placebo effect or add/adhd

[flowerhorn61]

What an awkward way to "introduce" myself but here goes:

I am currently a Ph.D. student in Psychology (research, not clinical). Although I don't hate what I do, it's certainly not what motivates me and I do not want to pursue a career in academics (especially not research psychology) past getting the Ph.D. I am seriously considering taking the Masters and leaving in Spring 2011 in spite of the fact that the program I am in is Ph.D. only (most people get kicked out and take a Masters if they have the misfortune to become pregnant or ill; otherwise you stick it out until you defend {no one has ever not received a Ph.D. if they make it that far without quitting}).

In any case, it has gotten to the point that I cannot do any work (much less get out of bed and get dressed most days) unless I take some sort of medication (to be specific, Adderall). This was originally prescribed to me for a very short time to counteract the effects of anti-depressants and anti-anxiety medications (both of which I was originally prescribed after explaining my boredom with my program to a therapist, both of which I was promptly taken off when the side-effects were depression and anxiety). I didn't use the entire prescription, and the right thing to do would have been to throw it away once I was safely off the sedatives, but I saved some anyway.

At my undergrad institution I knew many people who took Adderall or Ritalin to get the famed "study high." However, although I tried this once in undergrad (unprescribed) and was on a low dosage (prescribed) a few months ago, I never experienced this rush that one is supposed to get. When I told my therapist that the only thing that can get me out of bed and able to do work is taking the left-over Adderall and that I think I might actually have Adult ADD or ADHD, she said (my actual therapist) that "adult ADHD is not real and no one will ever diagnose you with it." Given that she is a board-certified psychiatrist, I was very taken aback by this answer. She further suggested that I "increase my caffeine intake with coffee and/or caffeine pills" because "grad school is tough and you have to power through."

When I spoke with the therapist (a regular psychologist, not a psychiatrist) at my university about what my therapist said, he told me that I would never been assessed or provided drug treatment even if I were diagnosed with adult ADD/ADHD while I am in school because of the risk that I would sell drugs.

As this is probably an unusual circumstance, I am just wondering what people's opinions are. Should I seek another therapist (psychiatrist) and explain what both my original therapist and the university therapist told me? Should I just OD on caffeine until I get the Masters (hopefully in June)? I have a feeling that my problems will be resolved when I am in a more stimulating line of work (the program I am enrolled in, while well-ranked, is terribly boring and not at all interesting to me)...

Any input would be greatly appreciated. Thanks.

[shepardn7]

Obviously, we can't diagnose you, but it's interesting that you do not get a "high" from the drug. I wonder why you don't. Is it possible you've had ADD for longer than you think? Sometimes learning disorders go unchecked and undiagnosed. But you also have to consider that all this might be your already-diagnosed clinical depression exacerbated by your waning interest in your demanding program (especially because you frame it as an issue of "getting out of bed and getting dressed," which is a problem of motivation and not attention).

From the way you describe it, honestly, it doesn't sound like ADD. If I were as bored as you sound, I would also have trouble motivating myself and concentrating on the work. But I don't know you and am not qualified to make that call. Is there anyone you can see in your area who might be more receptive to your concerns? Someone who "believes" in adult ADD or ADHD and can agree to give you a test of some kind, just in case? I don't really know how any of this works, but I do think there must be someone out there with at least a neutral opinion on adult ADD who might take you seriously and help you figure out what's wrong, even if it's not ADD after all.

Regardless, your current psychiatrist doesn't sound incredibly helpful and, at least judging from this exchange, she might not be the best fit for you (you sound unmotivated and depressed, not tired, and taking a bunch of caffeine pills isn't going to fix that.). But again, I don't know this person, your history with her, or how she has handled your therapy thus far. All I have to judge is the exchange you provide, and it doesn't sound like a very positive or constructive one, but that doesn't mean your overall relationship with her has not been positive or constructive.

Edited November 29, 2010 by sarandipidy

[Alyanumbers]

In any case, it has gotten to the point that I cannot do any work (much less get out of bed and get dressed most days) unless I take some sort of medication (to be specific, Adderall).

...

When I told my therapist that the only thing that can get me out of bed and able to do work is taking the left-over Adderall and that I think I might actually have Adult ADD or ADHD, she said (my actual therapist) that "adult ADHD is not real and no one will ever diagnose you with it." Given that she is a board-certified psychiatrist, I was very taken aback by this answer. She further suggested that I "increase my caffeine intake with coffee and/or caffeine pills" because "grad school is tough and you have to power through."

Uhhhh, see a different therapist. This sounds quite serious, and I'm a little shocked at how casually she's treating it.

[StrangeLight]

this doesn't sound like ADD or ADHD, this sounds like depression. and rather than seeking medications to treat that depression (which you tried, and which had negative side effects), you should try to find a therapist that will treat your depression with regular (frequent) therapy sessions. maybe you can find another mix of anti-depressants that works for you, but first and foremost i'd recommend finding a cognitive therapist that will take your depression seriously and not immediately reach for an Rx pad.

second, the adderall clearly IS having an effect on you. the fact that you need to take it just to get out of bed, and that not taking it means you don't get out of bed, means it's doing something for you. if you're expecting to actually get high from adderall, you'll have to crush and snort it to bypass the time-release properties of the pill. but i wouldn't advocate snorting amphetamines. that's not really good for you in general and especially not if you're using it to self-medicate depression. it'll lead you right to addiction.

it sounds like you've been misdiagnosed and mis-medicated plenty. there may be other things going on, since we only know what you've decided to tell us, but starting some real therapy and stopping the adderall seems to be in order. improved diet and increased exercise will also help fight the depression, but you'll need to get to the place of wanting to do those things first, hence my recommendation for CT.

as for hating your grad program, it happens to the best of us. better to find out now that this isn't something you want than 10 years into your career. good luck with all of this!

Edited November 30, 2010 by StrangeLight

[modernity]

I would also add that this "no one will give you medication because you're in school and you will sell it" business is ridiculous as well. If that was the case no one in high school or college (at any level) could ever be treated, have a surgery, etc. That's just one of the most outlandish things I've heard in awhile. Withholding treatment for something like that would probably fall under malpractice (unless you have some record as a drug dealer and of course that might be a different story entirely).

Sometimes you need to therapist shop - board certified or not, they're still human and have different personalities and different ways of doing things... you should find someone who is more apt to understand you and your particular situation. Yes grad school is hard, and depression and wanting to quit is absolutely normal - I've had professors tell me if I don't feel like that every few weeks something is wrong with me and I'm not trying hard... BUT if its on a new level to where you can't get out of bed in the morning, that's something more significant -and could be killing your grad school drive too.

[flowerhorn61]

Thanks for all the kind replies. I was able to get in touch with my doctor (PCP, not a therapist) and he agreed that my therapist was more than a little...out of touch. He is going to supervise any new prescriptions I'm on and help me look for a different therapist. It's only tricky because I'm kind of in the middle of nowhere, which we discussed could be a part of my dissatisfaction with grad school in general. Anyway, thanks again and good luck to everyone in their respective programs!

[bls]

Hi,

First, I don't have the credentials to diagnose.

I am in research psychology, but this is not my direct research area, either. I just have done a lot of research and work in this arena as I grew up.

I know this is a bit late, but as someone who has been diagnosed with AD/HD combined type since the fourth grade and mood disorders from a very young age, I think that a mood disorder and /or AD/HD is a definite possibility. Especially the way you have described your struggles. Contrary to whatever your old therapist might have said, there IS such a thing as adult ADD. And if you had it, you probably had it when you were a kid, too (it is not like depression or anxiety, really. It doesn't just "pop-up" or "cure itself" with age). If you do have AD/HD, it is possible that it was very hard to get diagnosed because of your generally ability to succeed in academia. It is also possible that graduate school and its changes have caused it to be exacerbated. It sounds like you weren't prescribed the right meds at the right doses and you didn't have good therapeutic support outside of medication. And you were possibly misdiagnosed. Support and other therapy is crucial. Think of mental health like any other diagnosis. For example, if you have diabetes you can take insulin all you want, but if you don't monitor your sugar intake, you're still in trouble.

I'm not sure I would recommend something like a CT though. There is no one AD/HD test, and you can't really tell things like AD/HD or mood disorders from neuroimaging (though, there are patterns in the brain structure and activity of people who have them- it's just not really a diagnostic tool). In my experience, you should really be diagnosed by someone who specializes in AD/HD in adults. I have always been diagnosed with psychoeducational evaluations, but unless you want/need accommodations it might not be necessary. The disability services center on your campus can probably point you in the direction of a good resource, regardless- I would talk to them.

You might not have gotten the "high" depending on how you took it and your own biochemistry. I don't really get the study high from my meds, I get it from the AD/HD itself (hyperfocusing). AH/HD doesn't really mean that someone cannot attend, trust me. It is more of have trouble motivating, focusing and maintaining your attention appropriately. If you are having trouble doing that, you're likely to feel overwhelmed or bored, which can easily trigger anxiety and depression, which can exacerbate ADHD symptoms.

Just to go off on the "abuse/gateway drug" argument: (1) you shouldn't be penalized for someone else abusing the system and (2) Many ADHD meds are methylphenidate and (like someone else already said) they are all time released. Yes, it is similar to cocaine, but the crucial difference is how the drug is taken/released and how it increases dopamine. (Drugs of abuse cause a phasic increase in dopamine, most research concludes that the increase has to be phasic to lead to addiction. In contrast, orally taken whole methylphenidate pills cause an increase, a plataeu and then decrease in dopamine activity- it leaves your system and doesn't build a 'level') If you take the pill whole, you should not get the high you would with cocaine (that being said, it is definitely possible for it to produce physiological arousal. It's a stimulant). If you cut the pill in half, whatever was causing to drug to be time released is deteriorated- this is when you are more likely to get a stimulant like 'high'. It's science. (Still, if it's the wrong med for your system, you can get weird effects. When I went on adderall for a week as a kid it was like I was stoned. With I different drug, I can get through my day productively....usually. It is not one size fits all.)

I apologize if I rambled, but the the 'non-existance' argument for AD/HD is a pet peeve of mine, and I am glad you are seeing a different care provider. In an ideal situation, you'll be able to find a prescriber and a therapist (two different people) to work on both the chemical and cognitive side of whatever is hindering you. But you should know that you are not alone in your experience. If you find yourself diagnosed with AD/HD or a mood disorder (or anything at all/not at all) and want to talk to someone about making them work for you and not against you, feel free to message me.