month.

Finally it occurred to me that my clinic at UCSF, which takes my health insurance, has one of the best mental health outfits in the country.  They probably also take my insurance.  I called them, and while they themselves are booked up, they could recommend a few people who had the knowledge to deal with my problems and who also take my health insurance.  

I think I've found someone I can work with (*fingers crossed*) and I hope to start late this week or early next week, depending on availability.  He's knowledgeable about both depression and ADHD, which I think will help me a great deal.  I've always wondered how depressed I would be if my ADHD weren't such a problem.  I underachieved in elementary school, and was constantly shamed by my teachers.  I came to believe that I was actually stupid and wished to hell everyone else would catch on and stop expecting so damn much of me.  When things got better in junior high and high school, I sort of felt like a fraud; when I got to college I hit a brick wall and was finally diagnosed with ADHD and learning disabilities; as an adult I've been chronically unemployed and underemployed.  Under these circumstances it's hard to have much self-confidence.  It's easy to get depressed.  

So I'm pretty glad to have a therapist who understands both mood disorders and AHHD.  One lesson I've learned is that if a therapist doesn't really understand ADHD, all sorts of problems can arise -- for instance, if you're chronically late, it's time to explore why you might be resistant to therapy.  Oh, of course you have ADHD, but what's really going on?  What's "really" going on, dammit, is that people with ADHD are chronically late.  That particular therapist was excellent in all other respects, so I kept working with her.  I guess the only good thing I can say is that I damn well learned to be on time to appointments.

Last week I was feeling pretty hopeless.  Just knowing that I'll be getting help has made a big difference.

Why Anti-Authoritarians Are Diagnosed As Mentally Ill

A friend of mine posted an article on Facebook about the medicalization of anti-authoritarian sentiment.  It's an important piece and well worth a read.

The author, Bruce Levine, PhD (psychology), asserts that to succeed in the medical profession or in academia one must subit to plenty of arbitrary authority.  By the time these professionals are in a position to practice in their fields, they're used to obeying, and people who don't make them nervous.  There must be something "wrong" with them, right?

And what about the anti-authoritarians?  Is it always invalid to diagnose us with mental, learning, and behavior problems?  Sadly, it's not.

When we try to make a good life for ourselves, we struggle to fit in, but our deficits are apparent -- look, it's ADD!  It's a learning disability!  But why do I have to be good at math, or for that matter any other academic subject?  Why do I have to pretend to be interested in math?  Who decides which subjects are "important" enough to be taught in school?  I come to this example again and again -- if I have LD in math, why don't other people have LD in art or music?  As for the attentional issues, isn't there something kind of coercive about deciding that any person must focus their attention in a direction not of their choosing?

This isn't fair.  It pathologizes a legitimate difference in my brain. Yet, I have to try to fit in if I want anything like a life for myself.  My choice is between medicating myself and having no life.

Levine's concern is that too many social critics are diagnosed and medicated before they come to political consciousness.  I count myself lucky that I'm not one of these people.  For that matter, there's a great discussion of social class and access to ADHD treatment going on at ADD Forums.  Check it out.  And be sure to check out Levine's article too.

Motivational Problems: (Or: My Life Keeps Getting Worse)

My cat is probably dying.

A few weeks back she lost her appetite, then seemed to regain it.  Since returning home from my trip, however, she's no longer eating.  Within 24 hours I was in the vet's office.  My cat, who's been 16 lbs most of her life, is now 8 lbs.

The vet recommended an x-ray, but the results, like the results of the blood panel and the urinalysis, showed nothing wrong.

Great news, right?  Not so much.  When you've got a cat who's obviously as sick as mine -- all that loss of weight and apetite -- you're probably looking at cancer.  The next step is to get a second opinion from an internal medicine specialist.  They would probably do an ultrasound, which would cost about $600, and be one more traumatic experience for my poor kitty.  Since I have yet to talk to anyone who's had a good experience giving their cat chemo, I would probably opt for palliative care.  I'll be talking to the specialist about this.

In the mean time, I've felt really unmotivated.  I need to clean the house, because it looks like a tornado threw up on it.  I need to sell some crap on Craigslist.  I need to work on my stained glass project.

I wondered if my meds needed adjusting, if somehow they'd started to fight with each other ... and then I realized: I am motivated to do one thing, and just one.  I am motivated to spend quality time with my cat.  I will sit on the couch for as long as she wants me to.  That's my motivation right now.

Lamictal 300: Why am I "depressed"?

Hotbrain wrote me a nice supportive note the other day about my mood problems (apparently my comment form is evil, which isn't surprising, since Blogger is run by Google).

I don't know whether my mood problems are caused by some sort of medication poop-out or not.  They may be.  I think it's more likely that my stress is situational.  This is still a problem when you have a clinical mental illness.  Situational stress drags down your mood, obviously, and unlike the mentally boring, we lack the resources to pull our mood up when the situation resolves itself.

I feel like my meds are working.  I feel stable, I'm not normal one minute and then sobbing the next.  But my life is depressing me.  I'm not meeting my goals for this year.  My cat isn't eating (but maybe she's getting better ... or maybe that's just what I want to see), which has led to a lot of unexpected expenses.  I find myself ruminating on these things.  It's hard for me to remember all that MCBT I learned ... and I'm not meditating like I should be.

I've stopped boozing.  I'm back to drinking one drink a few nights a week.  As when you throw away any sort of mental crutch, a painful realization followed: drinking had been one of the few things I enjoyed doing.  Painting seems like too much work.  Music?  Need to tune the instrument first, and harpsichords have A LOT of strings.

In all honesty, the prep for these activities are not that bad, but when you have ADD and depression, they seem overwhelming.  The thing I really want to do is work with stained glass.  But I don't have the tools, and doing it in your house is a great way to spread shards of glass all over it.  I'm thinking seriously of setting up outside on my deck and buying the damn tools.

Not having a part of your day that you really enjoy is ... well, it's depressing.

What is it like to have ADD, Part II: The Radio Metaphor

A few months ago Mo at Milligrams requested a post about what it's like to have ADHD.  Since I was writing a blog post, I gave my long, detailed answer

This week I was asked the same question by a friend in my stained glass class.  When people in real life ask me about ADD, I don't give them the long answer.  They don't need to know what my typical day is like.  They don't need to know what it's like to have your mind wander all over creation.  They need to understand the experience of ADHD quickly and concisely.

Since I have trouble with "quick and concise" when I write, I've put the important bits in bold.  The bold face type is what I would say to someone in real life who asks about ADHD.  The rest is just elaboration and explanation, in case you're into that sort of thing.

When someone I know in real life asks what it's like to have ADD, I turn to my radio metaphor.  The radio metaphor looks something like this:

Having ADD is like driving through a rural area with your radio on.  Unfortunately, the radio in your car is stuck in the "on" position and the volume control died a long time ago.  Since you're out in the boonies, your radio is picking up two or three stations at once.   All you're getting is garble and horrible, earsplitting static.   You wish you could change stations, but you can't.  None of them come in clearly.   


I gave this explanation to my friend, who was very sympathetic.  "That sounds really hard," she said.  Another friend who had been listening, nodded and said, "I'm deaf in one ear, and it's a similar experience.   I can only process half of what people are saying, and I can't filter out what's important."

That was on Tuesday, and in the days since, I've been thinking about her hearing loss, and my grandmother's hearing loss, and how similar they are to the ADHD experience.  As with my mental "radio", they have trouble tuning into any one thing in their audible environments.  But I have ADD; I can treat my condition.  What does treatment do for the radio metaphor?

Taking medication for ADD allows your "radio" to tune to a single station.  Finally, you can enjoy some blessed quiet -- only one radio station at once!  But there's a catch (isn't there always?): you don't always have a choice about which station that is. 

For instance, you might open the fridge door, notice that it's pretty full, and decide that you'd have a lot more space if you put the leftovers in smaller containers.  So you do that.  You're on meds, so you can finish the task without getting distracted by something shiny.  Which is great, right?  Yay, a task has been accomplished!

Except that you opened the fridge door for an entirely different reason -- you need to make lunch and eat it before you have to meet someone in half an hour.  In other words, you needed your radio to be tuned to the "making lunch" station, but it jumped over to the "deal with leftovers" station instead.  And you don't know to change it back.  Fortunately, since you're on meds, after you finish the task you remember that you have somewhere to be, only now you have ten minutes instead of half an hour.  So how do you tune your radio?

Pills don't teach skills.  Getting control of your radio is a skill.   

In order to tune your radio to the station you want, you need to learn skills.  You need to learn a lot of them, but I'll use just one as an example: scaffolding.

"Scaffolding" refers to creating habits and routines that support your day to day existence.  For instance, my keys and my sunglasses are in the hat that I wear every day.  I know they will be there, so I don't have to spend half an hour looking for my keys every time I leave the house.  My wallet?  Always in the outer pocket of my bag.  My cell phone?  Either on the charger or in my left jacket pocket.

Neurotypicals can take paying attention for granted.  For ADDers, it takes a ton of energy.  By building the scaffolding I described above (and believe me, that's only a small part of it) I can free up a great deal of mental energy.  I can put that energy toward learning other ADD coping skills.  I can learn how to keep track of what tasks I need to accomplish, and I can learn how to tell which ones are the most important or time-sensitive.  Eventually, when something unexpected happens to disrupt my routine, I can figure out how to deal with it instead of allowing it to disrupt my whole day -- or my whole week.

In other words, I'm finally in charge of choosing the station on my radio.

Lamictal 300 mgs: Plus 2 mgs Abilify, minus 5 mgs Adderall

The short version: my mood has been all over the place for the last week and a half.  My pdoc had two options.  Number 1: Go back on 12.5 mgs of Zoloft, which would numb me out a bit, and shouldn't give me SSRI problems because they'd be tempered by the lamictal.  Or, number 2: go back on Abilify for the short term at a very low dose; I'd still feel my feelings, but I won't be reduced to tears over stupid shit.

In other words, the lamictal is helping a lot with the depression, but it's not stabilizing my mood as much as it needs to, and it needs help.

We decided to try Abilify first. We know from past experience that it will work immediately.  I also think it's important to feel my feelings; I just need not to be completely overwhelmed by them.  I feel pretty good about this.  I can start it tomorrow and stop crying like an emo kid.

We're also removing the Adderall from my cocktail.  After two weeks it's clear that while it does help my mood, it doesn't help enough.  It also wreaks havoc with my sleep.   Unless I can be sure to squeeze in some seriously vigorous exercise, and I can't always do that, and messed up sleep equals messed up mood.

A few words about my mood lately.  At some times I'm feeling really good, almost too good, and for no particular reason.  Then if I'm triggered (or sometimes when I'm not), I crash and crash hard.  I start sobbing and simply can't talk myself down, let alone stop, for several hours.  When I finally do, I last about ten minutes before I start sobbing again.

What do I mean when I say "stupid shit"?  Well, let me tell you about the day after Thanksgiving.  We like to cook our own small turkey, because we like to do things with the leftovers.  But, unbeknownst to us, the turkey was partially frozen.  It probably was up against the side of the refrigerator case or something.  Anyway, it took all afternoon to cook (way too long for a 12 lb turkey, so I was already crying about that).  Then we cut into it, half of it was raw.

The rational side of my brain, and my husband, told me that this wasn't my fault, and that we could just use the turkey for stock, so it wouldn't be a total loss.

The crazy part of my brain was in tears because I'd wasted all day and my husband was sick so he couldn't help me cook so we hadn't spent time together and he was leaving the country the next day AND I RUINED THE HOLIDAY!

Don't even ask what happened when he returned from his trip and didn't immediately give me a hug.

I can't be crying so much that it interferes with my life.  And with my husband probably also being depressed, I can't be triggering that feedback loop where does something without knowing it will upset me, and then I start crying, and then he feels bad for upsetting me ... and gets stressed ... and I feel bad for stressing him out, so I cry more ... and he withdraws from me emotionally ... so I get more upset ... and the cycle begins anew.

To wrap up: Abilify.

ADHD Medication and Federal Law: Why Is It Such A Hassle To Get My Medications?

A few weeks ago, Mo over at Milligrams asked me to write a post on ADHD.  I realized that responding to his comment on my post actually required a series of several more posts.

Today's post addresses is actually one in a sub-series, concerning the legal issues that pertain to ADD medication.   This post United States covers federal drug laws, which operate under the United States Federal Controlled Substances Act.  When you're having trouble finding treatment for your adult ADHD, it pretty much comes down to the Controlled Substances Act.  That's why I'm beginning my series with this topic, even though it's rather dry.


*** Today's post concerns federal law and how it affects the simple act of filling your prescription.  I will begin with a brief overview of the classification of ADD medications under the federal Controlled Substances Act.  I will define the term"Schedule II medication".  I will go on to describe what that classification means when it comes to filling prescriptions ADHD meds.

As always, this long and complicated post is broken up into sections which are named in bold.  I will recap the main points of my post at the end.


And because it makes me feel better to write it, even though I'm sure you know better, I want to make it clear that I am not a lawyer, and this post should in now way be construed as legal advice. ***

The United States Controlled Substances Act: Schedule II

By and large, medications for ADHD are psychostimulants, and they generally fall into one of two categories: amphetamines and methylphenidate.  Under the US Controlled Substances Act of 1970, these drugs were designated as Schedule II controlled substances.  Schedule II includes any medication that has a high potential for abuse and addiction.  To put this in some context, other meds in this category include cocaine and opium.  

(To put it in even more context, the only class of medications that is more restrictive is Schedule I.  Schedule I drugs have no recognized medicinal purpose in the US and can only be used for research.  An example of a Schedule I drug is heroin.)

Notice the bold font I used up there, in the section on Schedule II? I wanted to make the point that this is some serious sh*t. 

As you might imagine, Schedule II drugs are tightly regulated by the feds.  But that's not the only set of laws that regulates these meds.  The Controlled Substances Act permits states to enact whatever regulations they want to regarding a controlled substance -- as long as those state regulations are even more stringent than federal law. I'll get into that in a later post.

What Does the Schedule II Classification Mean for Filling Prescriptions of ADD Medications?

Obviously, any prescription medication needs a prescription from a practitioner order to be dispensed -- otherwise, it wouldn't be a prescription med.  Where Schedule II medications differ from other meds is how the scrip can be transmitted to the pharmacy, and how many refills are allowed.  Unlike other, less regulated medications, Schedule II drugs are subject to the following rules.  And these are just the rules that pertain to pharmacists:

• Schedule II drugs cannot be dispensed without a written prescription from a medical practitioner.  There are two exceptions to this:

• The prescribing doctor is the one giving you the meds, and is you're the end user.  In other words, your pdoc can give you free samples of Medication X  -- if you are the person who will be taking the medication -- to make sure the medication is effective, you can tolerate it, etc, before you pay for a whole month's prescription.  Basically this means that you have to be an adult patient.  Your child's pdoc can't give you free samples on behalf of your kid, because you're not the end user.  And you can't just go giving drug samples to kids.

• It is a medical emergency, in which case oral permission from a practitioner is sufficient.

• There can be no refills of a Schedule II medication.

In short: None of the conveniences available for other prescriptions are available in the case of a Schedule II.  You have to have a written scrip -- your doctor cannot phone it or fax it in.  And when it comes time to refill?  You have to bring in a whole, brand-new, written prescription.

(The section of the Controlled Substances Act that governs the dispensation of Schedule II drugs is

Title 21 > Chapter 13 > Subchapter I > Part C > Section 829.  It can be found at on the website at the Cornell University Law School.  Go on, click on it.  It's exciting!  Besides, all the cool kids are doing it.)

What Do Schedule II Dispensation Rules Mean For Patients With ADHD?
 
Reading the last paragraph, it might sound like federal law requires people with ADD to see their psychiatrists once a month just to keep taking their prescribed medication.  Sounds like a major inconvenience, doesn't it? Is this really the case? Well, that depends.

Prescribing Schedule II Drugs Under California State Law:

In California, the answer  -- from a legal perpective at least -- is NO.  Granted, some pdocs might prefer to check in with their patients on a monthly basis, sometimes for good reasons, and sometimes for bad ones (more on that later).  But as far as the law in concerned, psychiatrists can write multiple prescriptions for a Schedule II medication and post-date them.

This is what my pdoc does.  By this point he knows me and trusts me, so I see him once every three months for a med check/depression check, and he then he writes three scrips with an "OK to fill after [this date]" notation.  That being said, he saw me once a month at the beginning; partly this was to check in with the meds, and (though he didn't say this outright) to make sure I wasn't tweaking. 

Other doctors like to see their patients once a month regardless.  It's not their legal obligation; they just feel more comfortable checking in more often.  Or, in some cases, they might prefer to bill the insurance company a monthly fee, and make more money than they would by seeing the patient every three months.

Again, this is the case in California, and if you live in another state the situation might be completely different.  Even so, when it comes to prescribing Schedule II's, doctors can impose all kinds of restrictions on their patients.  But that's a topic for another post.

To recap for my ADHD readers who just skimmed this post (and if I hadn't written it, believe me that's what I would have done):

• ADD meds are placed in Schedule II under the Controlled Substances Act, along with drugs like opium and cocaine.
• Schedule II substances require a written prescription, with a few exceptions (such as emergencies)
• Schedule II substances cannot be refilled
• Some doctors require monthly visits from their ADHD patients in order to give them the written scrip
• In some states, this is the law; in others, it's the doctor's personal preference

The next post in this series discusses drug laws and the impact they have on prescribing doctors.  The third post is about what it's like to live under these laws.

My Pharmacoepia

Just for fun the other day, I decided to compile a list of all the medications I take.  Here they are in all their scary, scary glory.

Morning cocktail:

• Lamictal, 300 mgs (mood stabilizer)
• Vyvanse, 70 mgs (long-release amphetamine to treat ADD)
• Claritin, 10 mgs (anti-histamine)
• Nasacort, 2 puffs each nostril (corticosteroid to keep my sinuses and ears from inflaming)
• Singulair (leukotriene inhibitor to prevent asthma symptoms

Midday:

• Adderall, 5 mgs  (used as an amphetamine "booster" to treat late-afternoon mood slump)

Bedtime: 

• Ativan, 1.25 mgs.  

Monthly:

• My good and dear friend, the Nuvaring (birth control)

As Needed:

• Q-var (corticosteroid for wheezy asthma -- I pretty much have this for emergencies)
  
• Abuterol (corticosteroid for acute asthma attack -- I need this even less often than the Q-var)
• Phenlyephrine (decongestant that is MY BEST FRIEND, because I can't tolerate Sudafed; for the longest time there were no other decongestant options out there, but phenylephrine was released because you can't cook meth from it.  Thanks, crystal meth epidemic!)
• Advil (If you don't know what this is, you live under a rock and probably don't have internet anyway)
• Booze (for fun.)

My poor liver.  My poor, poor liver.

 

Lamictal! Adderall! Ativan! The Musical!

In yesterdays post I wrote about feeling tied to my sunlamp for most of the day.  This is particularly bad during the late afternoon during my usual 4pm to 8 pm slump.  It's seriously cramping my style.

I saw my pdoc recently, and he was concerned about the slump.  He wants to try other things before raising the dose of lamictal.  It which seems fair enough. 300 mgs of lamictal is as high as they usually go to treat mood disorders; 400 mgs and upwards puts you into anti-convulsant territory.

So his suggestion is to take 5 mgs of Adderall XR in the afternoon.  Great.  Another drug.  I wasn't already feeling like my pee could be sold as a street drug that "will really make you trip, man!  This stuff is primo!"

Hmmm.  Maybe there's a profit to be had there ...

Yesterday was the first time I tried the Adderall booster.  It definitely helped my mood, but I slept like crap last night.  I was exhausted, and hope to sleep like a baby.  As I sometimes (OK, all too frequently) do these days, I had two drinks to make damn sure I would sleep well.

Testing for ADHD: Simple Psych Evaluation? Or Complete Pysch Battery?

This post is long, so out of kindness to readers with ADD, I've summarized it at the end with nice bold bullet points.  Also, I'm not a doctor and I'm not a psychologist, so you know this isn't medical advice, right?  

Good.

I'm glad to be in correspondence with Mo over at Milligrams Blog.  We've been through a lot of the same shit.  And lately he's been raising some very good questions about ADHD -- what it's like, how it's treated, and the latest question, how it's diagnosed.

He thinks that a lot of his symptoms could be explained by ADHD, and recently asked his doctor about getting an evaluation and medication for the condition.  In a comment to my earlier post, he said that his doctor, who's an addiction specialist among other things, wants him to get a full neuropsychological evaluation before putting him on potentially addictive meds for ADD.  The psych eval will take several hours.  His insurance company won't cover it.  And he's never heard of this one before.

I'd always read that ADD is diagnosed by a psychiatrist carefully interviewing the patient, their family members, and looking at records like old report cards in order to establish that the symptoms have been present since childhood.  Symptoms must also be present in all areas of a patient's life -- education, work, home, leisure, interpersonal relationships ... you name it.

I'd also read that neuropsych evals were considered problematic for diagnosing adult ADHD, and were not often done.  Certainly there are plenty of folks on ADD Forums who were diagnosed through psychiatrist interviews alone.

I was surprised to learn that (according to Wikipedia and WebMD anyway) neuropsych batteries are supposed to be part of the adult ADD diagnosis. 

Fun Facts About ADHD Medication

To start with, I'd like to explain why I keep alternating between the acronyms "ADD" and "ADHD".  This is because the DSM keeps changing them on us.  When I was diagnosed, it was ADD -- attention deficit disorder.  Shortly thereafter it was changed to ADHD -- attention deficit hyperactivity disorder.  There's some talk of changing it back to ADD in the next iteration of the DSM.  Since both acronyms are used, I'd like to make it easier for people to find my post, regardless of which acronym they're using.

A few weeks ago, Mo over at Millgrams Blog asked me to do a post on ADHD.  In his comment to the post, he raised several interesting issues.  So many issues, in fact, that responding to them requires a series of posts.  In this post I'm going to cover the general facts about ADD meds and how they work.  In following posts I'll talk about the legal issues surrounding ADHD meds.  The final post will deal with the social issues that come with medicating ADD.

Since this post is pretty long, I've put the topic sentences in bold.

Niacin Rash vs Lamictal Rash: Why You Should Be Careful with Supplements

Disclaimer: this is not medical advice.  I am not a doctor.  If you take lamictal, and experience an unexplained rash, contact your doctor immediately.

Before I left for my trip, I had kind of a weird experience.

I was sitting at my studio table, typing away in front of my sun lamp, when I suddenly felt sunburned.  It came on very suddenly, almost in an instant.  Since lamictal can cause a deadly rash, I tend to freak out every time something weird happens to my skin.  The rash, officially called Stevens-Johnson, is so serious that a lot of pdocs will take you off lamictal if you have any kind of rash at all.  Now, it's pretty uncommon to experience the rash after the first two weeks on the med, and even rarer after the first eight weeks, but nonetheless I started to feel panicked.  I'd just been offered a job -- what if I have to go off my meds, at this time of year?  I wouldn't be able to work.  I wouldn't be able to do anything.

The rash was on my cheeks, nose, around my lips, on my chin, and even on my elbows ... but not on the rest of my arms.  It looked something like this: (I wanted to play with my drawing tablet, so I drew this.  Note the quivering lips and sad, shocked expression.)

(I wanted to play with my drawing tablet, so I drew this.  Note the quivering lips and sad, shocked expression.)

As always, I googled the question, and determined that the lamictal rash does not present as a feeling of sunburn.  I actually knew this but had forgotten it in my panic.  Then I googled "rashes that feel like sunburn."  I turned up a bunch of hits for something called a "niacin rash".  Niacin, or vitamin B3, is found in grains, and if you take too much of it, it can cause a sunburn-like rash, and if you keep taking too much of it, something called pellagra.

I had been eating one of my whole grain waffles as the rash appeared.  But I eat those every day, and I've never gotten a rash before.   So where was all of this niacin coming from?

I thought about it, and realized that the electrolyte mix I'd been taking to try and ease my lamictal constipation was also a vitamin supplement.  Maybe that contained niacin.  For the last few days, I'd been drinking 4 to 6 packets a day, just like the directions said ...

I double checked the box, and learned that, yes, it does contain niacin.  But I'm not supposed to take 4 to 6 packets a day.  I'm supposed to mix 1 or 2 packets into 4 to 6 oz. of water.  ADD strikes again.

Lesson learned.

Back from Family Trip: Thoughts About Memory Loss, ADD, and Blue Light Therapy

A few weeks ago, I wrote about my anxieties about my pending visit to my grandmother.  Some of my anxieties were due to childhood memories of being bored at my grandparents' rural home.  Some of them were due to the fact that my father had told me that she her cognition had "really declined".  Would she even remember that my sister and I were coming in to visit?  Would she recognize us?  Would she be startled every morning to find us there?

The answer to all of these questions was, hell no.  We had a great visit with Grandma.  She has trouble remembering things like what day it is, and therefore what day we were coming, or what time my aunt was going to visit her next.  Her long-term memory, her personality, and -- thank the gods! -- her sense of humor are intact.

In Which I Ponder My Eccentric Family, and the Nature of Existential Boredom

I'm taking a trip during the last week of October to visit my grandmother.  I've been anxious about the trip for a lot of reasons.  I don't know how much my grandmother's cognition has declined.  I don't know what it will feel like to see such a strong personality reduced to confusion.  Then there's the whole daylight issue; the days are a bit shorter in PA than they are here in Norcal, and she lives in the mountains, so they may feel even shorter than they are.  I'm concerned about my sleep.  On the one hand, it's normalized somewhat; on the other hand, I know that the three hour time change will probably mess it up.  Even so, it's settled in at 2 am to 9 or 10 in the morning.  And Grandma gets up early.

I've been trying to calm myself by reminding myself that my sister will be with me, and we can support each other when we need it.  It will be fun to see my grandmother and my aunts and uncles.  We'll also be able to give compassionate, concrete help to a family member in need.  I'm on medication and I'm bringing a portable sunlamp with me.  My pdoc has given me the OK to travel.  Everything will be fine.

Yesterday I realized that the underlying cause of my anxiety was actually none of these things.  It's the fact that there's no internet at my grandmother's house.  How pathetic am I, right?

I started to laugh at myself, and my anxiety evaporated.  I can survive without the internet.  I've done it before.  So why does it feel like such an existential threat right now?  Well, like so many answers, this one lies in the past.  It also has much to do with the eccentricities of my late grandfather.

By Request: What Adult ADHD Feels Like

Today's post is is by request, by Mo over at Milligrams blog.  I had left a comment on a post he had written called "Depression Without Sadness".  He described having a week off work, feeling like he should get off the couch and go do something, but lacking the motivation to do it -- even though his mood was pretty good.  I commented that this sounded a lot like me, before I was medicated for my ADHD.  Mo emailed me to ask me to write about ADD.  Could I write a post about my experiences with it?  What does it feel like to have it?  What meds do I take?  What's my experience on those meds?

Some of these questions are hard to answer.  It would be easier for me to describe how it "feels" to have ADHD if I had any idea how it felt not to have ADHD.  As for my experiences with ADD ... well, that would be my life story.  I decided to tackle this by considering my subjective experience of the world -- how I perceive it, internalize it, interact with it.

What I wrote is still pretty long, so I apologize if you have ADHD and find it overwhelming.  To help with that, I've broken it into sections, which are titled in bold face.  The sections describe my unmedicated brain on those rare "good" days, and then my unmedicated brain on "bad" days (which was most of them).  This is followed by an attempt to put the ADD experience into an analogy that a non-ADDer might understand.  Finally, there is a section about my experience with my ADD medication.

The Innermost Circle of Hell: Relationship Counseling

My partner and I started seeing a couples counselor last month.  What with my partner's travel schedule, and the counselor's travel schedule, our second visit wasn't until a few days ago.  And it was awful.

The therapist we're seeing uses the Gottman Method.  We chose this method because it's evidence based, and we're both big fans of that sort of thing.

Another thing that appealed to me about the method is that you start with exercises that help you build positive feelings your relationship.  This is supposed to give you a strong foundation of love and affection from which to work on conflict management.  Conflict management, by the way, is supposed to be one of the later steps in the process.

For some reason, our therapist chose to bypass this step.  My partner mentioned one of his frustrations, and the therapist asked me if I was OK with using the session to address it.  I wasn't, really; but I figured, hey, this process isn't always going to be comfortable for me, right?  Besides, our therapist was there to help us if things got bad, and maybe he could teach us some new skills to keep it from getting bad in the first place.

Nope.

Lamictal 150 mgs: ADHD vs. The Lamictal Stupids, and More Problems with Word Finding

I've been on 150 mgs of lamictal for three weeks now, but for some reason it wasn't until the past few days that I've had a recurrence of The Lamictal Stupids.  For instance, it took me several tries to write the word "recurrence" just now.  I kept trying to write "reoccurence", which of course is not a word, and I know that.

I've had all kinds of word-finding problems since the middle of last week.  Trouble finding simple words like "collaborative".  There are several other instances, only I can't remember the specific words I was having trouble with (ha!).  Times when I reach for an everyday word and it's simply not there.  I'm not talking about those times when the word is on the tip of my tongue and it takes a few seconds to find it; at best, it takes up to a minute for me to find the word, if it's there at all.

There's a difference between the Lamictal Stupids and my ordinary ADD stupid.  ADD stupid, at least in my case, is usually as a result of rushing through something and making a careless, stupid mistake as a result.  With the Lamictal Stupids, the mistakes I make are carefully considered stupidity.

Depression, ADHD, and Radical Acceptance: When You Can't Make The Changes You Need (Right Now)

There's an excellent post over at 18 Channels about "radical acceptance".  Radical acceptance is probably called many things by many people, but the general idea is that when you're facing a situation you really can't change, you need to just accept it and live with it until you can change it.  I guess it's a mindfulness practice, really.

It's a valuable thing for me to keep in mind right now.  I've lost a lot over the past year.  I lost my job.  I had a bad injury to my neck and shoulder.  I lost my mind to psychotic depression.  I lost several months of my life to the wrong med.  And I lost the relationship I thought I had, the one that I thought was working, the one thing that I used to look at and say, at least I've gotten one thing right in my life.