It's Official: Adult ADHD Combined Subtype

Yesterday I had the final session of my Adult ADHD assessment at a specialized ADHD clinic. I met with a new psychiatrist and the psychometrist who had administered and analyzed a series of psychometric measures, and who had interviewed me in the first session.

We all sat down, and they said they had reviewed the notes from the original doctor, the psychometric results and the historical and interview information. I was watching carefully, waiting to hear the 'verdict', almost afraid to hear that they didn't think I had ADHD, but in fact was simply a nervous hypochondriac (!). But the psychiatrist nodded affirmatively as he finished his statement, and then leaned his notes towards me where it was written "ADHD-C". He said that the diagnosis was ADHD, and that the subtype was the combined type. He said the subtype was more of interest for the diagnostic process and less important to me, but suffice it to say, I have ADHD. The psychometrist commended me on the volume of historical records I had brought to bear, and then said that all the test results indicated that I had 'all the hallmarks' of the diagnosis.

So I asked a few questions about the diagnosis. They asked me if I was intending to pursue counseling beyond their office, and I said yes. They asked me if I had self-harm or suicidal thoughts. I said no (I guess they need to ask that as it relates to medication). Then the psychiatrist presented his conclusion that medication would be appropriate. He said given my age, my history, and my comorbidity of anxiety, the best course of medication would not be one of the stimulants (Concerta, Ritalin XR, etc...) but rather a norepinephrine reuptake inhibitor (NRI) called Strattera. I didn't know much about NRIs so I asked a lot of questions. I think he was getting a little irritated with me at one point for trying to understand the benefits of NRIs over stimulants, but I steeled myself thinking that I was owed at least a good explanation (noting of course my tendency to perseverate!). In the end I was convinced it was a better choice.

Adults are better candidates for NRIs because while the results may take up to 3 or 4 weeks to kick in, they have better self-control and don't need an immediate fix - they've developed sophisticated coping mechanisms for the disruptive and painful symptoms of ADHD. Instead of two or more doses a day of stimulants - which may end up causing insomnia, NRIs build up and provide 24 hr relief that does not affect sleep. Children on the other hand often need to demonstrate a quick response to medication because they have a lot less self-control over their symptoms, for all of the obvious reasons, and so stimulants are a better candidate for them. Also, because of my anxiety (which stimulants can increase), NRIs (which do not increase anxiety) are a better choice.

A quick note about anxiety etc... You should imagine a Venn diagram with circles for anxiety, depression and ADHD symptoms. Adults generally (something like >85% of adults) suffer from comorbidities that have arisen due to or in concert with ADHD symptoms. Being able to tease out which is which can be important in some cases, but in my case, it is enough to help me be more functional, and less affected by ADHD and anxiety symptoms at the same time - which NRIs can address. I was told that it would be a good idea to lay off the 6 or more caffeinated drinks I have daily, as that would increase my anxiety. I figured that it would help focus me, but I have decided only decaffeinated cola for me now, and I will try to limit my caffeine intake to maybe a single cup of tea or coffee in the morning. I am to take the NRI in the morning along with my SSRI antidepressant (Celexa). It may be that in short order I will be able to come off the SSRI, as I am not exhibiting signs of depression currently - both shown by their examination, but also by my self-report.

They are going to pass the consultation notes on to my family physician who will then prescribe me the Strattera. This could take up to 2 weeks.

I am relieved. I was thinking that there was my life before yesterday and then there is my life from today onwards - ADHD never goes away. One cannot be cured of ADHD. But many report incredible changes to their lives post diagnosis and upon the start of a medication regime - and this gives me a great deal of hope. I am weary, and I am tired, but I know that I have headed down the right path. I wish I had known about this years, or even decades ago, but so it goes. I'm here today, and have only the future to fulfill. I am doing this for me. I am doing this for my wife. I am doing this for my lovely 16 month old baby boy. I am doing this for the person I was, who I am in a way reaching back into time and taking care of.

Onwards and upwards,

Mungo

Thanks for reading! If you enjoyed this, perhaps you'd like to subscribe to the RSS feed.

You can also follow my tweets at Twitter.com/MungosADHD