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Getting out of drugs.
#91
(21-05-2017, 01:04 AM)Exxplorer Wrote: Hi, I came back after a long time, yes I was diagnosed with bipolar disorder, but doc is unsure, hum...
I had Quetiapine dosed up to 200mg sustained release, but he tried me on Abilify (Aripripazole) with a very uncertain benefits (lots of bad effects like akathisia, muscle cramps, nights with no sleep at all,...) doctors don t believe ADHD is a real trouble here in Belgium, mostly.
Now I take a 2.5mg Lorazepam or 10mg Diazepam when needed, also have some sleep pills for really occasional use:

All good to you

Hi Exxplorer

This is too familiar. I am myself diagnosed ADHD (and, these days, prescribed dexamfetamine although of course, not enough of it...).

I've previously been diagnosed bipolar and been on quetiapine (briefly) at 300mg for a month, than a few years later at 200mg. Of the atypical anti-psychotics it's probably the best of a bad bunch; I was offered risperidone and aripiprazole, but I declined. There was at the time (2012) no firm evidence for the use of aripiprazole as monotherapy in bipolar disorders and limited evidence for adjunctive benefit when used alongside lithium or lamotrigine. To your point about ADHD, the same thing is very true in the UK. But, whilst the doctors don't know much about it, the evidence is overwhelming, and they reckon that, out of the adults who would benefit from ADHD medication, just 1 in 10 is diagnosed and receiving it. My point is that this is in the hands of specialist psychiatrists and many people don't know the first thing about it. Including my GP, it seems. I'm going to link you to some of the clinical guidance published within the last 10 years over here. Obviously, it carries no 'prescriptive' force over in Belgium, but, it does include a fair bit of evidence that might be useful.

- the clinical guideline on ADHD is 664 pages, all told. That's what happens when our (so-called) National Institute for Health & Care Excellence asks the Royal College of Psychiatrists and the British Psychological Society to look at the evidence. See: https://www.nice.org.uk/guidance/cg72/ev...-241963165

- section 5.3 (p. 95 et seq.) deals with the validity of ADHD as a diagnostic category

- section 5.16 (p. 129 et seq.) deals with differentiating ADHD from other conditions, including mood disorders (s. 5.16.2). Note that they can and do co-exist; the diagnostic manuals now favour an approach of giving specific labels to specific problems (this is fairly new).

What this means is that ADHD implies *only* what it says - inattention and hyperactivity of neurodevelopmental origin (N.B. this can include mental and/or verbal hyperactivity as well as physical (hyperkinetic) hyperactivity). These difficulties may (or may not) happen alongside, inter alia, motor coordination problems (developmental coordination disorder) and/or impairment of reciprocal social interaction (autistic spectrum disorder), both of which are commonly co-morbid in children. (i.e. 50% and 43% of children with ADHD, respectively. I believe those figures come from Dutch and German studies, as regards current diagnostic labels, but see also the Scandinavian concept of Deficits in Attention, Motor Control and Perception (DAMP) - https://en.wikipedia.org/wiki/Christophe...C_and_ADHD which came first.)

In adults, particularly in adults who have grown up without awareness or recognition of their ADHD, these difficulties (i.e. of developmental origin) can occur alongside psychiatric disorders including, without limitation, somatoform disorders (e.g. generalised anxiety disorder) and/or mood/affective disorders (e.g. bipolar affective disorder), which can create a real minefield for diagnosis and treatment. Many, including me, will have been treated for depression, anxiety and other symptom presentations (e.g. addiction) with 'variable' levels of success, and the notion of giving stimulants to people who have been treated for so many different things is sometimes controversial. Both of the front-line ADHD treatments (methylphenidate i.e. Ritalin, Concerta, Equasym, Medikinet and dexamfetamine, i.e. Dexedrine, Attentin, Amfexa) are controlled under the UN Convention on Psychotropic Substances, so definitely there is a 'hearts and minds' battle about prescribing them, as well as a whole load of cautions and contraindications. These sound scary, but many are the same warnings as are given with e.g. quetiapine.

So, the fact that you have overcome addictions, mood disorders etc. shouldn't go against you, and it's not uncommon for people who have typically relied on 'downers' (i.e. sedatives. anxiolytics, narcotics - prescribed or otherwise) in order to control/limit/palliate the problem to benefit from uppers (stimulants) in order to treat the problem. The guidance also addresses the use of stimulants in this situation; see section 2.7.2 (p.35 et seq.) which looks at special issues for adults diagnosed with ADHD. Quote: "there is evidence from follow-up studies that the appropriate treatment of ADHD with stimulants is associated with a reduction in substance abuse disorders (Wilens et al., 2008)."; my individual experience agrees with this. The reason I've given you detailed references to what's in the clinical guidance over here is that the misdiagnosis/underdiagnosis of ADHD as bipolar disorder is very common, even more so now that definitions for bipolar affective / bipolar spectrum disorders are broader than they were for DSM-IV 'bipolar disorder'. So is the use of anti-psychotics as mood stabilisers, to the extent that the ADHD guidance makes provision for it. With the obligatory disclaimer that information offered over the Internet is not medical advice, and it does not substitute for qualified medical opinion as to what is suitable for you, see also 10.13.3 (p.290) "There is no evidence that atypical antipsychotics are of value in treatment of the symptoms of ADHD." and 10.18.7.10 (p.309) "Antipsychotics are not recommended for the treatment of ADHD in adults.". For the usual reasons don't stop taking anything abruptly... but you know that as well as anyone, I mention it only for completeness.

I don't know whether the problem that you describe in Belgium is a lack of any framework for ADHD at a national level or a lack of awareness on the part of individual clinicians treating you. But, between an uncertain diagnosis of bipolar disorder and your remark that mostly, doctors don't believe ADHD is a real problem (same is true here, hence the guidance), I hope that it may help you to make the case for differentiating ADHD from bipolar disorder, if you wish to do so.

To conclude, a note of sympathy and encouragement about what's known to the medical profession in any given country or language. Five years before I was diagnosed with ADHD, the first diagnosis I picked up was Asperger's syndrome, which had been overlooked in my case for 30+ years. Hans Asperger published his work in 1944, in German, but it was 1994 before it could be found in an English-language diagnostic manual, and 2011 before I was diagnosed. At that time, diagnosing any sort of autism ruled out ADHD; that's changed based in research done over the last decade. So, I'm familiar with the problem.

For another good summary of the evidence, the 2014 guideline from the British Association for Psychopharmacology, a short but dense 25 pages, is also a fine read. https://www.bap.org.uk/pdfs/BAP_Guidelin...ltADHD.pdf and I note that it makes mention of a 2010 European consensus statement on adult ADHD. Here's a copy of that, too: http://download.springer.com/static/pdf/...7c6a612690

Good luck educating the local medical profession!
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