Oh Yeah, My Mood Action Plan

My experience the other night made me remember that I'd created a Mood Action Plan back in the day.  I've printed it up and posted it above my desk/studio table.  I've already acted on some of them -- namely those that deal with my daily mood crashes:

• Troughs or crashes in mood between the times of 4 and 8 pm become more frequent
• Troughs or crashes in mood between the times of 4 and 8 pm become worse (tearfulness, paranoia about relationships, pessimism running to despair)
• Troughs or crashes in mood lengthen beyond the 4 to 8 pm range

All three of these symptoms are occurring, a fact to which I have alerted my pdoc (which was action number 1 on my Plan). We're trying an Adderall booster in the early afternoon, but it's proving to be problematic for my sleep if I don't get in some vigorous exercise during the day.  And I do mean "vigorous". It has to be weight training -- going for a run don't cut it.

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. 

Lamictal 200 mgs: Two Weeks, and Still Not Stable

I realized today that it's been awhile since this, my mood diary, has included writings about my actual mood.  Mostly I've been bitching about side effects.  Because they've really sucked.

It's been two weeks since I've titrated up to 200 mgs of lamictal.  My mood was higher, and more even, for the first few days ... and then it rained for a few days.  The days got shorter.  My mood started slipping, and my late-afternoon troughs returned.  I'm still at a point where waking up to a cloudy day, or hearing something that's only a little sad, can leave me depressed for the rest of the day.  I'm seeing my shrink today, and planning to ask him if we can raise my dose.

But.  The last two days have been pretty good.  I think.  Maybe.  Too good?  Maybe.

A few nights ago, I stayed up until 4 am reading Tina Fey's book, Bossypants, after staying up until 2 am watching Voltron.  It was hilarious.  So was Bossypants.

Are you a Patient, Consumer, or a Client? Or Something Else Entirely?

If you haven't gathered by now, I'm a big fan of John McManamy's work.  If you don't know McManamy, he's a patient advocate who's articulate, intelligent, and knowledgeable about the science of mental illness.  He is an unapologetic critic of much of the psychiatric establishment.

One of his articles concerns the use of the word "consumer" to describe those of us who live in the mental health morass.  McMamany decries the use of this word mainly because "consumers" have choices.  Most mentally ill people have very little choice in the services we receive and the medication options available to us.  Moreover, he points out, "consumers" are usually consulted as to their needs and wishes, and their experience with the product.  He writes:

"Tell me, when was the last time someone invited you to participate in a Risperdal or Abilify focus group? When was the last time your psychiatrist asked you to fill in a customer satisfaction survey?"

The answer, of course, is "never".  We are not Big Pharma's customers, the health insurance companies are.  We are not the insurance companies customers, employers are.  Your employer does not give you a choice in insurance providers -- some of them only offer minimal coverage, others only offer coverage through one specific HMO, and others will give you a choice between one specific HMO and one specific PPO.  That, of course, assumes that your employer provides health insurance at all.  Or maybe you rely on an underfunded, overstaffed public program.  Or maybe you're unemployed and uninsured.  How much choice do you have then?