In my practice, I often meet with adults who have never tried any medication for the treatment of their anxiety, depression, or Attention Deficit Hyperactivity Disorder (ADHD). I am privileged to help explain the process of diagnosis to these patients, as well as to educate them on their medication options, potential side effects, and optimal treatment outcomes.

There is another category of patients I see at times, as well: patients who let me know they’ve tried mental health meds in the past but had a bad reaction. Maybe they felt like a zombie on their antianxiety medication. Maybe the side effects of their antidepressant medication were intolerable, and their provider wasn’t able to help the patient select a better medication for them. Or maybe, the medication was just plain ineffective at managing the patient’s symptoms of anxiety, depression, or ADHD.

It can be challenging for adults who have had bad past experiences with their mental health medication to seek treatment again. I always let patients know that they’re taking a big step by coming to me for behavioral health care.

And I tell them that seeing a behavioral health expert, rather than a primary care physician (PCP), will likely make a big difference in how treatment will go for them.

Whether I’m seeing a patient from El Paso, from Albuquerque, or from another area of the Southwest, I want patients who had an unpleasant reaction to medication before to get effective treatment for their disorder now.

Diagnosis of Behavioral Health Disorders

Why does seeing a behavioral health expert matter? Well, the main factor is that many PCPs don’t have the time or the experience to properly diagnose and treat mental health disorders. For some PCPs, if their patient tells them,  “I’m feeling sad all of the time,” or “I’m feeling anxious,” the PCP will find this to be sufficient information to prescribe an antidepressant medication.

Hold on, it’s not that simple! Many behavioral health conditions can mimic one another. If a patient is feeling irritable with their children, is this irritability caused by depression, or by the strain of making it through their workday while battling undiagnosed ADHD? If a patient is having trouble concentrating during the school day, is this a sign of ADHD? Or maybe this poor concentration is caused by major depression. Sometimes adults with ADHD are constantly nervous and on edge, trying to keep all of their work and home tasks straight. If the right assessment isn’t done, these ADHD symptoms may be mistaken for an anxiety disorder.

To obtain the correct diagnosis, it’s important to see a mental health expert and take standardized screenings. Some examples of standardized screenings are the Adult ADHD Self-Report Scale (ASRS-v1.1) for ADHD and the GAD-7 Anxiety for Generalized Anxiety Disorder (GAD). Mental health experts then take the information from these standardized scales and use their training and experience to ask further questions of their patients. If your PCP spends two minutes with you, asking just a couple of questions about your symptoms, misdiagnosis can easily follow.

Why does potential misdiagnosis matter? Because treating a disorder with the wrong medication can have results that are anywhere from ineffective to dangerous.

Medications for Mental Health Disorders

Medications for ADHD

When adults have ADHD, the standard treatment for this disorder is stimulant medication, such as Vyvanse, Adderall, or Concerta. Stimulant medications can help balance the neurotransmitters (brain chemicals) dopamine and norepinephrine in the brain of an individual with ADHD. With dopamine and norepinephrine in better balance, an adult with ADHD can more clearly focus and feel more able to complete tasks. Stimulant meds can cause a few side effects like poor appetite and trouble falling asleep, but they are generally well-tolerated by a person with ADHD.

However, to a provider without significant experience treating ADHD, sometimes the symptoms of bipolar disorder may look like ADHD. Overlapping symptoms of mania in bipolar disorder can include talking excessively, the mind racing, and being distracted. If a PCP doesn’t have expertise in diagnosing ADHD, and if they don’t use a standardized screening like the ASRS-v1.1, they may misdiagnose a person with bipolar disorder as having ADHD.

If this person is prescribed stimulant medication, they may end up having a manic episode. This consequence could be very disruptive to the patient’s life, and it won’t treat their underlying symptoms.

Medications for Anxiety Disorders

Patients with GAD, obsessive-compulsive disorders, and other anxiety disorders are often treated with a selective serotonin reuptake inhibitor (SSRI) antidepressant, such as Zoloft. Serotonin is a neurotransmitter that impacts mood, and imbalances of serotonin in the brain can contribute to anxiety disorders and depression. As noted above, if a person’s ADHD is incorrectly diagnosed as an anxiety disorder, an SSRI won’t be an effective treatment, because this medication isn’t targeting the correct brain chemicals.

Patients with anxiety disorders are also sometimes prescribed a breakthrough or emergency medication such as Xanax, which is a benzodiazepine. Again, if a person’s ADHD was misdiagnosed as anxiety, Xanax and other benzos aren’t the correct treatment. Benzos relax the entire nervous system, so a person with nervousness caused by their ADHD will likely feel more relaxed on Xanax. However, they may also feel “out of it” and zombie-like due to the sedating effects of Xanax. Benzos can also have the potential for misuse and addiction.

Medications for Depression

Most patients with depression will also be started on an antidepressant. As with ADHD being misdiagnosed as anxiety, if ADHD is misdiagnosed as depression, an SSRI will not be an effective treatment. It is frustrating for patients to take medication that doesn’t help their symptoms. And although SSRIs are usually well-tolerated by patients, there can be concerns if a patient with bipolar disorder is prescribed an SSRI only. If a patient with bipolar disorder takes an SSRI without a mood-stabilizing medication, like Depakote, the patient may experience a new or worsening manic episode.

If you’ve had a bad experience with a mental health medication in the past, don’t give up. Understand that being diagnosed and treated by an expert in behavioral health care can lead to a significantly better outcome than being treated for a mental health disorder by your PCP. Are you ready to live life without always having to struggle with your anxiety, depression, or ADHD? If you live in El Paso, Albuquerque, or one of the other areas we serve, Upper Valley Behavioral Health would love to serve you. Fill out our short application for treatment today.

Disclaimer: This post is for informational purposes only. It does not replace instructions from your licensed prescriber. Please consult your healthcare provider for guidance on your specific medication regimen.

Tags: mental health, medication

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