[brewski]

Hi all,

I have a very weird story. I was seeing a therapist in the summer and was diagnosed with ADD among depression and eating disorder (bulimia). The bulimia and depression are getting better but the ADD comes and goes. I'm taking Wellbutrin XL 300 mg and that is working for 2/3 but I started seeing a psychiatrist to manage my medication. He upped my WB to 450 mg (visit #1), and that was too much for me. Next he suggested Strattera (visit #2) but I told him I didn't know much about that medication and wanted to research, so he said to come back in 2 weeks and talk about it. I researched and found that Strattera is not very effective, is the newest, can have GI side effects, and there is a warning on Medline not to take with wellbutrin!! I saw him again today (visit #3) and began explaning this and he said well I think you should try Strattera. And I said I know, but I am not comfortable taking that and you asked me to research it...so he said that he wouldn't have accepted me as a new patient if he knew i was ADHD and that he was not comfortable prescribing anything but Strattera, and that he had enough patients on adderall. He offered to give my co-pay back so I took it!!!

Umm...can someone please help me figure out what this is about?? I finally found a reason for why I've felt all over the place for 15 years and have admitted to a weakness and was looking forward to some help and he basically accused me of asking for Adderall or Ritalin. He expressed concern for those medications and eating disorder history, but I am taking Wellbutrin and that is contraindicated for eating disorder and i'm fine. I am mad, frustrated, and in a worse state of mind than when I began going to see him in the first place. I don't understand why he didn't tell me this on the first visit, not the THIRD. Help I am so confused and distraught!!

[Brian37]

my GP didnt want to treat me for ADHD either...(he doesnt believe its a real problem, just a side effect of depression

so my therapist set me up with a psychiatrist

he made it very clear on my first visit that hes not a big fan of Adderall
, Straterra, Ritalin, or any of the newer so called ADHD drugs

He prescribed me Klonopin .5mg twice a day and its completely changed my life....I also take Wellbutrin and Celexa as well

the Klonopin keeps my anxiety in check and the Celexa works the serotonin and the Wellbutrin works the other brain chemical....cant think of it right now

Just remember very few doctors want to prescribed controlled substances due to the very nature of it....

I would try another psychiatrist and see what happens

[embarassed]

Yeah it sucks. A lot of people like this b**** pretend to have ADHD and abuse it so doctors are wary about prescribing it. I HATE drug abusers. They make life harder for people who actually need the drugs.

Were you suffering from ADHD symptoms before you developed an ED? There is a possibility that malnutrition could be causing you to have ADHD-like symptoms and maybe your symptoms will improve when your nutrition is restored. But if you've had ADHD symptoms your whole life then it's probably true blue ADHD and not a symptom of your ED

[BalishBun]

well how rude. mean doc.

[brewski]

I’m not sure which came first – I know that I have always had trouble being on time for things. It’s something that everyone knows about me no matter what I’m doing and it’s followed me throughout school, sports, work, and social gatherings, I am always last to arrive. I don’t know if that definitely means ADHD but it’s one of the symptoms/signs of it. And I don’t have the ability to multi-task well. It sounds crazy because if you’re ADHD you think typically you do a million things at once. I am like this too, but if I want to really do something well I’ve got to really buckle down and create a distraction-free environment. I work as a writer and most days when I really have to write for a solid chunk of time I’ll wear headphones and close all of my internet browsers because otherwise I’ll be more in tune to the distractions around me instead of my work. I believe the eating disorder was my way to fill in the down time I had when my mind wanted to wander, especially in college when I was bored or sick of studying, I would turn to the eating disorder for something else to do. Throughout my life I’ve had a difficult time being alone – at my parents’ house, my dorm, babysitting, my apt, and even now sometimes…it’s getting better…but I could not be alone in a house with food. I’d have to plan my day so I was out for the entire day and constantly busy. If I went home for any reason in the middle of the day it meant a break in my rhythm and I could not just eat a snack it was an entire meal or more…I don’t know, it’s just recently occurred to me it could be ADHD.

[embarassed]

If you're not sure which came first then your ADHD-like symptoms could possibly be a result of your ED. Malnutrition can definitely affect your brain function. I'm not a psychologist or psychiatrist so I don't know. Have you been thoroughly tested or evaluated by a psych? If not, then you should look into getting tested when you're farther along in your ED recovery. Do you have trouble concentrating on doing things that you're interested in? If you do, that's a strong sign of ADHD. Another thing I've noticed about ADHDers is that we don't get hyper when we drink coffee. It's hard to describe ADHD in a nutshell. PM me if you have any questions. Good luck.

[selfy]

hmm id reccomend a new T tbh. they should believe you. idk
goodluck
dot

[sunrise]

I'm sorry you had that experience with the pdoc, brewski. It seems rather harsh for him to say he wouldn't have accepted you if he'd known you had ADHD. ADHD people need help too

</font><blockquote><div id="quote"><font class="small">Quote:</font>
he basically accused me of asking for Adderall or Ritalin

</div></font></blockquote><font class="post">Ummm, yeah, and what is wrong with that? Those are two meds shown widely to be effective with ADHD--why wouldn't you suggest them? When I went to my doctor for anxiety, I suggested Buspar to her. She took my input. She said her approach to medicine is a team approach with the patient, so she wants my input. Why wouldn't your pdoc want to know your ideas for meds? (My doc did prescribe the Buspar for me, but it didn't help, but nothing was harmed, so big deal she took my suggestion seriously.)

What did your pdoc think of your objection to Straterra, that it doesn't mix well with Wellbutrin? Maybe that medline reference has been debunked. There are often conflicting publications of new medications, and it can take several years to sort it all out. Maybe the interaction with Wellbutrin is not worrisome after all? If Straterra is OK with Wellbutrin, maybe you could give it a trial. Maybe it would work for you? If not, maybe pdoc would be willing to then go to Adderall. I see this as somewhat similar to what I am going through now with heart medication. My doctor wants to prescribe one class of medication, but my drug plan will not allow it until I have first tried a different type of medication and shown that it is ineffective for me.

Best of luck.

[brewski]

yeah the whole thing is pretty lame. i called another doctor and explained the whole thing and they were shocked that the doctor would not continue to treat me. really unprofessional. i am cautiously optimistic that this doctor will be better than the last, but we shall see. i have to schedule an appointment this week. wish me luck!!!

[chaotic13]

I lost my GP whom I had been with for like 15 years over the Strattera vs. Adderall issue. In hindsight I think I could have handled that situation better. In particular, been a bit more open in my communication with him about the symptoms I was experiencing and the therapy I was also pursuing. I also was a bit forceful with my opinion. I knew how I wanted to address the issue and got upset because he wasn't listening to me, however, I wasn't really listening to him either. I think as patient's we need to appreciate that we did not go to medical school, don't have to pay their liability insurance, and don't have to risk malpractice if we have an adverse reaction to our "proposed" treatment plan. I was well informed about ADHD when I went in for my appointment, but I think I rubbed my GP the wrong way by trying to play doctor. I learned a lot from this experience and was much better at presenting my symptoms and negotiating a plan of care with my new GP.

What you posted about your therapist/ MD not taking you as a patient seems a bit extreme. If you don't feel like you are able to communicate with him and get your input at least heard, then I would recommend changing doctors and trying again.

I think your disordered eating and depression conditions have a lot to do with the treatment approaches chosen by your therapist/MD. These condition pose serious concerns. You want your health care provider to be considering them when deciding on the best course of action for managing your symptoms. Just like in Sunrise's case with her potential heart condition and in my case my blood pressure issue needs to be considered. I wanted to try the Adderall, but at the same time I'd like to avoid having a kidney problem or some other complication due to elevated blood pressure. Here again we may not have the medical training to consider all of these co-morbitities and who the interact with one another. That is why we rely on our MD's to help us.

[PsyChris]

Did a family doctor provide the diagnosis of ADD/ADHD or did your Mental Health Provider?

You may want to try to get treatment for your ADHD from a Mental Health Provider and/or a Psychiatrist.

Strattera is indicated for the treatment of ADHD and the off-label treatment is for Binge-Purge eating disorders.

[InsaneMax]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
brewski said:
Hi all,

I have a very weird story. I was seeing a therapist in the summer and was diagnosed with ADD among depression and eating disorder (bulimia). The bulimia and depression are getting better but the ADD comes and goes. I'm taking Wellbutrin XL 300 mg and that is working for 2/3 but I started seeing a psychiatrist to manage my medication. He upped my WB to 450 mg (visit #1), and that was too much for me. Next he suggested Strattera (visit #2) but I told him I didn't know much about that medication and wanted to research, so he said to come back in 2 weeks and talk about it. I researched and found that Strattera is not very effective, is the newest, can have GI side effects, and there is a warning on Medline not to take with wellbutrin!! I saw him again today (visit #3) and began explaning this and he said well I think you should try Strattera. And I said I know, but I am not comfortable taking that and you asked me to research it...so he said that he wouldn't have accepted me as a new patient if he knew i was ADHD and that he was not comfortable prescribing anything but Strattera, and that he had enough patients on adderall. He offered to give my co-pay back so I took it!!!

Umm...can someone please help me figure out what this is about?? I finally found a reason for why I've felt all over the place for 15 years and have admitted to a weakness and was looking forward to some help and he basically accused me of asking for Adderall or Ritalin. He expressed concern for those medications and eating disorder history, but I am taking Wellbutrin and that is contraindicated for eating disorder and i'm fine. I am mad, frustrated, and in a worse state of mind than when I began going to see him in the first place. I don't understand why he didn't tell me this on the first visit, not the THIRD. Help I am so confused and distraught!!

</div></font></blockquote><font class="post">
<font color="blue"> Hi there Brewski----
The reason your doctor didn't want to treat you with the first line treatment of choice (and ery effective) stimulant class of drugs, is because he is incredibly ignorant about ADHD, and is afraid of stimulants as he obviously thinks they are nothing but addictive or otherwise harmful. This guy is what, a psychiatrist? Or??? I've been diagnosed for almost two years now with ADHD (Combined Type), and in that time, I've discovered how much ignorance there is out there. I would think the best thing to do is to find a psychologist who has a lot of background with ADHD. This was probably a good thing to know about your quack doctor early in the game, rather than later. Better to take your healthcare into your own hands and be an active participant like you have started doing (with research and education) than to blindly follow the doctors preference. FYI---Wellbutrin doesn't work well for ADHD, and is an anti-depressant. It is used off-label as a second line medication for those who are contraindicated to take stimulant meds. A good therapist is also a good idea to help manage the ADHD with the other disorders. Let me know how it all works out-
insanecollegestudent@gmail.com</font>

[JustForToday]

I have a hunch that pdoc doesn't want to rx a stimulant because of the eating disorder. Stimulants and laxatives are usually not prescribed for anyone with and ED, just as controlled substances are not usually prescribed for addicts. Strattera is, as far as I know, the only non-stimulant med for ADHD.

[PsyChris]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
JustForToday said:
I have a hunch that pdoc doesn't want to rx a stimulant because of the eating disorder. Stimulants and laxatives are usually not prescribed for anyone with and ED, just as controlled substances are not usually prescribed for addicts. Strattera is, as far as I know, the only non-stimulant med for ADHD.

</div></font></blockquote><font class="post">

If only that bit about addicts were true... Some addicts spend a majority of their time trying to get those medications from doctors. If they get inventive enough, it usually works.

I know a lady who used to use fake names, fake complaints all in an effort to get anti-anxiety medication. It worked for many years. She is now in her late 60's and goes into a psychotic state when she does not have Ativan or similar benzo. This happens all too often. Physicians do not want to promote this kind of behavior. Anyone that tells the physician what to give them is going to come under the looking glass.

[chaotic13]

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Insane Max said:
I've been diagnosed for almost two years now with ADHD (Combined Type), and in that time, I've discovered how much ignorance there is out there.

</div></font></blockquote><font class="post">

I strongly agree with this statement. I feel just in the past 9 months, I have become more knowledgeable about ADHD than my general physician and the supposed expert he referred me to. My new GP is a very competent and detail oriented doctor. He seemed very upset during my latest appointment when I shared my opinion of the quality of care I felt I received from the neurologist he referred me to. I basically told him that I was going to continue seeing him intermittently for medication refills, but that in my opinion he was nothing more than a sugar daddy to me. Obviously I didn't say it in those exact words. My GP was going to investigate ADHD further to find me a better specialist to be followed by. In my personal experience the way in which the ADHD diagnosis was made and my medication dosage was determined was nothing short of trial and error. His suggestion to try doubling up on taking the 30 MG XR Adderall and then giving me 4 separate Rx papers so I could get monthly refills without coming back to the office makes me wonder about all the regulations on schedule II drugs. If I was an addict, I could easily have gotten myself double the Rx that I currently have.

If you really think you would like to be treated with a stimulant medication, then simply see another physician. Eventually you will find someone who will be willing to write the script.

If on the other hand, you want to find someone who is really interested in evaluating your symptoms, determining if you actually do have ADHD, and then is willing to provide the best comprehensive health care for this condition factoring in your co-morbidities...GOOD LUCK. My experience has been that we are on our own. You need to educate yourself and be honest with yourself about your intentions for seeking pharmacological intervention. The ED is a real problem for you. Honestly as much as you hate the fact that it my be limiting your treatment options, it is good that you have a physician interested enough in you to raise the caution flag. For me, I think my psychologist serves as a place for me to check my motivations for using the Adderall.

</font><blockquote><div id="quote"><font class="small">Quote:</font>
PsyChris Said:
Anyone that tells the physician what to give them is going to come under the looking glass.

</div></font></blockquote><font class="post">
I agree. I had made the false assumption with the GP who treated me for 15 years. For other health issues he seemed to appreciate my intelligence and respected my opinion. This was not the case with ADHD. Despite the fact that I was well informed and had no previous history of addiction or ED, he still refused to hear me regarding my ADHD and the course of treatment I wanted to try. There was no exchange or debate on this matter. This angered me a great deal and I took his closed-mindedness as an insult and a sign of disrespect. I left his practice as a result. I learned a lot from this experience and when I presented my case to my new GP, I was a lot better prepared and he was a lot more receptive.

Wow, I'm really lucky. My pdoc dxed me as bipolar I & ADD or ADHD (I have a hard time keeping all these initials straight--314.9 on the DSM code) & had no problem prescribing me the appropriate medications for both conditions though there are some controlled substances (Klonopin, Concerta, Provigil--maybe more, I don't pay attention to that designation--if it i called for & effective it should be available to the patient).--Suzy

[sunrise]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
PsyChris said:
Anyone that tells the physician what to give them is going to come under the looking glass.

</div></font></blockquote><font class="post">I disagree. My MD (PCP) takes a team approach to medicine and has told me that. She says the team is doctor-patient and that one solution does not fit all. She values my input and takes it into account. I really like this approach. I would not do well with a "top down", know-it-all sort of doc. I can read the medical literature quite well so doctors need to be knowledgable enough to explain their recommendations to me. If they balk, it tells me they don't have sufficient knowledge or that they don't respect patients. The "team" attitude is very respectful of the patient and I think does not compromise care. For example, when I needed help managing anxiety, and therapy was not enough, I researched the drug options and then talked with my doctor. She had recommendations, and I had other ideas, which I presented respectfully. (I wanted to try Buspar, and she wanted to prescribe an anti-depressant such as Lexapro for my anxiety.) She did some reading on Buspar, listened to my concerns about ADs, and prescribed a trial of Buspar for me. She also gave me a benzo for spot use to help with intense times, as she thought this would be beneficial. I respected her opinion on this and did get both benzo and Buspar prescriptions. I think this is a good example of the team approach. She did not have such a huge ego that she was unwilling to take patient input. Anyway, I do not see a patient wanting to give input to a doctor as in any way waving a red flag. Doctors should encourage that behavior, IMO, not become suspicious of their patients for taking an interest in their treatment. We are our own best advocates.

Complete agreement about the "team" approach in treatment with your pdoc. Mine wants me to take Serequel (sp?) to help with sleep but I am already on so many sedating drugs (& they aren't helping me sleep) that I balked. She allowed me to express my concerns (A la a Heath Ledger episode) & also allowed me the respect to make the final decision in my treatment program.--Suzy

[InsaneMax]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
PsyChris said:
</font><blockquote><div id="quote"><font class="small">Quote:</font>
JustForToday said:
I have a hunch that pdoc doesn't want to rx a stimulant because of the eating disorder. Stimulants and laxatives are usually not prescribed for anyone with and ED, just as controlled substances are not usually prescribed for addicts. Strattera is, as far as I know, the only non-stimulant med for ADHD.

</div></font></blockquote><font class="post">

If only that bit about addicts were true... Some addicts spend a majority of their time trying to get those medications from doctors. If they get inventive enough, it usually works.

I know a lady who used to use fake names, fake complaints all in an effort to get anti-anxiety medication. It worked for many years. She is now in her late 60's and goes into a psychotic state when she does not have Ativan or similar benzo. This happens all too often. Physicians do not want to promote this kind of behavior. Anyone that tells the physician what to give them is going to come under the looking glass.

</div></font></blockquote><font class="post">

It is extremely difficult to get a prescription for stimulants, considering that they are confined to two FDA approved disorders for treatment: ADHD, and Narcolepsy. They are sometimes used "off-label" but I haven't heard of too many doctors prescribing them for other disorders, although I have read of their use in treatment resistant depressive disorders. ADHD assessments are usually very expensive too... most of them involve neuropsychiatric testing alongside traditional psychiatric/psychological workups. Any doctor who gets a new patient who says they have ADHD and doesn't have a report from the last treating doctor, is likely to be very resistant to prescribing a stimulant, making doctor shopping unlikely.

It's also unlikely to get much of a high from prescribed stimulants, as the 30 day supply will be of the lowest dose possible in any patient, especially a new one. The low dose is unlikely to get you high for very long, as you would have to take a copious amount, depleting your 30 day supply rather quickly. The same goes for any dose; addiction always requires taking higher doses in order to obtain the same high. When stimulants are abused, the tolerance builds up very quickly, and the abuser needs more and more to achieve the same high they once did. This said, the likelihood of an addicted person to continue getting refills for stimulants is very low. The physician is very likely to be highly suspicious of patients who "lose" their stimulant medication less than halfway through, especially new ones. You have to request a new prescription from your doctor every month, which means you will either have to make an appointment if he demands it. A new patient will be reassessed after the first trial prescription to determine efficacy. Some doctors demand an appointment every time.

The extremely high cost of stimulants will also confine most purchases of stimulants to insurance holders; which means that any pharmacy that the patient goes to will have a detailed record of the stimulants prescribed, and how far apart they were prescribed. Every prescription filled will be evaluated against the insurance record by the pharmacy. They are likely to give the doctor a call if they notice something fishy, insurance or no insurance, as the law requires it. They don't want to be taken advantage of, or lose their license. The insurance might not even allow additional early prescriptions to go through, and they will flag your policy anyway if they think a controlled drug is being abused. They will talk with your doctor if they have doubt. It would be very expensive for an addict to pay out of pocket, even if they could somehow keep getting new prescriptions.

The ADHD assessment itself is usually very detailed, and they do look for any signs of addiction and addiction history. I've no doubt some get through, but I don't think we should compare apples and oranges here to your lady you once knew with the benzodiazapene addiction. Anecdotal evidence isn't very good to rely on anyway. Additionally, most stimulants prescribed are of the long-acting variety. These are very difficult to abuse, as they are made of special time-release beads. They cannot be crushed and injected, nor snorted. Multiple longetudinal research studies have even indicated that of people with ADHD, those who are properly treated with stimulant medication are LESS LIKELY to become drug or alcohol abusers than those who have no treatment.

I'm a big fan of telling my doctor if I want to try a different medication, or up the dose. Good physicians are appreciative of the interaction as it helps to determine what works and what doesn't. Unfortunately, drugs like this are all trial and error.

[Behindthemoon]

No offending...but he sounds like a meds salesman for Strattera. I think you should feel lucky that this kind of man doesnt become your doc at last.

[InsaneMax]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
JustForToday said:
I have a hunch that pdoc doesn't want to rx a stimulant because of the eating disorder. Stimulants and laxatives are usually not prescribed for anyone with and ED, just as controlled substances are not usually prescribed for addicts. Strattera is, as far as I know, the only non-stimulant med for ADHD.

</div></font></blockquote><font class="post">

<font color="green">True about the eating disorder, especially Anorexia. But... considering that her PDOC said that he "has too many patients on stimulants already," and also "I wouldn't have taken you as a new patient had I known you were ADHD" seem to indicate something else was the barrier to effectively treating his patient. I think it would be a case by case scenario to discuss with the prescribing physician, just as in those who have ADHD and also a Bipolar Disorder.

It is also known that the side effect of loss of appetite usually subsides, and can also be dealt with by eating before you take the medicine, or any other combination that works. Some people never get the possible side effect of loss of appetite, but even then it's usually not dramatic. I take a stimulant because it was the first medicine I tried (Dexedrine Extended Release Spansules) and it was very effective.

However, if I were to have tried Strattera first, and it was effective with either none or very few manageable side effects, I would have gone with that one too. It's only annoying that you have to have a blood test every few weeks to check sure it's not toxic, but if the benefit outweighs the minor annoyances, no one should count out a non-stimulant for ADHD treatment. In her case though, she said that Wellbutrin is contraindicated for people taking Strattera. I haven't researched that yet, but she's probably right as she read it from Medline herself. That in itself is enough of a red flag for me to say saianora! There are some realy good psychiatrists out there (granted, very few...), and it's too bad that persons like this are out there making the profession a disgrace. Ack. Just don't go to Student Health if your a college student. Fair warning. </font>