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Suggest Treatment For Depression, Anxiety And PTSD
Question: Hi, I am very concerned about my 20 year-old son who has been diagnosed with ADHD, Anxiety and Depression. The ADHD has been present since childhood and has been treated with several different medications as well as neuro programming therapy. For the past four or five years he has been unable to complete tasks such as picking up his room or putting things away after use. His room has become a disaster of dirty dishes, trash, clothing old food and "stuff". I have helped him clean it many times but he just doesn't seem to be able to deal with any of it on his own and it piles up again. He has had therapy over the years but 3 years ago his father committed suicide and I am wondering if he is not only suffering from depression and anxiety (diagnosed), but PTSD. He is also very concerned about his inability to deal with daily tasks and is currently being evaluated for depression (again). He has been screened for hoarding disorder and isn't interested in keeping things because of an attachment of any kind, but just can't deal with the stuff. He has gotten to the point now where he sleeps in his clothes and then gets up and goes to work in the same clothes. He has not slept on his bed in over a year because of the mess. Any thoughts on how I can help him find the right treatment?
My son has a very high IQ, but was unable to graduate from High School due to inability to complete complex assignments on paper. If they had given him oral exams, he would have passed everything. He scored in the top 10% on his ACT and in the top 2% on the GED tests.
My son has a very high IQ, but was unable to graduate from High School due to inability to complete complex assignments on paper. If they had given him oral exams, he would have passed everything. He scored in the top 10% on his ACT and in the top 2% on the GED tests.
Brief Answer:
He should be evaluated for schizophrenia spectrum disorders.
Detailed Answer:
Hi,
Welcome to Healthcare Magic!
It must be really painful for you to see your son not being able to perform up to his potential. ADHD does take a huge toll on the academic accomplishments of children, but I do not feel that his current issues of not being able to deal with dirty dishes/clothing or other stuff are due to ADHD or anxiety. A depressive episode may cause this but then it is unlikely to last for four or five years. I have a feeling that your son's current problems which have led to poor self care are due to some other cause, which has so far not been diagnosed. He may be having PTSD but that again comes in the depression/anxiety spectrum and is treated on similar lines.
I would like to know what your son's reaction is to the disorder in his personal life. If he does not care anymore and does not make an effort, it is again more suggestive of not being related to depression/anxiety/ADHD because in all these disorders, one retains insight and would express frustration at not being able to take care of himself. Poor self care is common in schizophrenia spectrum disorders and your son should also be evaluated for these. These can be treated with medicines which are different from those used to treat depression/ anxiety/ PTSD or ADHD. I do not think he has schizophrenia but there are some other related conditions which are milder but are treated with the same group of medicines. If he is suffering from one of these, then a right diagnosis will make a lot of difference in his condition.
I hope this helps him. Please feel free to ask in case you need any clarifications.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
He should be evaluated for schizophrenia spectrum disorders.
Detailed Answer:
Hi,
Welcome to Healthcare Magic!
It must be really painful for you to see your son not being able to perform up to his potential. ADHD does take a huge toll on the academic accomplishments of children, but I do not feel that his current issues of not being able to deal with dirty dishes/clothing or other stuff are due to ADHD or anxiety. A depressive episode may cause this but then it is unlikely to last for four or five years. I have a feeling that your son's current problems which have led to poor self care are due to some other cause, which has so far not been diagnosed. He may be having PTSD but that again comes in the depression/anxiety spectrum and is treated on similar lines.
I would like to know what your son's reaction is to the disorder in his personal life. If he does not care anymore and does not make an effort, it is again more suggestive of not being related to depression/anxiety/ADHD because in all these disorders, one retains insight and would express frustration at not being able to take care of himself. Poor self care is common in schizophrenia spectrum disorders and your son should also be evaluated for these. These can be treated with medicines which are different from those used to treat depression/ anxiety/ PTSD or ADHD. I do not think he has schizophrenia but there are some other related conditions which are milder but are treated with the same group of medicines. If he is suffering from one of these, then a right diagnosis will make a lot of difference in his condition.
I hope this helps him. Please feel free to ask in case you need any clarifications.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello Dr. Parakh, Thank you for your insight. He does care greatly about his situation and thinking or talking about it increases his anxiety. He also feels ashamed that he can't take care of it. When he is in his room on his computer he seems to just block it out and says it makes him very anxious to do the work it takes to clean it up. It does seem to be a cycle he can't break out of. He has asked for treatment this time and I am encouraged that he is seeking it on his own. Your information has been very helpful and I will share your response with him. Kind regards, XXXXXXX
Brief Answer:
Schizophrenia spectrum disorders are unlikely.
Detailed Answer:
Hi XXXXXXX
Thanks for writing back. From the information you have given, it appears unlikely that he is having any of the schizophrenia spectrum disorders. He has already been evaluated for hoarding disorder. We now return to his previously confirmed diagnoses of ADHD and depression.
People with adult ADHD are known to have prominent disorganization and can have cluttered workplaces or homes. In your son's case, it appears that there is no other cause for the disorganization than Adult ADHD [the term adult ADHD refers to adults who had ADHD in childhood and in whom the disorder persisted even after growing up]. I understand he has been treated for ADHD with different modalities and did not have much benefit. But there are a few strategies that may help him deal with the disorganization better. Perhaps he is already aware of these and has tried them. These involve prioritizing the pending jobs, making to-do lists, and doing things one at a time. An online search for "adult ADHD disorganization" turns up a lot of links with useful material. I particularly liked this article on dealing with clutter (http://www.additudemag.com/adhd/article/729.html).
I am also interested in knowing about the medicines he has tried for ADHD. I was actually wondering why he is still suffering when there are so many medicines available for treating ADHD.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Schizophrenia spectrum disorders are unlikely.
Detailed Answer:
Hi XXXXXXX
Thanks for writing back. From the information you have given, it appears unlikely that he is having any of the schizophrenia spectrum disorders. He has already been evaluated for hoarding disorder. We now return to his previously confirmed diagnoses of ADHD and depression.
People with adult ADHD are known to have prominent disorganization and can have cluttered workplaces or homes. In your son's case, it appears that there is no other cause for the disorganization than Adult ADHD [the term adult ADHD refers to adults who had ADHD in childhood and in whom the disorder persisted even after growing up]. I understand he has been treated for ADHD with different modalities and did not have much benefit. But there are a few strategies that may help him deal with the disorganization better. Perhaps he is already aware of these and has tried them. These involve prioritizing the pending jobs, making to-do lists, and doing things one at a time. An online search for "adult ADHD disorganization" turns up a lot of links with useful material. I particularly liked this article on dealing with clutter (http://www.additudemag.com/adhd/article/729.html).
I am also interested in knowing about the medicines he has tried for ADHD. I was actually wondering why he is still suffering when there are so many medicines available for treating ADHD.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Parakh,
He took Adderall XR and Strattera when he was in middle school and early High School but said they made him feel bad generally. There was some improvement, but he really wanted to stop taking them and his Psychiatrist let him discontinue them. His resistance to treatment stems from therapy he had when he was 10-13, where he felt that the only purpose of the therapy was to remind him of his problems and issues and make him feel less capable. He was also bullied in school through most of his childhood. The only therapy he has participated in since that time is grief therapy with a hospice program after his Father's death. The fact that he is actually asking for therapy is a good sign and perhaps he needs to try a medication again. He also has some friends who are encouraging him to seek treatment and have referred him to a local program. Your assistance is really helping me clarify where we might need to go with treatment. Are there newer medications available?
He took Adderall XR and Strattera when he was in middle school and early High School but said they made him feel bad generally. There was some improvement, but he really wanted to stop taking them and his Psychiatrist let him discontinue them. His resistance to treatment stems from therapy he had when he was 10-13, where he felt that the only purpose of the therapy was to remind him of his problems and issues and make him feel less capable. He was also bullied in school through most of his childhood. The only therapy he has participated in since that time is grief therapy with a hospice program after his Father's death. The fact that he is actually asking for therapy is a good sign and perhaps he needs to try a medication again. He also has some friends who are encouraging him to seek treatment and have referred him to a local program. Your assistance is really helping me clarify where we might need to go with treatment. Are there newer medications available?
Brief Answer:
Wellbutrin can be tried.
Detailed Answer:
Hi XXXXXXX
Yes, there are options other than Adderall and Strattera. Even both of these can be given another trial as a lot of time has passed since these were found unsuitable. It is possible that this time he might not have any problems with these medicines. Both are quite effective and it would make a lot of difference if your son could get settled on either of the two.
Supposing both of these do not work for him, there is also the option of trying bupropion (Wellbutrin). It has been found to be effective in Adult ADHD and also has antidepressant effect. A small dose of clonidine (a medicine used to lower blood pressure) can also be added to augment whatever medicine is started. Clonidine helps in both ADHD and anxiety. The bottom line is that his doctor should make a serious effort to motivate your son to start medicines. Therapy can be added on if your son wishes so but medicines must be tried. He is losing out a lot because of the disease and it is high time that something is done.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
Wellbutrin can be tried.
Detailed Answer:
Hi XXXXXXX
Yes, there are options other than Adderall and Strattera. Even both of these can be given another trial as a lot of time has passed since these were found unsuitable. It is possible that this time he might not have any problems with these medicines. Both are quite effective and it would make a lot of difference if your son could get settled on either of the two.
Supposing both of these do not work for him, there is also the option of trying bupropion (Wellbutrin). It has been found to be effective in Adult ADHD and also has antidepressant effect. A small dose of clonidine (a medicine used to lower blood pressure) can also be added to augment whatever medicine is started. Clonidine helps in both ADHD and anxiety. The bottom line is that his doctor should make a serious effort to motivate your son to start medicines. Therapy can be added on if your son wishes so but medicines must be tried. He is losing out a lot because of the disease and it is high time that something is done.
Best wishes.
Dr Preeti Parakh
MD Psychiatry
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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