GAD, MDD or ADD?

A therapist that I was seeing with my wife for marital suggested to me that I might have ADD, based on some of the problems I told her I was facing at work. I did some research, some reading and answered a few online questionnaires, and had some discussions with my family doctor and with a local psychiatrist.

Based on those discussions and on my reading and personal research, everything points to me having ADD or Inattentive type ADHD (I don't have much of the H symptoms): I have difficulties staying engaged in work discussions and meetings, keeping track of tasks at work, as well as paperwork and bills at home, I am very forgetful, I get distracted very easily, always start grandiose projects and plans but never seem to finish them, and I am very disorganized at home, my car and at my work desk. At work (I'm a developer), I'm often capable of figuring high level conceptual problems and discussing complex abstract solutions, but I do poorly and get into frequent trouble because I am slow and sloppy, and frequently get blocked on small details and simple mistakes. Many of these symptoms I remember struggling with since my late teens, but they have gotten much worse in the last couple of years (I'm 40).

Several people have told that for some people medication really helps. In fact some described it to me as "It's like having your glasses off, and then putting them on: Everything becomes very clear and obvious."

The psychiatrist I was seeing didn't want to put me on medication before I had a formal psychological test.

The psychologist who tested me said that I definitely don't have on ADD, based on my results. He tested me for math skills, memory and vocabulary - basically he was saying my IQ was too high for someone with ADD. But instead that I likely have General Anxiety Disorder or Major Depression Disorder (He mentioned the word 'Anhedonia'). The thing is, I don't usually feel sad, or suicidal or anything like that - although I do feel down from time to time, I feel it is mostly driven by my failures at work and my constant underachievement more than anything else.

He insisted that my test results were not consistent with someone with ADD, and that moreover ADD improves with age, whereas in my case my symptoms seem to be getting worse. He also mentioned that GAD and MDD can have cognitive and functional consequences similar to what I have, and that most likely I will need CBT, not medication, to address my problems.

Am at loss. My problems at work have always been there (since my days in school) and they are now getting to the point where they are endangering my job. Every single second hand and first hand description of ADD I've had describes my own life perfectly, and I thought I had finally arrived at the root cause of my perpetual underachievement. I thought all I had to do was seek treatment and I would be able to get it.


Yet the psychologist disagrees and now it seems like I am headed for several more months of therapy and discussions with psychiatrists before I know what to do.

What can I do? Is the psychologist right? Does high IQ and math ability contradict an ADD diagnosis? If so, why do I identify so squarely with the symptoms of ADD? What can I do? I am getting desperate

AlexBird wrote:What can I do? Is the psychologist right? Does high IQ and math ability contradict an ADD diagnosis? If so, why do I identify so squarely with the symptoms of ADD? What can I do? I am getting desperate

High IQ and math ability do NOT contradict an ADD diagnosis. They can help a person compensate for the difficulties presented by ADD, which probably explains how you got this far without medication. And the kind of discouragement you feel, because you know you aren't achieving as well as you could without the "static" caused by ADD, is also common. (That's another analogy I've heard: with medication, it's like the radio station you're trying to broadcast is suddenly tuned to the right frequency and you don't have a lot of static to try to get past.)

Did you have symptoms as a young child also? They may not have interfered with school, but were you a daydreamer, forgetful about chores, etc? I think you need to have had symptoms before age 12. And it's also not true that it improves with age. It can improve, but plenty of adults have enough symptoms to cause impairment. I read somewhere that after one's teens, one third of people with ADHD get better, one third stay the same, and one third get worse.

The diagnosis isn't made by psychological testing alone--self report measures and reports from family members (your wife, for example) are a key part of the assessment. As long as you meet the criteria in the DSM V and there isn't anything else going on, that's how the diagnosis is made. Did this psychologist have expertise in adult ADHD? Based on what your account of what happened, I would be very surprised if you said he did.

A psychiatrist with experience in treating ADHD can make the diagnosis (usually these are psychiatrists who also have training in child and adolescent psychiatry)--it often isn't necessary to have formal testing done unless you want accommodations and need "proof" that you have it. That's my understanding, anyway.

I would say to trust your instincts and your research, and find a professional with the specific expertise that you need. They are out there. (Maybe that sharp marital therapist can give you some referrals?)

He insisted that my test results were not consistent with someone with ADD, and that moreover ADD improves with age, whereas in my case my symptoms seem to be getting worse. He also mentioned that GAD and MDD can have cognitive and functional consequences similar to what I have, and that most likely I will need CBT, not medication, to address my problems.

You can get better or worse from time to time, it depends on the use of coping strategies. ADD can cause great distress and anxiety, but also an anxiety disorder can cause ADD like symptoms. In the end it sounds like you should see a specialist for ADD to really make sure what's up with you.