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Old 01-20-2013, 10:57 PM   #1
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Husband-OCD/ADHD & Depression -Anti Depressants Possibly Fed His ADHD

Hi Everyone,

Help !!! My husband has had some form of depression since he was a child. To try & summarise, he has been on several different meds for about 15 years. He has previously been diagnosed with post traumatic stress & bipolar.

He has what we call "episodes" where he becomes extremely angry and verbally abusive. He will often punch walls & has broken 2 mobile phones. His most recent episode was just before Christmas and he ended up taking some 23 tablets of various kinds. The Police & Ambulance came. He was assessed at hospital & discharged the same night with nothing positive to help him. He was very embarrassed & ashamed when he came home.

Back to the GP who referred him to a new Psychologist. This man is amazing, he completely understood what my husband was saying, & wasn't saying.
He has diagnosed him with adult ADHD, severe OCD & depression. This is a coincidence to us because after being with my husband for 6 months I joked with him & said he had ADHD.

He has started Luvox for the OCD, which is apparently the best one out there for it. The alternative will be Ritalin to treat the ADHD.

Since starting Luvox, about 5 weeks ago, his depression has gotten worse, there is no change in his OCD, he sleeps all the time (sometimes all day) & he feels like he is going to "snap". We have both spoken to the psych who has tweeked with the dose. As of last week he was to double the dose, but hubby is completely over it.

As my husband & I have discussed, this affects all of us. We have 3 year old twins that are suffering, I only have about 4 hours sleep at night worrying about him & my blood pressure has gone back up after being off blood pressure meds for about 6 months.
I am fortunate that I have been on a weight loss journey & have the gym to release some of my frustrations.

His family live interstate and are of no help. In fact his mothers' first response when he told her he has ADHD and has had it from childhood said "are you saying that's my fault". As far as I am concerned, she should have been on the first plane down here after he took an overdose.

He is getting more depressed each day, today is possibly the worst I have seen him. We have a apoointment with the psych this afternoon.
So any suggestions where we go from here? My husband just wants to go on the Ritalin but for some reason the psych wants to persue this other med first.
I am almost certain it is not going to work for him. As we all know some meds will work for some people but not others.

I love him so much & hate seeing him like this every single day. He has absolutely no desire to do anything & just wants to sleep all day.

Any response would be truly appreciated.

NOTE: Since I posted this thread it was moved to the Support-Family/Friends Section. I am not in need of support for myself but rather others' experience with this medication etc.
Since this thread we have just returned from the psych who is now 100% convinced we are dealing with excessive OCD and Adult ADHD. When I pressed him it would appear the misdiagnosis of depression all these years and treating the depression with anti-depressants has possibly "fed" the ADHD making it worse.
Does anyone know if this is a valid point?

 
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Old 01-21-2013, 05:07 AM   #2
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Re: Husband-OCD/ADHD & Depression -Anti Depressants Possibly Fed His ADHD

You're in an incredibly difficult situation.

I'm going to start this off with my standard disclaimer: I am not a psychiatrist or a medical doctor. I am not a chemist and I am not a pharmacist. My observations are based on my own study and experience, and may not be in any way accurate or even logical.

I was in my mid-30s when I was diagnosed with depression, along with 'possibly' ADHD and Borderline Personality Disorder. The psychologist that diagnosed me recommended SSRI anti-depressants and conceded I may benefit from treatment for ADHD. My GP started me on Celexa (an SSRI) for depression, and at my request, Dexedrine (a stimulant) for ADHD. I was told that whatever else I had, I needed to get a handle on the depression first.

Within weeks I was a wreck. I had a long history of self loathing, feelings of worthlessness, and situational depression, but what I developed during this period of treatment was the worst depression I'd ever experienced. I developed a plan to kill myself, and wrote letters to my parents, siblings, and fiancee, informing them that I didn't want a funeral, and to dispose of my body in the least expensive way possible (these were never sent, so this wasn't a cry for attention). It's hard to describe the depths to which I sunk during that period.

Ultimately my fiancee (at the time), who was alarmed and frustrated by my depression, convinced me that I should come off the Celexa, which I did, cold turkey (apparently this is ill-advised). My depression immediately started to subside, and within maybe 2 weeks I was myself again (that's not to say healthy, but certainly not in imminent danger of suicide). I have spent the subsequent five years seeking treatment for my ADHD with varying levels of success; I have learned to accept what I can't change, and I have gained a sufficient level of function to graduate university, lose a significant amount of weight and find myself an excellent job. Again, I'm far from the person I would hope to be, but I'm miles beyond where I was when I started, and worlds beyond what I became on Celexa.

Any mental health professional, physician, or pharmacist with whom I have discussed my experiences with Celexa doesn't believe me. While it's well known that SSRI medications can lead to an increase in suicidal thoughts and behaviours in children and young adults (indeed, parents of young people treated with anti-depressant medications are advised to monitor their children for signs of suicide ideation), I wasn't 16, I was 35! My age makes it inconceivable to most that the Celexa could have led to the effect I described. Yet to me, the evidence is clear--SSRI treatment can absolutely lead to an increased severity of depressive symptoms, and can absolutely lead to new thoughts of suicide. I don't expect you'll be able to sell that to your doctor, however.

The reason, I suspect that some ADHD cases may respond poorly to SSRI medications is that increases in seratonin can result in decreased levels of dopamine. A shortage of dopamine is implicated in a myriad of conditions, including - ironically - major depression, but also ADHD. So someone who is already deficient in dopamine pumps up their seratonin levels; this leads to a further decrease in dopamine, as well as epinephrine and norepinephrine (adrenaline and noradrenaline) both of which are derived from dopamine. This results in exacerbation of ADHD symptoms, and whatever depressive effects that derive from low dopamine.

What I would recommend is educating yourself about the benefits and drawbacks of various anti-depressants, and medications that treat OCD and ADHD. Pushing the Ritalin angle when your husband has a history of abusing medications is going to be a non-starter in many cases, but perhaps you can convince your doctor to meet you somewhere in the middle. Suggest an atypical anti-depressant, like Wellbutrin. Wellbutrin is a dopamine and norepinephrine reuptake inhibitor that is classed as an anti-depressant, but acts to increase the neurotransmitters implicated in ADHD. You could try Intuniv, or a low abuse-risk stimulant med like Concerta or Vyvanse. It all depends on how far your doctor is willing to compromise.

I'm curious, is your husband significantly overweight? It's pretty well known that we larger men have different bio-chemistry than our skinnier brethren. I wonder what sort of role that plays in the dopamine-seratonin-treatment chain.

Best of luck

 
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