Need help!

so i am going to my pdoc today. i am going to discuss the whole issue i am having with concentration, irritability, procastination etc. for some reason i am really nervous about it. i've tried adderall before and it really helped me. i don't know how to tell him that, without him thinking that i just want adderall. i am usually never nervous about appts, but i am today. i am mostly afraid that he will be resistant to prescribing anything for me since he has given me a difficult time with prescribing my sleep meds. does anybody have any advice on how i can approach this issue?

I never did understand why people stayed with their Pdoc (or other healthcare provider/therapist) even when the Pdoc did not include the patient as a part of the treatment team and treated the patient as if they might

I don't know why you went off of Adderall, or who prescribed it--but I remember you saying in another thread that you weren't sure if you had ADHD, but thought it a possibility considering your symptoms not remitting with Bipolar treatment. Were you diagnosed by this same Pdoc as Bipolar??

If you don't mind sharing, what are your current diagnosis and medications? It helps to know what exactly it is you are dealing with in order to make an informed decision. Maybe your Pdoc has a legitimate reason to be concerned (such as he would in the case of a past drug abuser as an example). Without knowing the basis for his hesitancy in prescribing the sleeping aids to you in the past, it is difficult to say if he would do a similar thing if you ask for another scheduled and controlled drug for ADHD (which I remember you saying you weren't sure you had??).

Adderall and other stimulants are not prescribed for Bipolar dx'd patients unless they ALSO have ADHD. In the case of comorbid ADHD with Bipolar Disorder, if any stimulants are prescribed, the patient needs to be watched very carefully, as stimulants MIGHT exacerbate and/or induce a manic cycle in true Bipolar patients. They DON'T ALWAYS do that, but the risks are present, so doctors are sketchy to prescribe them in Bipolar without close monitoring (like, weekly visits and the like). I don't know what percentage of ADHD/Bipolar comorbid dx'd persons actually have this occur, but that's the data the Pdocs are going by.

Any doctor who isn't a partner in your care isn't someone you should continue to visit. Just by your brief description here and in the other thread, I'm a little concerned that this one has not really alleviated your core concerns as they affect your life (what measuring stick is he using to determine "wellness"?). ADHD can lead to a severe Major Depressive Episode if untreated, and we can't let that happen. Setbacks in college, which is closely tied to a successful future career AND can limit your career options can easily lead a person down that road, ADHD or not. ADHD would just increase the risk.

I'm a big fan of psychotherapy with a licensed psychologist-a PhD in clinical or counseling psychology (or licensed Master degree therapist), either used alone or in conjunction with medication. Have you ever seen a therapist? They are also better at diagnosis than Pdocs usually are, and they spend way more time with the person trying to figure it out. Some of them devote a large part of their practice to treating adult ADHD, which can help teach you strategies and conquer procrastination (in addition to dealing with the other issues). They can even collaborate with your Pdoc (hopefully a new one) if you sign a consent to release information with them. Usually, that's the best approach.

I hope my advice is helpful, and that I didn't ramble too long!

thank you so much simcha, you didn't ramble at all. i greatly appreciate you taking the time to respond. i went to pdoc yesterday and told him everything that i was experiencing now and what i had been through in the past. i started seeing this pdoc after my inpatient treatment for a major depressive episode. my pdoc prior to the hospitalization left her practice for medical reasons and she was the one who had felt that i was suffering for ADD, but she would not rule out bipolar disorder. well when i was hospitalized the only focus was on the depression and the bipolar, they were not concerned about ADD and to be honest, at that moment i didn't care about anything. so when i was released from the hospital i too only focued on beating my depression and settling back to normal. however, things aren't exactly the way they should be. and now that i am back in school the ADD is more pronounced and my grades are a reflection of my functioning. so i explained all of this to the pdoc. we went over everything. and he told me that he agreed with my previous pdoc. and he told me that we should try Ritalin, he explained that it is similar to Adderall. i have no history of drug abuse, on the contrary when i am in "manic" mode i don't feel like taking my meds because i feel i can overcome anything without the meds. of course that has come back to bite me in the rear. so i have trained myself, and also with the help of my hub i don't do that anymore. he reminds me of the importance of staying on meds when he sees that i am preparing to drop them. sorry for going on and on. so today is my first day taking the ritalin and i really hope that it works. i was in psychotherapy for many years. i started therapy at 13 years of age. at 16 i was diagnosed with psychosis nos. there was a pdoc on staff and my therapist recommended meds so i saw the pdoc with my parents and i was put on meds then. but after that i got pregnant and stopped the meds. i was in and out of therapy for the years after that, until 2006. that's when all hell broke loose and i started seeing a pdoc. the pdoc i see now does therapy and meds so i am only seeing him. though i am beginning the feel that i need to see a psychologist for therapy as their techniques on treatment greatly differs from that of a pdoc. thanks again for your support.

agony