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From: "Steve Harris" <>
Subject: Re: Nuerontin causes mania too
Date: Thu, 21 Feb 2002 03:17:25 -0700
Message-ID: <a52ih5$tb8$>

"Mark D. Morin" <> wrote in message
> > Wellbutrin's an upper,
> a little bit
> > and puts some people on edge. It doesn't seem the best choice for
> > anxiety.  (Hint-- don't let them give you Ritalin either).
> Hint: Ritalin isn't prescribed for anxiety

Hint: Ritalin is prescribed for AHDD (a Dx considered in every distracted
and distractible person these days, which-- surprise-- many depressed and
anxious people are), and also Ritalin is used for "activating" vegetative
depression. I've seen a lot of (later considered) bipolar people put on it
at some time in their psych history. Seems some shrinks like T3 and some
Ritalin and after they start the SSRI, they're itching to find an excuse for
one or the other.  They fight with the Klonopin shrinks who start everybody
on benzos after the SSRI, who in turn fight with the antiepileptic/lithium
shrinks who see the world in terms of bipolar and cyclothymic disorder.  You
can go from one to the other on a great merry-go-round.  Eventually if you
don't get better, or if --zounds!--the uppers, downers, and sidewaysers make
you worse, you will finally end up with.... the low dose neuroleptic
shrinks. The baddest ones of all.

> > BTW, why are you not taking some treatment for bipolar disorder,
> he is--see above

Neurontin. Certainly not the drug of choice.  Or even one of the first 3. So
what gives?

From: "Steve Harris" <>
Subject: Re: Nuerontin causes mania too
Date: Thu, 21 Feb 2002 12:34:52 -0700
Message-ID: <a53iec$130$>

<> wrote in message

> Thank got they had not yet invented ssri's when I was 14 so they just
> fed me Lithium and Tegretol and thorazine and ritalin and loxatian and
> trilaphon and.. basically every damn thing in the arsenal only to do it
> all again 20 years later but with a whole new arsenal with SSRI's and
> wellbutrin and Risperdal and Zyprexa and Neurontin and Topamax and
> Lamictal.  My pdoc was even itching to give me hormones.. Damn doctors..

<Sigh>  Note that I hadn't seen the history above when I wrote by somewhat
satyrical response below. Those who have critisized me take a read.

From: "Steve Harris" <>
Subject: Re: Nuerontin causes mania too
Date: Thu, 21 Feb 2002 20:20:09 -0700
Message-ID: <a54dmt$374$>

"Mark Morin" <> wrote in message news:Gbdd8.145119
> > > > > Hint: Ritalin isn't prescribed for anxiety
> > > >
> > > > Hint: Ritalin is prescribed for AHDD (a Dx considered in every
> > > > distracted and distractible person these days,
> > >
> > > hint--WRONG
> >
> >
> > Well, we now find he did get it. Egg on your face.  Golly, I must've
> > just guessed right and been wrong for the right reasons, eh? That has
> > to be it.
> "He" isn't everyone.  It's fallacious reasoning to start with the
> particular and make conclusions about the general.

In this case I reasoned from an a priori general, to this specific case.
And happened to be right, so sorry.  They guy even got the narcoleptics.

>  Do you have any data suggesting
> that practitioners routinely diagnose ADHD when the proper diagnosis is
> either depression of anxiety?

There are a lot of hidden assumptions in that statement, such as whether or
not ADHD is a real thing, recognized at the same prevalence across the same
countries (not), and hopefully with a diagnosis test (not). And that it
cannot coexist with many of the other diagnoses (it can, as DSM defined).
Judging of ADHD prevalence is rather like judging of pairs Olympic
skating--- if you want to believe in your heart in the objectiveness of
quality, it it's best not to examine it too closely.

> didn't think so.

Think what you like. There are studies in which people thought to have ADHD
were re-evaluated and thought to have either something else instead, or in
addition. Example:

J Clin Psychiatry 1992 Apr;53(4):133-6
Misdiagnosed bipolar disorder in adolescents in a special educational school
and treatment program.

Isaac G.
Division of Child Psychiatry, Nassau County Medical Center, East Meadow,

BACKGROUND: Twelve adolescents found to be the most problematic, crisis
prone, and treatment resistant were comprehensively reevaluated in the
special educational day school and treatment program they were attending.
This reevaluation took place over a 6-month period and was done to arrive
upon a more comprehensive diagnostic understanding so that more relevant and
effective treatment measures could be instituted. METHOD: The author
conducted semistructured interviews with the adolescents on multiple
occasions as the clinical situations warranted. All information available,
recorded or otherwise, was comprehensively reviewed and reevaluated. The
children were observed informally in and out of their classrooms throughout
the period. All parents available were interviewed to clarify the children's
present and past symptomatology and to assess the nature of psychiatric
disorders, if any, in first- and second-degree family members. RESULTS: The
reevaluation showed that 8 of the 12 youngsters clearly satisfied DSM-III-R
criteria for bipolar disorder, which had been misdiagnosed mainly as
attention-deficit hyperactivity disorder (ADHD) and conduct disorder. Three
other youngsters showed significant bipolar features though not fully
satisfying the criteria for this disorder. CONCLUSION: Bipolar disorder may
be very common among highly problematic adolescents in special educational
and outpatient treatment facilities for emotionally disturbed youngsters but
may still be misdiagnosed very often as ADHD and conduct disorder, with all
the negative consequences of such misdiagnosis.PMID: 1564049 [PubMed -
indexed for MEDLINE]

Harris COMMENT continues:

But those studies don't make me any happier, because even if you decided you
screwed up the first time in diagnosis of ADHD, there's still no gold label
for any of these things. So studies in which they decide that they're
"diagnosing" this successfully (though the rate differs from country to
country, and gets larger every year) may well be data proof. If the
scientisits were talking about location and diagnosis of witch craft or
devil worship or True Born Again Christians, you've got the same problem. Is
Salt Lake City full of true Christians?  That depends on who you ask.  But
suppose the answer was used by our society to give you legal access to
psychotropic mental performance enhancers?

 They're SYNDROMES. The utility of a diagnosis-label in medicine is only
it's power to prognosticate, and (sometimes) predicting the success of this
vs. that treatment. For ADHD we still haven't done the studies about the
last well enough to really know.  The idea that amphetamine works oddly or
differently on these unruly "ADHD" kids, than it would do in any other kids,
has no foundation at all. If amphetamines help just about any kid become a
better student (which they do), then in treating what you've labeled "ADHD"
your control group should involve giving Ritalin to perfectly ordinary
children with no psych diagnosis on their backs. No such has been done. Our
fond idea that Ritalin does something in ADHD that it doesn't in normal
people, remains unsupported. What evidence DOES exist, points in the other


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