How do I appear not to be drug-seeking when I am, in fact, drug-seeking?

January 23, 2015 10:26 AM

I have ADHD. I would like to give Adderall a try. I've tried several other ADHD drugs and they haven't worked, but it almost seems like doctors are avoiding prescribing me Adderall. Do I just walk in and say, "I would like to try Adderall?"

I've tried four other commonly prescribed drugs for ADHD, including two stimulants (Vyvanse and Ritalin). Both stimulants really ramped up my anxiety, and Ritalin had the fun bonus of making me incredibly pissy and depressed as it wore off. The other two drugs I tried, Strattera and Wellbutrin, had unpleasant side effects of their own that led to me discontinuing them (and I never noticed that they helped with the ADHD).

Many people on Metafilter and elsewhere seem to swear by Adderall, and I'd really like to at least try it. Is this the sort of thing where I can simply request at the doctor's office that I would like to give it a try? I am so not a drug-seeker, and in fact from the little I've tried of stimulants have found them pretty unpleasant, but I know that doctors might see it differently.

Right now I'm not actively seeing a doctor for this condition. My family doctor prescribed the Strattera, Wellbutrin and then Vyvanse over the course of several years, and she has since retired. And I saw a psychiatrist well over a year ago, who prescribed the Ritalin. I found that experience so unpleasant that I decided I was done trying to medicate myself. But I continue to have ADHD-related issues in my life, and am wondering if I've given up too soon.

TL;DR Is requesting a specific drug considered reasonable behavior in mental-health treatment circles?

posted by whistle pig to Health & Fitness (20 answers total)

You have a diagnosed medical condition and other medications have not worked for you for legitimate and specific reasons. When you go to the doctor and explain your history, it's totally reasonable for you to ask about other medications you haven't yet tried, including Adderall. They aren't going to be suspicious; you've already been prescribed other medications that can be abused and you're going to tell the doctor straight out that you don't want any more of them. It is totally fine and normal to do this.
posted by something something at 10:32 AM on January 23, 2015 [10 favorites]

Yeah, it's totally ok to go into the doctor and say "I've tried [list] these other meds for my ADHD and I didn't have great results, I'd like to try adderall now". This is not drug-seeking behavior. not by a long shot, and any doctor who would take your medical history and decide your perfectly reasonable request was actually drug-seeking behavior is a doctor to ignore.
posted by poffin boffin at 10:35 AM on January 23, 2015 [5 favorites]

I would just detail your medication history and side effects to your doctor and see what all the options are. There's no reason Adderall is definitely going to be the magic bullet for you, and by saying you want to try that drug specifically, you might miss out on the right medication for you.

Also, considering that Adderall is notorious for recreational use, I think you run the risk of not only circumventing your own treatment, and being seen as a difficult patient, but also looking like someone who maybe doesn't have a medical condition at all but is simply there to try and score Adderall.
posted by Sara C. at 10:35 AM on January 23, 2015 [1 favorite]

Also, considering that Adderall is notorious for recreational use, I think you run the risk of not only circumventing your own treatment, and being seen as a difficult patient, but also looking like someone who maybe doesn't have a medical condition at all but is simply there to try and score Adderall.

So is Vyvanse and the OP doesn't want that because it doesn't work for them. OP it's totally ok to say xy&z haven't worked because of reasons 12&3, but I have heard good things about adderall and would like to try it.
posted by headnsouth at 10:41 AM on January 23, 2015 [3 favorites]

It is 101% reasonable to ask your doctor to try Adderall. And this is not drug seeking behavior… You have a medical condition and haven't been able to find effective intervention. Don't let people shame you into thinking this is somehow not okay.
posted by pintapicasso at 10:41 AM on January 23, 2015 [4 favorites]

Perfectly reasonable thing to want to try a different medication. However, why not work with the psychiatrist you saw who prescribed the ritalin and say it was not helpful and could you try a different medication, and see what he/she can come up with for you.

Also, my relative with ADHD sees a psychiatrist whose focus is in the field of psychopharmacology. They had to try various meds before finding one that worked for him. You might also consider looking for someone like that to talk to.
posted by gudrun at 10:42 AM on January 23, 2015 [4 favorites]

So is Vyvanse and the OP doesn't want that because it doesn't work for them.

It's worth clarifying that part of the appeal of Vyvanse is that it has reduced recreational value: unlike Adderall, it cannot be snorted for a more intense "high".
posted by Sticherbeast at 10:54 AM on January 23, 2015

Maybe try phrasing it as, "Is there a reason I shouldn't try Adderall?"
posted by mskyle at 10:55 AM on January 23, 2015 [8 favorites]

Another option is that before you go see your new doctor, you have your old medical records from your retired doctor and they psychiatrist transferred over so the new doc can see what you've tried and what results you've had.
posted by If only I had a penguin... at 10:55 AM on January 23, 2015 [2 favorites]

N'thing that you just walk in and ask. But!

I would see a psychiatrist with the expectation that you will be seeing them every few weeks at first. Some people have great success with the first drug their GP throws at them. But since that's not the case, you need someone with the experience of adjusting meds just so. I also have an issue with stimulants and anxiety, and it took a while to find a combination that helped with both.

The annoying thing is my underlying treatment for the anxiety is lexapro, which takes a while to kick in. So it wasn't until about six weeks before I could actually see the benefit of lexapro and adderall.
posted by politikitty at 10:59 AM on January 23, 2015

Unless you don't like the psychiatrist who prescribed you ritalin for some reason, I'd just go back to them and say the ritalin and Vyvanse didn't work for you due to the anxiety (and you crashed hard on ritalin) and that you've tried Strattera and Wellbutrin in the past and they didn't work for reasons X, Y, and Z. And then talk about your other options. "Do you think Adderall would be less likely to provoke anxiety, doc? What else is there that I can try?" Adderall is not the only thing left in the ADHD arsenal to try, for one thing. Then commit to working with your doctor to figure out what (if anything) works.
posted by drlith at 11:01 AM on January 23, 2015 [2 favorites]

If you have tried several different kinds of medication, I would go in with that history and say that you don't think it has worked for you and you would like to start on a low dose of adderral while being closely monitored.

Several years ago I was exactly you, the only difference being that my psychiatrist didn't think I had ADHD, and that I was going regularly to therapy. In my context I was in law school and going through a pretty bad feedback loop of depression --> inability to focus --> anxiety over inability to focus --> getting nothing done ---> Depression.

I began going to a therapist, and had a separate psychiatrist who would check in with the therapist about my progress and monitor any concerns. The psychiatrist similarly had me on a few months of different types of medication, some for depression, others for the inability to focus symptoms - wellbutrin, strattera, provigil, prozac.

I had mentioned adderral early on but the doctor was very resistant because I was not the first law student to come to her seeking adderral, and that compared to other medications adderral was particularl ripe for abuse. I acknowledged her concern, and said I was happy to try the regimens she suggested and hope one of them would work.

After maybe a year of trying the different medications and still being frustrated that I wasn't seeing a general improvement i was seeking (although therapy helped, somewhat), I also became increasingly obsessed that adderral was the answer (based off of an increasing obsession with an errant comment a friend had made that it made "studying a pleasure"), going as far as to consider mexican pharmacies. I told the psychatrist as much, and said that I had tried everything she suggested, and also noted that I was continuing to go to therapy. She acknowledged that and put me on the lowest, extended release dose, which helped immensely for maybe 8 months.

Eventually it stopped working as well, by which the next step was to go to a higher dose or move off of it, and I chose to go off it all because therapy gave me a lot of tools to use without the assistance of the drug.
posted by Karaage at 11:16 AM on January 23, 2015 [6 favorites]

The seeming reluctance you've experienced could be related to semi-recent supply chain problems with Adderall and it's generic equivalent. Granted this was in 2011 and 2012, but it was bad enough to make the news.

Going in and specifically requesting it, after trying other regiments seems perfectly reasonable to me.
posted by ApathyGirl at 12:12 PM on January 23, 2015 [1 favorite]

What worked for me was, basically, not just "stop taking the Strattera because it makes you feel gross and then never see that doctor again", which was my first impulse and didn't go well. I had one doctor who refused to prescribe stimulants to anybody who hadn't been on them since childhood. But after that, I went in, I said, I'm willing to try the Strattera again as a first line, and I did. And then I went in and I was very specific: I have tried taking it in the morning, at night, with food, without food, I've had ginger and antacids, this medicine is still making me too nauseous to function and I can't keep taking it, what's our next step.

And I got given an Adderall prescription that I've been taking with only a few tweaks for years now. And I reported my side effects with that, too--I sometimes got heart palpitations--and got an Inderal prescription to go with it that helped that substantially. I don't love the end result, but only because I only get about 8, maybe 12 good hours in a ~16-hour waking day. It's okay, basically. It's helped me a lot, but I've never tried a long-acting one; I was self-pay when I started and my doctor was thankfully willing to work with that. (Including, initially, my full Strattera prescription from his sample cabinet. This was before my state expanded Medicaid.)

Basically, the thing that distinguishes "drug seeking" from "other stuff hasn't worked and I want to try something else" is communication. Be humble about it. Be willing to try solutions that aren't your first choice. Mostly, though, just be thorough: "I want Adderall" is suspect, "these other drugs I've tried had the following benefits and drawbacks, what else can we try" isn't going to go poorly. If you get told there are no other options, then it's entirely reasonable to seek another opinion.
posted by Sequence at 12:20 PM on January 23, 2015 [2 favorites]

Response by poster: Thank you for your responses. They've given me the courage to begin the somewhat daunting task of trying to schedule an appointment with the psychiatrist (where I'll be seen as a new patient, as it's been so long since I was there), as well as reminding me to go into it with an open mind.
posted by whistle pig at 1:38 PM on January 23, 2015

I'm not sure how much I can add, but I too have been taking Adderall for several years. I think that doctors' reactions will vary widely, depending on how long you've been seeing that doctor, and what they think of you in general. For me, it was rather like your case: I had tried lots of things that didn't work - okay, how about adderall? A lot of people claim it works for them. The one difference is that I've been seeing this doctor regularly for years and he knows he can trust me.

BTW, dealing with getting a new Rx every month is a PITA, but I do it because I gotta.

Good luck with this. I'm pretty sure I'm not alone in having something of a phobia about asking doctors for specific meds. Yet there are all of these television commercials for drugs that have a tag line: "ask your doctor if Fuckitol is right for you"
posted by doctor tough love at 1:46 PM on January 23, 2015 [1 favorite]

Re Vyvanse...really ramped up my anxiety:

in case you aren't aware, Adderall and Vyvanse are very much alike. Paraphrasing my doctor's words, Adderall is essentially the active ingredient in Vyvanse, but the latter includes a chemical (amino acid? I don't remember the details) that modifies the way the amphetamine is metabolized, which tends to minimize the negative side effects often associated with Adderall. (And, as mentioned above, makes it slightly more difficult to abuse.)

Seconding the advise to just talk to your doctor about what you've tried and see what he/she suggests. But if you couldn't tolerate Vyvanse, I would be surprised if Adderall works for you.
posted by she's not there at 3:04 PM on January 23, 2015

I'll preface this by saying I'm depressed and anxious, not ADHD, and there's not much street resale value on anything I've ever been prescribed. But psychiatrists have always been happy to listen to any ideas I have when it comes to new meds to try. And since you're diagnosed and have had various other prescriptions in the past, why not ask? Ritalin and Adderal are the most widely-known ADHD meds, so if you need a different scrip and haven't buried yourself in medical journals to try to find obscure ones, it only makes sense that you'd wonder about it. The more so if you have friends (be they online or otherwise) who have said it worked very well for them. Why wouldn't you think of it?

Semi-tangentially addressing she's not there's comment above: it isn't always true that the single-isomer derivative of a drug affects a person all that similarly to the original. That's supposed to be the reason they exist: to administer the chemical with the therapeutic effect and avoid others which may cause side effects. Anecdatally, I had a friend who tried both Celexa and Lexapro and found their effects quite different. I and a different friend have both tried Modafinil and Adrafinil and reacted very differently to them. (In that case opposite reactions. He found Modafinil too focusing for his liking, and Adrafinil did exactly not a single thing for me.) So even if Vyvanse and Adderal are very closely chemically related, one may still work for you where the other did not. (Not knocking you at all for mentioning that, she's not there. That's actually very good information to have, especially before the psychiatrist brings it up!)
posted by Because at 5:13 AM on January 24, 2015

Much like renting a car, if you're over a certain age and have a steady job, it's a lot more clearcut than if you're a 20-year old college student.

If you go to a doctor and ask what the process for being assessed for ADD/ADHD is, they'll usually refer you to a psychiatrist. Call the psychiatrist and ask if they have a standardized screening procedure for ADD.

If the don't have a standard process, they do not specialize in it, and your health will be up to random chance. (They might give you the drug when you shouldn't have it. They might often withhold the drug when you should have it, too!)

If they do have a standard process, ask what it would take to setup an appointment and be evaluated for ADD. An example of a specialty group that does this well would be something like this: the ADHD Across the Lifespan Program.

Normally, you're going to answer a *long* questionnaire that's setup to be hard to fake, either way. Assuming that agrees with your assessment that you have ADHD, they'll likely setup a psychiatrist to work with you on prescriptions, and if that psychiatrist doesn't additionally do therapy, they'll set you up with a therapist as well to discuss changing your habits (strategies) to be a better-fit for the brain you've got, with or without drugs.

You want both types of treatment, if you're at all willing; both sides of this will help most people. As a reminder, psychiatrists are full medical doctors; they went to med school, and even did surgical training. That said, they're more medication-focused than skills-focused, so therapists - who usually have psychology degrees and often a master's degree - are specialists at skills-focused therapy.

Eventually, when they get to a point where your medication is at a stable dosage and is having the effects that you and the psychiatrist want, the psychiatrist may send you back to your general practitioner (a 'normal' family practice doctor), who can then write the scripts without stress on their end. If the therapist agrees you've got the new coping skills they can help you with, they'll taper off therapy sessions as well. You will need to visit the doc between 4 and 12 times a year to have prescriptions written, pretty much forever.

Two warnings:
1. strong stimulants will make you pretty much superhuman... for a few days or weeks, then will quickly drop off; no matter what you do with the dosage, you will not get the same effects six months into it that you had six days in, and trying to chase that will result in higher and higher and higher doses, until the side effects strongly outweigh the advantages.
2. using the medications in any way other than what's prescribed is going to reduce the effectiveness of the prescription for the problem you're having. If it's a bad enough problem to seek help, don't screw it up like that, please.
posted by talldean at 12:11 PM on January 24, 2015 [2 favorites]

I've tried both Adderall and Ritalin, and am on Ritalin now. I can definitely tell you that Adderall was much more intense for me, my muscles were always tensed, my jaw was always tensed, and I felt like dazed and focused, but not very human when I was on it, even at a very low dose. Given that Ritalin has been bad for your anxiety in the past, I don't think that Adderall will be that much better.
posted by the_wintry_mizzenmast at 7:33 AM on January 25, 2015