I've posted about my case recently on M&M (and here at imminst in the past), though was interested in canvassing the opinions of posters like Animal and Rol82 here as well if possible, since it's taken me close to 3 years to gain a definitive understanding of my own history sans psychological defenses and whatnot, and this is probably my most crystallized version of it . .
I suffer from a pretty complex amalgam of ADHD and OCD (seems to be all the rage these days, huh). I was declared academically gifted as a child and went to a semi-elite high school which employed tracking (i.e. grouping students according to their test results). As a member of the upper echelon, we were groomed for medical school and also covertly instilled with a sense of superiority, which is basically a roundabout way of explaining how I developed coping mechanisms for my ADHD, whereby I would tell myself that I could concentrate if I wanted to, etc. That system even managed to get me halfway through college (doing an arts degree), until, unable to account for why it took me months to finish books despite my intelligence level, and caving under all the stress, I finally developed OCD symptoms.
I didn't really seek help for the OCD (it was missed by the handful of psychologists I initially saw), and instead lived in a state of semi-trauma/hypervigilance for nearly 3 years. SSRI's (I tried Prozac, Lexapro, Luvox and Paxil) killed the anxiety, but until 6 months ago, I had no idea why they were exacerbating my concentration issues; regardless, I'd always taper off them, since my psychiatrists would dismiss the concentration difficulties as lingering depression/anxiety.
Around 2 years ago, I finally caved into severe depression (resembling negative schizo. in quality), and was put on Nardil, which was effectively immediately, but destroyed my sleep and, as per usual, didn't help my ADD symptoms. My life was pretty unmanageable at that point due to the anxiety, but I basically lost a $15k writing grant, a scholarship for postgraduate study, and a position as editor of an arts magazine due to lack of proper treatment.
I tried seeing a couple of other psychs, but was always told the same thing - high anxiety - until I started working with a therapist for the OCD, which helped me uncover the ADHD. It's taken 1+ years, but I'm finally on the verge of being correctly diagnosed (quite the feat here in the Southern hemisphere), and am wondering what the best treatment plan might be. I'm undergoing neuropsychiatric testing at the moment, and have found a GP who is active in the promotion of ADHD (particularly where correct diagnoses are often thwarted here due to political bias).
FWIW, my depression symptoms largely revolve around anergia, a lack of motivation, mental sluggishness and concentration issues and social withdrawal. I'm on clomipramine at the moment, which has resolved the anergia, anhedonia and what not, but failed to help my anxiety or my executive function (which I didn't really expect it to). I'm tapering off it though due to some unexpected movement side-effects and sleep disturbances.
One thing that especially concerns me is that shortly after immigrating 5 months ago, I began to experience a panic-like anxiety which would last all day and also be accompanied by a sense of impending doom (without ever erupting into real panic). I also began to experience dissociative-type symptoms, as well as crippling fatigue. A sleep study revealed a depression-related lack of deep sleep, though I'm wondering if these might be the aftermath of PTSD or some adjustment disorder. I found Neurontin helped that specific anxiety, and relieved the fatigue, but was causing too much sedation and brain fog.
The other thing I should note is that I was given a Dexedrine prescription before I immigrated, and have found that it has a number of benefits (despite only trying low doses a couple of times) - anxiety-relief, improvement of my baseline attention (typically 45 minutes or so when reading), a normalization of my socialization habits (I can carry on normal conversations, rather than interrupting people with witty comments every 2 minutes), and most importantly, a correction of my processing difficulties, so that I can pursue complex trains of thought, and most importantly read books again!
What was written in response to medievil's thread was pretty discomforting because I can relate to an extent (it was the inspiration for this thread), i.e. in lieu of a real treatment plan, I generally rely on instantaneous boosts from stuff like caffeine, exercise etc these days. and can see myself falling into a bad trap. I am also very obsessive, though sometimes not without just cause.
I've ordered Stablon to try, since I've always been curious about it (and it shows efficacy in PTSD), though I highly doubt it'll be a real solution. But I'm only meeting with my next psych in six weeks, so I have some time to experiment.
Otherwise, I take:
Thorne multivitamin
Methyl-b12
Methylfolate
High DHA fish oil
Vitamin D
Niacin and Zinc at bedtime.
I walk for 45 minutes 4 days a week, do pilates-based strength training, and also swim twice a week.
My guess is an SSRI + stimulant combination might be most appropriate. My last psychiatrist tried to prescribe abilify, though I don't envision it being as helpful as a standalone drug for attention as Dexedrine.
I'd appreciate any input you might have. Thanks a lot.
