Chronic Forgetfulness and Disorganization
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Q:  Chronic Forgetfulness and Disorganization 

I have recently been diagnosed with bipolar disorder (this is my 2nd diagnosis as I wanted a 2nd opinion).  I have felt very strongly over the last 3 years that I have adult ADD and not bipolar disorder, but it seems that 2 Drs. disagree.  My question stems from the fact that I do not experience the mania or manic stage of bipolar disorder as it is suggested in all of the material that I have read.  I very rarely, if ever have an "inflated" view of myself.  I very rarely, if ever, experience elation and I am constantly tired, I rarely, again, if ever, have a decreased need for sleep.  I have experienced weight gain, (70 lbs in the last 9 years!) not weight loss.  Other symptoms include chronic forgetfulness and chronic disorganization to the point where I forget important appointments or paying my bills or completing work assignments (I am an Instructor at a comm. coll.).  These 2 aspects of whatever I have are the most trouble and the most invasive in my life as I feel out of control in these areas.  A doctor initially went along with MY diagnosis and prescribed Depakote and Ritalin, but after taking the medication for almost 2 months, I was still unable to organize my life and I was still forgetting things on a daily basis.  I saw him this passed week and he has advised me that he feels that I am bipolar and has prescribed Prozac along with the Depakote.  I don't necessarily like this guy alot, but I have no medical insurance and I can't keep jumping from doctor to doctor.  I would be interested to know if the characteristics that I am having the most difficulty with are also characteristics of Bi-polar disorder as well as ADD.  I need to know what is wrong with me.  Thank You for your assistance.

Dear Lori -- 
What do you think about the idea that you might have both bipolar and ADHD components in your symptoms?  They are often found together.  However, a growing number of experts agree that treating the bipolar piece first is the way to go; then, when the mood symptoms are really stable, you can try adding a stimulant if your concentration is still poor (it looks to me like a lot of folks see a dramatic improvement in their concentration just from getting the mood symptoms controlled, though; enough to allow me to take people off stimulants several times). 

You may not like the doc' but you can ask him about this general approach you read about (while you're at it ask about the general idea that antidepressants can make bipolar disorder worse and that many mood experts recommend not using them, or at least not using them until the only mood symptoms remaining, after mood stabilizers are on board, are just depression symptoms -- no insomnia, no irritability, anxiety, for example) (you can read more about that general idea on my website).  

Dr. Phelps


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