Is it worth it (time, cost, energy) to get diagnosed with ADHD/ADD?
March 26, 2018 11:09 AM   Subscribe

Based on my own research and discussions with family/friends, I am convinced that I fall somewhere along the spectrum of ADHD inattentive. I brought this up with my PCP, who has suggested that I go through the process of formal ADHD screening with a psychiatrist. She won't diagnose me herself, since it is easily misdiagnosed. However, all of the psychiatrists I've looked into offer out-of-network services only. Most tell me that the cost of screening will run me at least $900-$1200, and it likely will be much more in the event I need medication management follow-up appointments. I've made it to my 30s without pursuing a diagnosis or medication, relying on my quick wits, hyperfocus, and procrastination-induced panic-urgency to get things done. But, I've reached a point where I think this may be preventing me from living my life in the way I'd like, because I can't sustain interest in anything, including lifelong, beloved hobbies and a decade-long intellectual pursuit. This is causing me a lot of distress. It will take me months to save up for this process, not to mention how much mental energy it will take me to follow through with appointments. Have you been here? Was it worth it to you?
posted by houseofleaves to Health & Fitness (28 answers total) 25 users marked this as a favorite
So, I was lucky because my insurance pays for me to see their own in network prescriber, who is a psychiatric nurse practitioner and is very good. You may want to look into folks with that credential as they'll likely be much cheaper.

The crux of your question: I often tell people that getting diagnosed and going on meds for my severe inattentive type ADHD is perhaps the best decision I've ever made for myself as an adult. My entire life changed for the better. Looking back I can say that if I'd had to pay put of pocket, I still would do it, and if I suddenly had to start paying out of pocket now, I'd still do it. It has added so much value to my life in terms of what I'm able to do and put my energy into. Hope this helps, good luck! Memail if you have additional questions, I'm super open about my ADHD.
posted by fairlynearlyready at 11:32 AM on March 26, 2018 [4 favorites]

I've made it to my 30s without pursuing a diagnosis or medication, relying on my quick wits, hyperfocus, and procrastination-induced panic-urgency to get things done.

This was me, except maybe in my 40's. I don't understand your problems with insurance, as I had no trouble getting screening, diagnosis and medication with my work insurance. Some of it was through an Employee Assistance Program (EAP), which may be separate from your regular benefits and not as well-advertised, so be sure to check that out.

I personally found it didn't make a difference, but mostly because the recommended meds didn't work for me (the side-effects swamped the therapeutic effects). OTOH, my son was diagnosed in grad school, and meds made an enormous difference to him, so your mileage may definitely vary, especially since meds may have improved since the last time I looked at them (about 10 years ago).

In any case, I recommend that you pursue it (after first pursuing if it's really as expensive as you fear), because ADHD is strongly related to depression, and what you say you're going through now sounds much more like depression than attentional problems. Pursuing the possibility of depression may also be a way to get in-network services, and some medications that deal with depression also help with ADHD.
posted by ubiquity at 11:35 AM on March 26, 2018 [2 favorites]

I pay out of pocket for my psychiatrist/therapist. Granted, my most troublesome symptom is anxiety, which can be exacerbated by my ADHD. But it is absolutely worth the expense and headache of getting reimbursed through my insurance.
posted by politikitty at 11:40 AM on March 26, 2018

I seriously doubt there are no in network psychiatrists in your area for your insurance. Granted, they may not advertise a specialty in ADHD, but that doesn't necessarily mean they have no experience with it.

You definitely should see someone, though, as the longer you put it off the more likely you are to develop comorbid conditions like depression, especially now that you feel like it's seriously impacting your life.

One thing you could do on your own is think about what, if any, habits of yours have changed over the past couple of years. If you're sleeping less and/or not eating as well, that can easily exacerbate any conditions you may have or even cause symptoms that look a lot like a mental health issue. I go from mildly ADHD to impossibly severe inattention and high anxiety if I don't eat enough, for example. Lack of sleep does the same, to a lesser degree. If both happen at the same time I'm basically non-functional until I have a relatively normal couple of days.
posted by wierdo at 11:43 AM on March 26, 2018 [1 favorite]

Just a quick note that may be useful info: I was formally diagnosed with depression several years ago, and it waxes and wanes in severity. However, for the past year I've been (thankfully!) out-of-the-hole, stable, no-longer-medicated, and generally content. Except, I'm still not able to get out of my thoughts, and do the things I dream about and supposedly love. My inability to focus has been a lifelong problem (since childhood), and I think depression masked it for years and years as a "depression problem." Now that I can genuinely say I'm not currently depressed, I suspect there's something else at work here.
posted by houseofleaves at 11:44 AM on March 26, 2018 [1 favorite]

I self-diagnosed, therapist agreed. Went to MD Psychiatrist for meds. I no longer take the adderall. Knowing that I have the attention issues is a help, and I use lots of organizational strategies, like google calendar on my phone for everything. All the organizational stuff is straightforward, helps a lot, doesn't need formal assessment, no harmful side effects. Also, 3 cups of coffee before 2 pm is my current medication.
posted by theora55 at 11:50 AM on March 26, 2018 [3 favorites]

I was formally diagnosed with depression a few years ago, and began taking medication to manage that depression. As I considered the path my life had taken I came to realize that I had ADHD, and that the depression was really a symptom, or maybe more accurately a result of my ADHD. Life events that could be described as failures, which were at least partially caused by my ADHD, were triggers for my depression. So I pursued a diagnosis for ADHD, reasoning that as long as I was only treating my depression, I was treating the symptom and not the cause.

I was diagnosed about a year ago, and began taking medication for ADHD instead of for depression. This has made a huge difference for me and I absolutely believe it was the right choice. I have the advantage of being Canadian, so all of this was covered under our medical system. So, your mileage may vary, obviously.
posted by wabbittwax at 12:09 PM on March 26, 2018 [4 favorites]

Are you anywhere near a medical school? They most likely will have in-network psychiatrists or work with you on making this more affordable. It sounds like it is really impacting your life and you owe it to yourself to address the issue.
posted by galvanized unicorn at 12:23 PM on March 26, 2018

Getting the diagnosis in my 40s really helped me. I think you should approach your primary care doc again, though I don't know if you'll need to send an email, leave a detailed voice mail message, or have another appointment. Break down the initial and ongoing costs per your research, remind her of the previous depression diagnosis, and ask for her help getting referred to a psychiatrist who can perform the evaluation in-network. It's important enough that if I were in your situation, I'd consider switching to a primary care doc who was comfortable starting a low-dose medication to see if it would make a difference. (My experience: I'd moved, and did not have a primary care physician, but my long-time family doc listened to me and wrote the initial prescription. Nearly a year later, I did have a formal evaluation and started a slightly higher dosage. When I relocated again, the new primary doc continued the existing prescription and referred me to a psychiatrist to confirm the diagnosis, which involved having the paperwork faxed from the out-of-state evaluation.)
posted by Iris Gambol at 12:26 PM on March 26, 2018 [1 favorite]

The symptoms I experience sound similar to yours. I'm in my 30s, I've always had a short attention span, and I moved into a job where I have more autonomy and began to realize how much I struggle to complete tasks.

My PCP was skeptical because I am "too successful" to have ADHD. I pressed for testing, spent $800-900 (out of my HSA) on initial appointments + testing, and was told I am "very ADHD."

I haven't done medication. I tried Adderall briefly, felt like it didn't help much and wore off too fast. My doc started me on a half-dose, and I'm pretty sure I needed more for it to really work, but I was -- you know how this goes -- tired of all the follow-up appointments and stopped going.

That said, just having the official diagnosis has made me feel better. It's nice to not wonder if there's something wrong with me, and it gives me a new lens to examine myself and my behavior with. I'm glad I got tested.

Also, I'm in North Carolina, too -- in Raleigh/Cary. You're welcome to MeMail me if you wanna talk.
posted by katieinshoes at 12:46 PM on March 26, 2018 [1 favorite]

Getting on medication for my inattentive ADHD changed my life. I also had to spend about a thousand dollars to get diagnosed and ngl the meds checkups are a huge pain, but it was and is worth it and I'd do it again in a heartbeat.

I too was very successful but the level of work it took to manage it was completely ridiculous .Getting help has made so many things easier.
posted by winna at 1:01 PM on March 26, 2018 [1 favorite]

My diagnosis and treatment changed my life, and I went to a psychiatrist who was also board-certified in neurology. I would not rely on a family care or general practice MD nor any medical assn’t or nurse-practitioner. I was plenty quick witted and good with deadlines, but now my abilities to plan and follow-through without panicking and anxiety are much improved.
posted by Ideefixe at 1:04 PM on March 26, 2018 [2 favorites]

Just as another datapoint, in my case the "ADHD" (I'm not scare-quoting this in clinical terms, just my usage) seemed to be masking the depression and anxiety, which I'm being treated for now. Once certain parts of my life straighten out and I have less to be depressed about, there may be ADHD waiting for me on the other side, but for now I'm happy just to feel like doing more stuff.

One realization I've recently had is that "I feel bad for not doing X," is, for me, a defensive formulation of "I'm not doing X because I feel bad," which is really changing my perspective.
posted by rhizome at 1:26 PM on March 26, 2018 [3 favorites]

Getting a proper diagnosis helped me a lot, but I want to say: If you want to do a trial run before you go spending a ton of money to see if you can get stimulants, then you might see about how you feel after taking several times your usual daily consumption level of caffeine versus now. Not that this is necessarily a replacement for proper medication, but if significantly increasing your caffeine intake does not result in you feeling at least a little better, in my experience, Adderall or the like is just like that only more concentrated. I actually only take the caffeine, at the moment, because the Adderall side effects were bad and you can now get extended-release caffeine pills.

This is not at all to dissuade you from doing the real thing, but basically just, if caffeine makes you feel gross, Adderall is also probably going to make you feel gross and at that point you might want to pursue other things that don't require the same diagnostic headaches. Some people also benefit from Wellbutrin, for example, but your doctor can ostensibly give you that for depression.
posted by Sequence at 1:55 PM on March 26, 2018 [2 favorites]

because ADHD is strongly related to depression

Between 60% and 80% of all people with ADHD also have comorbid mood disorders. Depression and/or anxiety and ADHD are VERY frequently found in the same person, but one may be masking the other. So, getting one disorder diagnosed can actually keep the patient from seeking a second diagnosis because they believe they've "found the problem" and are taking care of it.

I hope that getting tested/diagnosed doesn't turn out to be as expensive as you currently think it will be (do check your workplace's EAP), but even if it is, as others in the thread have commented, the right diagnosis and medication may rapidly improve your life.
posted by tzikeh at 2:34 PM on March 26, 2018 [1 favorite]

Also the best thing about ADHD meds is that you will know if they work or not pretty much right off the bat, as compared to weeks or even months for depression. And you can stop them at any time without withdrawal.
posted by tzikeh at 2:36 PM on March 26, 2018 [1 favorite]

Caffeine only energizes me (and only up to a point, after which I'm queasy and have a headache). My ADHD medication grants focus and drive.
posted by Iris Gambol at 2:37 PM on March 26, 2018 [3 favorites]

It wasn't worth it to me until my 20's when my life responsibilities began to outweigh my ability to focus on completing them, so I began medication. It's also become useful for schooling. It really depends on what need/use you have for an offical diagnosis.
posted by OnefortheLast at 3:04 PM on March 26, 2018

Getting diagnosed and starting treatment for ADHD (at around the same age as you) was literally the best thing I have done for myself in my adult life. I was very lucky, because I was able to see an in-network psychiatrist that my PCP recommended for the diagnosis, and then my PCP went on to prescribe the medication. I was further lucky that I didn't really have any problems with the medication (after a bit of tinkering with specific kind and dosage). I assume you have already called your insurance to ask if there is someone in-network who can screen you? And can your PCP prescribe once you are diagnosed? Most people I know with ADHD were diagnosed by a psych but get their prescriptions from a GP.

If you want to read more about how treatment helped me, you can look through the extensive commenting I've done about it here. I have a theory that a lot of smart, driven people with undiagnosed ADHD start to have problems around late twenties/early thirties, because you don't have the structure of school or entry-level jobs anymore, you're at the point where if you really want to get things done, you have to be self-motivated, and that's hard for ADHDers. So you're not alone there.

However, the one caveat that I have is that, anecdotally, the medication doesn't help as much with the long-term stuff. This is true for me and it's true for other people I've talked with. It DOES help you start to build habits that help you with the long-term stuff, but you really have to be very conscious of building those habits. And I think that's one thing a lot of people (myself included) miss with the medication-first approach. So I'd suggest really thinking through steps you can take regardless of whether or not you start medication - is it working with an ADHD coach? Is it going through a goal setting process? All of these things are easier with medication if you have ADHD but can be done either way.

Good luck! Feel free to memail me if you have any questions about my experience.
posted by lunasol at 3:09 PM on March 26, 2018 [7 favorites]

Can you call your insurance company and find an in-network provider for the screening and diagnosis?
posted by lazuli at 3:45 PM on March 26, 2018

Insurance companies typically have a directory and/or search engine for in-network providers. You should be able to generate a list of in network psychiatrists in your area to get started.
posted by Huffy Puffy at 4:17 PM on March 26, 2018

I was in a similar boat a few years ago. In the end, I was screened and diagnosed as part of a medical study. They didn't care that I hadn't been formally diagnosed before, as they needed to do a full diagnostic for the study anyway (and I tested "well" enough on a basic scale to be worth evaluating). In exchange, I got paid, so you know, not complaining. Obviously there was more to it, but it was a very comfortable situation and I'm glad I was able to contribute to science in my own small way.

It's *definitely* not for everyone, but if the cost is the thing giving you pause, it's worth looking to see if that's an option.
posted by mosst at 4:21 PM on March 26, 2018 [1 favorite]

Oh, and also: after the first call I made, the cognitive load of managing and scheduling was not an issue at all, since the people managing the study were so helpful and proactive. It's no wonder - recruiting/retention is a huge challenge for any study, doubly so for an ADHD study - and managing things was for their benefit rather than mine, but it sure helped.
posted by mosst at 4:33 PM on March 26, 2018

I never pursued the diagnosis, though it's very clear I have it. I avoid medication of any sort if at all possible (for reasons) and I rather like my symptoms (and have plenty of coping skills in place after a lifetime of dealing). I do have a quadruple espresso every morning, mind you.

As an educator, I researched it; a meta-analysis of the literature concluded behavior modification and coping skills were more important in long-term success with students than medication, though the medication apparently allowed people to manage the symptoms while putting the behavior changes in place.
posted by Peach at 7:22 PM on March 26, 2018 [2 favorites]

Adderall changed my life.
posted by bendy at 9:23 PM on March 26, 2018 [1 favorite]

Getting on Adderall was amazing. I could finally use my whole brain. So IMO it is very worth it to pursue diagnosis and medication.
posted by Jacqueline at 7:12 AM on March 27, 2018

After I started taking Ritalin, the obtrusive thoughts that had dogged me for years largely disappeared. Certain upsetting topics that used to be super sticky lost their hold over me. That was a completely unexpected benefit of getting my diagnosis and going on medication. For me, my diagnosis was life-changing because it helped me start working on the self-hatred born of not being easily able to do things everyone else could seeminly do. The medication is key in helping me accomplish virtually anything. As I have explained to my family, being on Ritalin for my ADHD is like someone else who needs a cane to get around. I can do much much more with Ritalin than without it, but I am still limited in a variety of ways even with medication. Glad I have the diagnosis partly because it is helpful when I’m dealing with bureacracy. If I am dealing with a nightmarish for me situation, I can tell people I have ADHD and ask if there is a different way to make a particular thing happen. Can the person interview me rather than making me fill out 47,000 forms, for example. I don’t ask for accommodations often but I am very glad I can ask for them when I need to. Best of luck however you decide to proceed.
posted by Bella Donna at 7:20 AM on March 27, 2018 [2 favorites]

There are a lot of really good answers here, so I'll just chime in to add another data point that diagnosis (aged 21) was very much worthwhile for me as well.
posted by spielzebub at 9:47 AM on March 27, 2018

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