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I am seeking out your help because none of the psychiatrists I have seen will listen to me about my concerns with their treatment. I am extremely frustrated and feel hopeless. My History: Around 2nd grade I began having problems at school. I was always in trouble for talking or drawing during a lesson. I rarely payed attention in class, and constantly forgot my homework assignments or would just not do them. For years my parents heard the same thing from my teachers: "She is so bright, she just doesn't apply herself," or "She has so much potential." I was taken to be tested and always tested well above my grade level. I was labeled lazy and unruly, and I did not get along with most of my teachers. It was hard for me to make friends, and I was told by my classmates that I was mean and bossy. Middle school came around, and things escalated. I developed a horrible relationship with my parents that consisted of huge arguments, moodiness, and complete disregard for their rules. I continued to do poorly in school and was the girl all the other girls didn't like. I lied a lot to my parents and friends, and created my own hell. My mother, concerned with my behavior took me to a psychologist. After many long sessions, my Dr. thought my behavior might be due to ADD and explained that depression and erratic behavior are normal symptoms of the disorder. I was tested by both my psychiatrist and my school- and I was diagnosed with ADD. I was told I had a "learning disability" and that I would be going to a special class each day for kids with disabilities. As a 13 year old, this was very hard for me to take. I rebelled against the treatment, and was in denial about the whole thing. I refused most of the medications because I didn't think there was anything wrong with me. This battle continued on into High School. I hardly went to class and smoked a lot of pot. There were a few teachers that understood me, and didn't think I was a "trouble maker" (English, Drama, Art, and History- the subjects I enjoyed) the rest greatly disliked me. I graduated by the skin on my teeth. After High School I got deeper into drugs and my impulsive behavior got me into a huge mess. I was sent to rehab (I was 19) and was wishing for a new start in life. I worked the 12 step program and learned a lot about myself and why I was using drugs. After about a year and a 1/2 clean and sober it was hard to accept that a lot of the same problems I had before I got into recovery- were still there. Lying, stealing, impulsive spending, unable to keep friends, lost many jobs, dropped out of many schools, and still the fighting with my parents. Up until about 2 years ago (I'm 27) the downward spiral kept spinning no matter what I did. I reached a really bad place in my life and had no friends and my family was sick and tired of bailing me out. So, I sought out professional help- I was desperate, and just wanted to find peace and happiness. The only option I had for mental health services was the local county program. I was first "assessed" by a MFT therapist, and after talking with her for a 1/2 hour- she decided I had Bipolar Disorder. I read about the disorder, and some symptoms fit me some did not. I began taking medication for bipolar disorder, anxiety, and my sleeping problems. I had a history of panic attacks that were debilitating- choking, increased heart rate, numbness of my hands, and feeling like I was going to die. I tried numerous medications over the course of a year. Most didn't do anything for my anxiety- most of the anti-depressants made it worse or they didn't do anything but make me groggy. I had little energy, I was still really irritable, was unable to focus on anything for more than a few seconds, and my depression grew worse as I gained 30 lbs. from all the medication. I had to go on disability and move back home because I was so messed up. After a year of my Dr. not listening to anything I said and her continuing to prescribe me the same type of meds over and over with no progress- I stopped treatment. I convinced myself that I could pull myself together and change my old ways. I found a job and everything seemed to be going well for about a month. Then all my old behaviors started resurfacing. My impulsiveness, irritability, lack of focus, making simple mistakes, forgetting my work hours, not completing things, and the constant anxiety and worry that everyone hated me because of how crazy I acted made it hard to go to work at all. Overwhelmed by everything, I quit. So, I started to do some research on bipolar disorder and started to realize my diagnosis was wrong. I had never had a "manic" episode. I didn't have feelings of being on top of the world. I was almost always depressed, tired, and I have never had high self esteem. I've never been really social, I always had a lot of anxiety and I never felt like I didn't need sleep (I wanted all I could get). On one site, they made a comparison between ADHD and bipolar disorder. I really didn't know what ADHD was, I just thought it meant you were easily distracted and hyper. I read all the symptoms and realized that ADHD could be what was going on with me. I took some online tests, and they all came back with the same result- I had ADHD. It also amazed me that drug and alcohol abuse were pretty common with people that had ADHD, and my Dad acted a lot like me at times (its supposed to be hereditary). You also didn't have to have hyperactivity to be ADHD. Breakthrough!! I made an appointment with a new doctor (hopefully one that listened to me) but it wasn't for another month, and the nurse recommended I make an appointment with a physician so I could get on some meds ASAP. At the appointment I told the MD that I thought I had been misdiagnosed and that I should be treated for ADHD instead of bipolar disorder. I told her my history and how I had been tested when I was 13. She asked me some questions about what symptoms I was experiencing and wrote me a Rx for adderall xl for the ADHD and wellbutrin sr for my depression. So, for a month- I felt great. My family noticed a big difference and so did I. I was happy and I felt motivated and hopeful. I was in a good mood 90% of the time, and I felt alert, focused and level. I just needed something for my anxiety and to help me sleep. Here is the problem- the BIG problem. So, I go to my psych appointment and meet the new doctor. His demeanor is cold and clinical. He interrogates me about my history like I was a criminal. He asks me what medication I'm on, and I tell him. Before I can even explain to him that I think I was misdiagnosed and that the new medication was working really well, he says "Your chart says you have a history of drug and alcohol abuse and you shouldn't be taking adderall for bipolar disorder anyways." I try to explain that I had previously been diagnosed with ADHD and I don't think I even have bipolar disorder. He then tells me, "You seem too smart and articulate to have ADHD, we need to treat your bipolar disorder." At this point I feel totally defeated. For the first time in years, I actually felt like a normal person- and this Dr. could care less. He tells me that he's going to give me lithium and seroquel for the anxiety and sleeping (I hate how lithium makes me feel, and I gained LOTS of weight taking it before). I ask him nicely if there is any other ADHD medication that he could give me because it's really helping me and he tells me that the seroquel should take care of any ADHD symptoms I have. Before I can say anything else he says that he needs to weigh me and for me to grab my stuff. At this point I tell him that I gained a lot of weight from all the other meds and my physician told me I needed to loose weight so I wasn't at risk for diabetes. He says, "well, just eat healthy and exercise more." This whole gaining weight thing really bothers me and I'm very sensitive about it. I try to tell him that I gained 30 lbs. but my emotions get the best of me and I start to cry. He just stares at me, walks me to the lobby and says, "I'll see you in 6 weeks." and closes the door behind me. I get to my car and tears start gushing out. At this point, I feel powerless and its hard to be optimistic. I've already tried all these meds, and they don't help me. How can I talk to him about a possible misdiagnosis and a different treatment plan? This whole situation has really depressed me, and I don't have motivation to do anything. I really don't want to even see this Dr. again. Do you have any advice or insight? Please help me figure this all out!

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• Dr. Schwartz responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
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