And then I'll forget to show up for the appointment...
November 8, 2011 9:59 PM   Subscribe

What is treatment for ADHD in an adult like? I need to get an estimate of how often one goes to the psychiatrist for ADD/ADHD after the initial screening. (If he thinks I am ADD, of course.)

What is treatment for ADHD in an adult like? I went to my doctor to be screened for ADHD. She doesn't do that, so she sent me to a psychiatrist. I have craptastic insurance, so just the first visit will be $200. Does ADHD entail a lot of doctor's visits? If it's $200 now and then a follow up here and there to check my reaction to whatever medicine they put me on, I can probably do that. (I would assume the follow ups would be at least somewhat cheaper and the $200 visit is for the screening?) If it's $200 every month or every other month or something, that's pretty much right out. I am probably going to call the doctor's billing department again tomorrow and see if they can tell me, but at the moment I'm asking this question to see if y'all stop me from just giving up right now. (If I do give up, I'll try again when we are less completely broke.)

Plan C (A is spend all my money that I don't even have on this, B is blow it off until some day in the future) is to ask my regular doctor when I see her Thursday for Wellbutrin. I've seen in some MeFi questions that it can be similar to Adderall, but isn't a crazy controlled substance so maybe my regular doctor will give it to me? If that is right out as a backup plan for some reason, please let me know. I have no experience with this whatsoever. I've never been on any medicine like this at all or been to any kind of mental health professional, obvs.

(Tomorrow's call to billing will be at least the 7th trying to set up this appointment. I think this is the test. If I actually manage to get through my regular doctor, her receptionist, the psych's two answering service ladies, the actual doctor, then his billing department 3 times so far to check on insurance, next will be billing again, then the answering service then the doctor than show up for the actual appt,=====> congratulations, you do not have Attention Deficit. I am not exaggerating in the least the phone calls that are happening here. And they always call back when I'm in the check out at Wal Mart with a three year old or something. I took an online test; it said, in bold, "SEEK MEDICAL ATTENTION FROM A MENTAL HEALTH PROFESSIONAL IMMEDIATELY!" So... (Also, my husband, mother and elementary school teacher keep telling me to get tested.))
posted by artychoke to Health & Fitness (20 answers total) 10 users marked this as a favorite
I am on concerta and see my doctor maybe twice a year. He wants me to have periodic (annual) blood work done because a small fraction of people on concerta have liver issues (I'm apparently fine). The big issue is that I need a script once a month to get refills, but my doctor doesn't charge for that or anything.
posted by Kid Charlemagne at 10:14 PM on November 8, 2011

Best answer: Well, here's how it worked for me. Like you, I asked my GP when I went for my annual check-up. Also like you, my Dr sent me to a psychologist to be screened (btw, a psychologist who specializes in ADHD can do the screening, so if that's cheaper, definitely do that). The screening took two sessions, but I know that's not always the case.

Once I was diagnosed with it, the psychologist referred me to a psychiatrist in his practice, but I realized it would be cheaper and easier to go back to my GP for the script. She put me on Ritalin, which was miraculous. Fortunately, I haven't had an issues with the drug, so we haven't had to fiddle around with the dose or anything. The one annoying thing is that I do have to get a paper prescription from her every month, since it's a controlled substance. I know some docs charge for those appointments, which seems sort of obscene to me. I just call mine once a month, she writes the script, and I pick it up at my leisure. So after the initial screening, I only had to pay the copay to see my doc and then the monthly prescription copay.

Also, a few logistical things: will your insurance allow you to see a different shrink for screening? The one you're dealing with sounds very unprofessional. And you say the appt for the shrink is $200 - wowzers. Is that your normal copay? Or is this person out of network? Is there someone in network you can see? You should also know that employer-provided health care plans are not supposed to have different rate schedules for mental health, due to recent mental health parity legislation (assuming you are in the US).
posted by lunasol at 10:16 PM on November 8, 2011

Pharmacies tell me that 60 days is the maximum prescription they can give me legally (U.S.) for Adderall / MAS. (But I've never made a concerted effort to get more, so maybe there are other ways.)
posted by XMLicious at 10:20 PM on November 8, 2011

Best answer: I see mine about twice a year. We chat, takes my BP, writes RXs in advance. There's no talk therapy for this. It's brain chemistry which is fixed by medication.
posted by Ideefixe at 10:27 PM on November 8, 2011

Best answer: Most of the meds* used to treat ADHD are Schedule II controlled substances and thus require the prescribing physician to write a hard copy prescription instead of just calling in a refill to your pharmacy. One thing to check is if your insurance offers prescription medication by mail and if so, what's the maximum amount you can get at a time. I'm able to get a 90 day's supply that way for my son (which is good because his doctor *does* charge for an office visit every time I go in to get the Rx written).

*The exception is Strattera, which is a non-stimulant and can be refilled.
posted by jamaro at 10:29 PM on November 8, 2011

Best answer: I've had some complications with my ADHD drugs, which entailed more visits than normal.

However: when my Psychiatrist treated my ADHD and depression with Wellbutrin, I only saw him once every six months. Now that I'm on Metadate, a Schedule II drug, I see him every three months. It's just a meds management visit, and I get three written prescriptions at the end of the visit.

I've found that Wellbutrin was effective for my ADHD, I only switched off of it because my insurance switched me to the generic, which I had horrid reactions on. YMMV.
posted by spinifex23 at 10:47 PM on November 8, 2011

Also - 'Metadate'? Best drug name *ever* for this board.
posted by spinifex23 at 10:52 PM on November 8, 2011 [2 favorites]

Best answer: 15 years post-diagnosis here.

I'd make my doctor's appointment, talk to them about how things had been going, and then take either my first pill every morning, and go about my day until lunch, and then take my second pill after lunch, and continue my day. Or, I'd take my only pill, and go about my day. (Brand name Ritalin comes in an eight-hour time release; generic is four-hour.)

Once the pill was in my system, I'd be calm, productive, and happy. Sometimes I'd turn around and go, "I don't even know why this is so hard! Yay, work!" I felt nothing was different. I got supremely lucky, and my original psych knocked it right out of the park on the first go... Ritalin and my brain chemistry agree quite nicely, and play very well together. YMMV, and don't get frustrated if it's not working... a lot of psychiatry is trial and error.
posted by mornie_alantie at 11:20 PM on November 8, 2011 [1 favorite]

I've been on generic Adderall for ~8 years now and I see my psych once a year to check in. I do have to call in to get a paper prescription, but my psych is allowed to write three paper prescriptions at a time (two of them dated for the future), and doesn't charge for this.
posted by clerestory at 12:21 AM on November 9, 2011

I take Adderall and have to go every month to keep getting the prescription. Whether you have better options will depend. My friend's psych was sensitive to her financial situation and wrote her a prescription for twice the doseage, so she takes half a pill a day for twice as long. (This is annoying with Adderall XR, I imagine, because it's a capsule, not a tablet, and I'm also pretty sure pychiatrists aren't "supposed" to do what hers did, but ones used to dealing with low income patients will sometimes bend the rules to help people.)
posted by Nattie at 3:16 AM on November 9, 2011

I take daytrana and I see my neurologist (not a psychiatrist, god no) quarterly, sometimes a little less. I get 3-4 months worth of prescriptions each time.
posted by elizardbits at 5:07 AM on November 9, 2011

Is EVERY visit $200, or just until you meet your deductible? Mine are full price until I meet the deductible, and then between $7 and $9 a visit after that. (I have no idea why it changes.)

I go to a psychiatrist once every 2 or three months and pick up prescriptions for Vyvanse on the alternate months.

(Also, ADHD is not strictly a chemical disorder. There are often comorbidities and thought patterns that need to be addressed too.)
posted by gjc at 5:48 AM on November 9, 2011

I was mostly diagnosed by my therapist and then referred to a psychiatrist who confirmed the dx and then prescribed medication ("So, do you want Adderall or Ritalin?").

The timing of your appointments is going to depend on your insurance and the laws in your state. My psych writes me prescriptions for a 90-day supply for my mail order pharmacy (I get amphetamines in the mail!), but before I switched to mail order, he used to write me post-dated prescriptions.

I DO have to go see him every three months though, which is annoying and I think is a requirement of my HMO, where I pay my co-pay and then he pretends to be interested in my life and sort of remembers who I am and what I do. And then he writes the rx and we're done.

And I'm on a drug vacation this week so none of this has probably made any sense.
posted by elsietheeel at 7:54 AM on November 9, 2011

Response by poster: Hey, thanks everyone. I wrote out an answer last night and apparently forgot to press post.

We have a crappy PPO through my husband's work with a $4000 family deductible. I pay for pretty much everything until we hit $4000. I think we have $1500 left, so we (hopefully!) won't get there before the end of the year. Although I did have a delightful $265 bill for a podiatrist yesterday. Luckily, the premiums are going up next year for the same coverage! Grrr... I'm going to call the billing person and ask about the cost of future visits now. Y'all have successfully talked me down from my "This is too expensive to even bother with pursuing" ledge.
posted by artychoke at 7:57 AM on November 9, 2011

Best answer: Y'all have successfully talked me down from my "This is too expensive to even bother with pursuing" ledge.

Glad to hear it. ADHD is really slick when it comes to convincing your mind that things are impossible.
posted by lunasol at 8:25 AM on November 9, 2011 [4 favorites]

Earlier comment of mine on this.
posted by BigSky at 10:47 AM on November 9, 2011

Response by poster: Just an update - the psychiatrist does charge for giving you the prescription each month, $67. So I called my GP back and asked her to prescribe Wellbutrin for me to try. If it doesn't work I'll look for a less expensive psychiatrist and do it right.

I've been on the generic Wellbutrin XL 300 mg since Wednesday and it's kind of awful the last couple of days - I am very jittery and my heart races sometimes. So, I'll be calling the doctor tomorrow to see if I need a lower dose or to stop taking it. Or maybe to switch to the brand name version.
posted by artychoke at 8:13 PM on November 21, 2011

Did you start at 300mg? My psychiatrist has always had me start at 150mg for a week or two before going to 300mg.
posted by XMLicious at 8:25 PM on November 21, 2011

Response by poster: Yep. I read that you're supposed to take 150 mg for a while AFTER taking 300 for a few days. So, now I don't know if I'm having side effects from the high dose or because it's the generic, or if I just can't take this medicine. Waiting for the doctor to call...
posted by artychoke at 8:29 AM on November 22, 2011

Response by poster: Wait, that didn't make sense. I read the dosage information after I'd already been taking the 300 mgs for a few days. Not take 300 mg first and then go down to 150.
posted by artychoke at 9:52 AM on November 22, 2011

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