Vyvanse & Sertraline in Germany?
May 1, 2016 1:44 PM Subscribe
I moved to Germany last week after an extremely busy and stressful few final months in the US, and I am now realizing that I never worked out how to deal with my medication situation. I've been taking Vyvanse and Sertraline (generic Zoloft) for ADHD and anxiety, and I'm wondering what to do in a few weeks when I have gone through the supply I had when I left.
I defended my dissertation on April 25 and flew over to Germany on the 27th. This was always an insane plan and now I'm realizing that I left quite a few things unresolved. The meds thing is probably a good first priority.
My psychiatrist (up to this point I guess) is in Atlanta (GA, USA), and my mom still sees her on a regular basis. I will be back in the US and seeing my parents in late May, so I think I could probably get her to fill at least one month of each. I'm actually not sure on the health insurance logistics of this: I think my coverage is probably ended now that I'm not a grad student anymore, but could my mom fill it using her insurance? Ideally I'd like as much of a supply as possible; what are the rules in Georgia like for that? I would think Vyvanse would be more controlled considering it's a stimulant, but I don't know.
More long-term, I'm seeing conflicting things online about whether Vyvanse/Elvanse is approved in Germany. I'd like to see a doctor sometime next week to work this out, but for now I'm hoping the Green can fill me in.
Also, should I be looking for a psychiatrist here, or is this something that a GP would be able to help me with?
Sorry this is so poorly thought out and rambly. After realizing my mistake, I went without the meds this weekend, and so I'm quite unfocused at this point.
I defended my dissertation on April 25 and flew over to Germany on the 27th. This was always an insane plan and now I'm realizing that I left quite a few things unresolved. The meds thing is probably a good first priority.
My psychiatrist (up to this point I guess) is in Atlanta (GA, USA), and my mom still sees her on a regular basis. I will be back in the US and seeing my parents in late May, so I think I could probably get her to fill at least one month of each. I'm actually not sure on the health insurance logistics of this: I think my coverage is probably ended now that I'm not a grad student anymore, but could my mom fill it using her insurance? Ideally I'd like as much of a supply as possible; what are the rules in Georgia like for that? I would think Vyvanse would be more controlled considering it's a stimulant, but I don't know.
More long-term, I'm seeing conflicting things online about whether Vyvanse/Elvanse is approved in Germany. I'd like to see a doctor sometime next week to work this out, but for now I'm hoping the Green can fill me in.
Also, should I be looking for a psychiatrist here, or is this something that a GP would be able to help me with?
Sorry this is so poorly thought out and rambly. After realizing my mistake, I went without the meds this weekend, and so I'm quite unfocused at this point.
BTW, Vyvanse = Elvanse in Germany.
posted by amf at 2:43 PM on May 1, 2016 [1 favorite]
posted by amf at 2:43 PM on May 1, 2016 [1 favorite]
Best answer: Do not have your mom get it refilled on her insurance. In the unlikely event that a doctor would go along with this, everyone involved (you, your mom, and the doctor) would be violating federal law both in terms of misuse of a schedule-II substance and also insurance fraud.
I mean, it's definitely possible nothing bad would happen, but it's an incredibly terrible plan.
posted by SMPA at 2:49 PM on May 1, 2016 [4 favorites]
I mean, it's definitely possible nothing bad would happen, but it's an incredibly terrible plan.
posted by SMPA at 2:49 PM on May 1, 2016 [4 favorites]
The Vyvanse is schedule II, I mean. Schedule II also includes cocaine and methamphetamine.
posted by SMPA at 2:51 PM on May 1, 2016 [1 favorite]
posted by SMPA at 2:51 PM on May 1, 2016 [1 favorite]
If you have had those prescriptions regularly filled at a specific pharmacy/chain have them email you your prescription history--or you might be able to access the history online if this is a service of your pharmacy. Have this available when you go the a local physician--is these meds have worked you might be able to stick with a primary care doc. good luck.
posted by rmhsinc at 3:21 PM on May 1, 2016
posted by rmhsinc at 3:21 PM on May 1, 2016
If you were diagnosed in the US with ADHD and anxiety and have been prescribed medication to treat it, you need to get copies of anything you have stating as such. Because those medications require a presciption, you will need to see a doctor first. Your normal Hausarzt might be a bit reluctant to write a prescription just because you claim you have a diagnosis that requires these medications.
From my experience German doctors are just generally much more reluctant to prescribe anti-depressants. He or she might first send you to a neurologist to verify that your diagnosis is legit and have the prescription approved. However, after that you should be able to get you prescription renewed through your Hausarzt.
If you can't prove you have been diagnosed with ADHD, technically the doctor can't give you a prescription, so you will have to be diagnosed all over again and fuck all that. It takes forever, especially for adults.
posted by chillmost at 3:22 PM on May 1, 2016
From my experience German doctors are just generally much more reluctant to prescribe anti-depressants. He or she might first send you to a neurologist to verify that your diagnosis is legit and have the prescription approved. However, after that you should be able to get you prescription renewed through your Hausarzt.
If you can't prove you have been diagnosed with ADHD, technically the doctor can't give you a prescription, so you will have to be diagnosed all over again and fuck all that. It takes forever, especially for adults.
posted by chillmost at 3:22 PM on May 1, 2016
Best answer: Get a copy of your diagnosis and history from your psych, stat. A lot of non-American doctors are extremely dubious of adult ADHD and have this "the Americans over medicate" attitude. Took me 2 years to get my meds again here in the UK. I don't think I would have even gotten my referral if I hadn't had documentation on me. So get that, and once you have that, make an appointment with your GP to figure out your options.
For next time, before you move again, look up how many months worth of controlled substance medications you're allowed to take with you. Some places let you take up to 3 months, so it's good to look this stuff up beforehand.
posted by the_wintry_mizzenmast at 4:46 PM on May 1, 2016 [2 favorites]
For next time, before you move again, look up how many months worth of controlled substance medications you're allowed to take with you. Some places let you take up to 3 months, so it's good to look this stuff up beforehand.
posted by the_wintry_mizzenmast at 4:46 PM on May 1, 2016 [2 favorites]
Also, if you get pushback from the German system, it might be worth having your psych in the US write you a prescription for as much as is legal to bring into the country and paying out of pocket instead of going without. If your mother can personally bring it to you or for you to go back to the States, that would be best, since it's illegal to ship/mail controlled substances.
posted by the_wintry_mizzenmast at 4:50 PM on May 1, 2016 [1 favorite]
posted by the_wintry_mizzenmast at 4:50 PM on May 1, 2016 [1 favorite]
Your mom definitely can't / shouldn't get the meds with her insurance - that would require the doctor to write the prescription for her, which is illegal.
Sertraline is not controlled in the US and the generic is cheap, so when you're in the US it's likely that your psychiatrist would be willing to write you a prescription (possibly without an appointment). You can then fill it and pay cash in order to buy yourself some time before you figure out the situation in Germany. Withdrawal from sertraline can be pretty brutal if you're on a high dose and stop abruptly, so I would definitely do your best to make sure you don't have an interruption in your supply.
posted by insectosaurus at 5:16 PM on May 1, 2016
Sertraline is not controlled in the US and the generic is cheap, so when you're in the US it's likely that your psychiatrist would be willing to write you a prescription (possibly without an appointment). You can then fill it and pay cash in order to buy yourself some time before you figure out the situation in Germany. Withdrawal from sertraline can be pretty brutal if you're on a high dose and stop abruptly, so I would definitely do your best to make sure you don't have an interruption in your supply.
posted by insectosaurus at 5:16 PM on May 1, 2016
Best answer: Where are you in Germany? You can look up your local psychiatric service center - google "krisendienst + cityname" (or "psychiatrischer krisendienst/sozialpsychiatrisches dienst +cityname"), those are free services provided by the local government, or connected to local clinics or university clinics, they are specifically intended for emergencies and they have both counsellors and doctors/psychiatrists who can prescribe medication.
Tell them straight away you do have a prescription for this medication in the US, show them any copies of papers to prove you already have a prescription, and ask for their doctor to give you a prescription for the local equivalent of that medication. No need to go through a diagnosis all over again.
You could try the same with a local general practitioner/family doctor (Hausartz), but you normally have to book appointments for that anyway and I’m not sure they can prescribe any psychiatric medication without referring you to a specialist first, so, it could be a waste of time really. (And that regardless of any potential bias of the individual doctor against medication for ADHD or not - sure you can always run into the individual doctor who’s a dickhead about anything, but that likelihood will be reduced if you go straight to the specialized central service).
The local services are open to anyone during their service hours. Language shouldn’t be a problem, whether you speak German or not, they should have people speaking English at least if it’s a major city.
If you have trouble locating the right local service (they are all managed locally and the names can differ!) and have no contacts who can help you, why not ring the embassy or consulate and ask them "where can I go here in x to get a prescription for the German equivalent of this medication?". Or, even quicker: go to the biggest local pharmacy (Apotheke), ask them!
Feel free to message me here if you need any help with any of this.
posted by bitteschoen at 1:26 AM on May 2, 2016
Tell them straight away you do have a prescription for this medication in the US, show them any copies of papers to prove you already have a prescription, and ask for their doctor to give you a prescription for the local equivalent of that medication. No need to go through a diagnosis all over again.
You could try the same with a local general practitioner/family doctor (Hausartz), but you normally have to book appointments for that anyway and I’m not sure they can prescribe any psychiatric medication without referring you to a specialist first, so, it could be a waste of time really. (And that regardless of any potential bias of the individual doctor against medication for ADHD or not - sure you can always run into the individual doctor who’s a dickhead about anything, but that likelihood will be reduced if you go straight to the specialized central service).
The local services are open to anyone during their service hours. Language shouldn’t be a problem, whether you speak German or not, they should have people speaking English at least if it’s a major city.
If you have trouble locating the right local service (they are all managed locally and the names can differ!) and have no contacts who can help you, why not ring the embassy or consulate and ask them "where can I go here in x to get a prescription for the German equivalent of this medication?". Or, even quicker: go to the biggest local pharmacy (Apotheke), ask them!
Feel free to message me here if you need any help with any of this.
posted by bitteschoen at 1:26 AM on May 2, 2016
Best answer: If you also want to get any other advice on local services or want to hear from people who have been in that situation, you could also post on this forum for English speaking expats in Germany - searching for "ADHD" brings up this thread from a few years ago on locally available medication and right on the first page there is someone talking of getting their prescription "refilled" in Germany (though with other medication):
"I don't know about Adderall, but my wife was able to get Concerta where we were (Near Regensburg). She took a copy of the files from her US doctor and copies of the prescriptions and her doctor didn't have any problems."
(and don’t worry about the bit where someone says "You can not get Vyvanse [Elvanse] in Germany" - that thread is from 2010, it’s allowed since 2013 and Elvanse shows up on online websites of German pharmacies - not sure it’s covered though, depends if you have any insurance for that or it could cost quite a bit of money)
posted by bitteschoen at 1:49 AM on May 2, 2016
"I don't know about Adderall, but my wife was able to get Concerta where we were (Near Regensburg). She took a copy of the files from her US doctor and copies of the prescriptions and her doctor didn't have any problems."
(and don’t worry about the bit where someone says "You can not get Vyvanse [Elvanse] in Germany" - that thread is from 2010, it’s allowed since 2013 and Elvanse shows up on online websites of German pharmacies - not sure it’s covered though, depends if you have any insurance for that or it could cost quite a bit of money)
posted by bitteschoen at 1:49 AM on May 2, 2016
I'm German, and German doctors (GPs) are actually not all that reluctant to prescribe anti-depressants, at least not the ones I used to see. In fact, I was precribed some without anyone ever having done a proper thyroid panel, hormon check etc. on me - not sure if that was because or despite my being a young woman. A lot of them do seem reluctant to send you over to specialists, though - the first GP I saw during my major depression of 2013 should have sent me for a check-up, but never did. Neither did the second. Apparently us Germans hate to admit we don't know something. (Or maybe it's just doctors. I had my Swiss ENT lecture me about my endometriosis today...)
I'm not sure if GPs can prescribe all kinds of medicine, but I have never heard anything to the contrary, so I guess they can? Actually, I googled this in German and apparently, any doctor can prescribe any kind of medicine, although a gynecologist prescribing a cough syrup might have to defend themselves in front of some committee.
I would definitely take your previous diagnosis, precriptions etc., and then still be prepared to fight a lot because some doctors here just hate it when a patient claims to have something they don't believe in, and a lot of Germans really do not believe in ADHD.
posted by LoonyLovegood at 11:42 AM on May 2, 2016
I'm not sure if GPs can prescribe all kinds of medicine, but I have never heard anything to the contrary, so I guess they can? Actually, I googled this in German and apparently, any doctor can prescribe any kind of medicine, although a gynecologist prescribing a cough syrup might have to defend themselves in front of some committee.
I would definitely take your previous diagnosis, precriptions etc., and then still be prepared to fight a lot because some doctors here just hate it when a patient claims to have something they don't believe in, and a lot of Germans really do not believe in ADHD.
posted by LoonyLovegood at 11:42 AM on May 2, 2016
I forgot one tip: bring the box with you too, the actual medication, that won’t hurt.
(I just remembered I did that in Germany not for antidepressants but for a particular kind of antibiotic that I’d been prescribed in another country for a sort of off-label use, and I didn’t even have the original prescription, so I just took the empty box with me to the doctor and got a new prescription for the local equivalent, without having to explain toooo much)
posted by bitteschoen at 1:49 PM on May 2, 2016
(I just remembered I did that in Germany not for antidepressants but for a particular kind of antibiotic that I’d been prescribed in another country for a sort of off-label use, and I didn’t even have the original prescription, so I just took the empty box with me to the doctor and got a new prescription for the local equivalent, without having to explain toooo much)
posted by bitteschoen at 1:49 PM on May 2, 2016
For various reasons I pay cash for my sertraline generic (Zoloft). While living overseas I've had my parents get me 3-month supplies (with the agreement of my psychiatrist) which they mail to me and I reimburse them. We've been doing this for almost 4 years and it works. Also I recently discovered goodrx.com which got me a really good deal on my most recent refill so it's not onerous. I don't know anything about the Schedule II business, unfortunately.
posted by orrnyereg at 3:28 PM on May 2, 2016
posted by orrnyereg at 3:28 PM on May 2, 2016
I should add, if you go this route, be sure to allow enough time for your Rx to arrive from the US before you run out of your current supply. Better safe than sorry.
posted by orrnyereg at 3:34 PM on May 2, 2016
posted by orrnyereg at 3:34 PM on May 2, 2016
Response by poster: Vielen Dank for all the advice, everyone. I'm signed up for health insurance with TK (Techniker Krankenkasse) although I'm still waiting for the paperwork to arrive. My company had me see a GP last week so I could be approved for work, and she suggested a psychiatrist for me to see. I haven't been able to get in touch with them because of holidays, but I'll be calling them first thing tomorrow. I will also be asking my doctor in the US to send over any info/docs that might get requested, and I'll be bringing the pill bottles to my appointment.
Also, it turns out my university health insurance lasts through July, so I can have my mom fill that prescription no problem.
posted by dondiego87 at 12:50 AM on May 8, 2016
Also, it turns out my university health insurance lasts through July, so I can have my mom fill that prescription no problem.
posted by dondiego87 at 12:50 AM on May 8, 2016
This thread is closed to new comments.
If you moved to Germany permanently, do you have health insurance in Germany now? It's mandatory for all citizens, but I don't know about the situation for whatever status you have. If you have public health insurance (gesetzliche Krankenversicherung), I think you need to see a general practitioner (Hausarzt) first and get a referral (Überweisung) to a psychiatrist if the GP cannot prescribe these himself. If you have private health insurance (private Krankenversicherung), you don't need a referral from a GP and can see a psychiatrist directly. You could also start by calling a psychiatrist's office and asking. Good luck!
posted by amf at 2:36 PM on May 1, 2016 [1 favorite]