Cleveland-based ADHD doctor who prescribes meds for those on Medicaid?
October 17, 2018 8:50 AM   Subscribe

My adult child voluntarily stopped taking their ADD medication (Vyvanse) a month or so back due to panic attacks and anxiety. Now they are close to losing their new-ish job due to a decline in work performance, and they are very much panicking. They talked to their doctor about going back on the meds, but the doc does not want to start them up again due to the attacks/anxiety. How can my child convince their doctor to prescribe again? Or else does anyone know of ADHD specialists that take Medicaid and prescribe in the Cleveland area?

My child has been despondent ever since their boss told them that they needed to step it up, since they do not think the decline in performance is not something in their control. But they do not want to let their boss know about the mental illness + ADHD aspect. They told me that anxiety due to potentially losing the job is even higher than it was when they were having the panic attacks!

So, does anyone have any idea of how to convince the doctor that the meds are necessary at this point in time? We have brainstormed ideas as to how any possible anxiety issues can be mitigated: Quitting their morning coffee, exercising more frequently, eating healthier, things like that.

And if not - does anyone know of any Cleveland-based ADHD specialists, or doctors who are not hesitant to prescribe ADD medication? Distance is not an issue, so long as the practice is within 30 or so minutes of downtown Cleveland.

We heard that this practice was okay, but they do not seem to accept insurance of any kind:

We are unsure of any other options at the moment. Thank you in advance. :)

PS: They tried non-stimulant medication in the past, it was not very effective.
posted by BuddyBoo to Health & Fitness (6 answers total)
Response by poster: I forgot to mention... please let me know if you need any more information. Thank you!!
posted by BuddyBoo at 8:53 AM on October 17, 2018

I’d go back to the doc and say “so ADD meds make me panic, and stopping the med made me lose my job. How can you help me manage both the ADD symptoms and the the anxiety?”

Going to a lower dose might help.
posted by bunderful at 9:12 AM on October 17, 2018 [2 favorites]

I will defer to other people on medication options, but if the choice narrows itself to losing the job or requesting accommodation, the latter might at that point be preferable. It's not a simple calculus, but you should at least be thinking about whether it might help (whether the tasks being failed at are essential to the job, whether the work environment might reasonably be modified in ways that would help with success).
posted by praemunire at 9:24 AM on October 17, 2018 [1 favorite]

Propranolol helped me a lot with the anxiety related to my Adderall. I unfortunately don't know of any specific practices that close to Cleveland, and switching doctors under these circumstances, even people who normally are pretty easygoing might be less so? But I'd definitely cut other stimulants and then ask about just going back to the old dose or possibly a bit less, but with a beta blocker as needed.

Also, as one ADD person to another, to your kid more directly: yeah, if you're in losing-your-job territory, tell your boss about the real problem and that you're working on getting it resolved. I'd rather not tell people at work about it, either, but it's better than being jobless, and a lot of times even people who aren't super understanding about ADD in general will go with "things are just bad because of a medication change but it's being worked on". Your trump card here is that you can tell them honestly that you were previously medicated in a way where clearly they found your work product acceptable, so they can have every expectation that you will be able to sort this out.
posted by Sequence at 11:13 AM on October 17, 2018 [2 favorites]

On computer now and wanted to add a couple of things. I'm not sure whether the doc refused to prescribe any stimulant meds at all, or the same med, or the same med at the same dose. If he was very urgent/insistent he could have set off some red flags for drug-seeking behavior which could also have contributed to the refusal.

If he was taking ADD meds, experiencing anxiety and also drinking caffeine - yeah, that's something to explore. I have to reduce my caffeine to be able to tolerate the meds - sometimes when I'm getting used to them I actually switch to non-caffeinated tea for a while - it still has a little caffeine in it. It sometimes takes a few days of trial and error to get an idea of what morning beverage makes me too jittery and what works.

When I've had intense anxiety on meds, going to a lower dose has helped. Also sometimes weird things change your tolerance. A few years ago after being on a fairly high dose of concerta I suddenly couldn't tolerate it any more - it started to make me incredibly jittery and nervous - and went off meds completely for a while. When I went back on meds I had to go back to my doc and request lower doses than what she initially gave me. You can always ramp up later.

Vyvanse can be tricky - it was for me - so he might do better on something else.

Also, eating when on the meds is really important. The meds can make you forget to eat. Some people literally timers to remind themselves to eat, and/or keep high-protein snacks on hand at work and home - string cheese, nuts, tuna packets.

There are some discussions on the internet about using supplements with the meds - I haven't tried this and can't make any recommendations, but it's another thing that couldn't hurt to bring up with the/a doc.

As far as finding docs who are comfortable prescribing ADD stimulants, if going back to the prior doc is not an option or not fruitful. Psychiatrists in my (limited) experience are more familiar with ADD and the meds than regular docs. Another option is to talk to other people with ADD in your area about their experiences with local docs.
posted by bunderful at 5:59 AM on October 18, 2018

I get unpleasant side effects with my meds as well, but also need them to be semi-functional. What seems to be most important for me is getting a decent amount of sleep whenever I take them, which for me unfortunately means not taking them every day. My productivity obviously suffers on the off days but I muddle through with coffee and make up for it on the medicated days. I've had such unpleasant reactions on the really short on sleep days that I had to make a firm rule that I won't take them on less than 6 hours of sleep.

FWIW coffee/exercise/diet did not affect the anxiety/nausea/sweating side effects that I was getting. Sleep and to a lesser extent making sure I'm hydrated and adequately fed are the only things that have made a difference for me.

Definitely suggest trying a lower dose and different stimulants if that hasn't been done yet.
posted by randomnity at 2:48 PM on October 18, 2018

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