ELI 5: ADHD meds edition
May 27, 2024 5:28 PM Subscribe
Many years ago, I paid out of pocket to visit a psychiatrist who specializes in ADHD. He evaluated me, diagnosed me, and prescribed Adderall. When I turned 26 and went on Medicaid, he referred me to a low-income clinic because he couldn't treat me anymore. I saw them and took meds for many years and all was well.
Then COVID happened, and I moved across state lines twice, and stopped taking my meds for a stupid reason and my anxiety and depression got a lot worse. Those are more under control now thanks to the magical power of SSRIs prescribed by my GP, but my ADHD feels more out of control than ever. Maybe it's because I have motivation because I'm not depressed all the time, but I feel like I have so many things I want to do and yet I feel paralyzed and unable to do them. It's the simplest things, too, like changing the water filter in my fridge or cleaning out my humidifiers or putting my laundry away. I constantly find myself staring into space and I lose things all the time, and I also keep getting sent to debt collectors because I'm overlooking certain bills. I just don't feel functional and I'm afraid it's only going to get worse. So I want meds again. I feel like I'm halfway there with the SSRI and an ADHD medication would make me a fully functioning person.
From there, however, I feel paralyzed on what to do. See my GP and ask for meds? I think she may send me to a psychiatrist, and I'm afraid it'll be a nine months wait and when I finally get there I'll have to pay $900 to be told that I did too well in school to have ADHD and just keep taking the Prozac. Should I just do a general follow-up with my doctor and say that I like the meds, they're helping, but my ADHD is worse? I'm just afraid of being labeled as drug seeking and/or not being believed, especially with the shortage, and that's making something that should be easy feel so daunting I cannot bring myself to do it.
I don't have records from the previous clinic or doctor, besides one little sheet that lists the diagnosis and has the doctor's signature on it. I keep thinking that they're going to send me to a psychiatrist and I'll need to be reassessed. It wouldn't be super easy for me to sign a release and have the previous records sent over since I'm in an entirely different city now. For those that have gone back on ADHD meds after time off, what did that look like? Is there something I can say to my GP to get her to just get me the meds? I keep thinking of maybe just sending her a message on MyChart asking if she would prescribe ADHD meds or if I would need to see a psychiatrist, but I'm not sure that's the best course of action.
I'm probably overcomplicating this, but with the state of healthcare plus my not quite under control ADHD, this feels super daunting. Thanks in advance for your help.
Then COVID happened, and I moved across state lines twice, and stopped taking my meds for a stupid reason and my anxiety and depression got a lot worse. Those are more under control now thanks to the magical power of SSRIs prescribed by my GP, but my ADHD feels more out of control than ever. Maybe it's because I have motivation because I'm not depressed all the time, but I feel like I have so many things I want to do and yet I feel paralyzed and unable to do them. It's the simplest things, too, like changing the water filter in my fridge or cleaning out my humidifiers or putting my laundry away. I constantly find myself staring into space and I lose things all the time, and I also keep getting sent to debt collectors because I'm overlooking certain bills. I just don't feel functional and I'm afraid it's only going to get worse. So I want meds again. I feel like I'm halfway there with the SSRI and an ADHD medication would make me a fully functioning person.
From there, however, I feel paralyzed on what to do. See my GP and ask for meds? I think she may send me to a psychiatrist, and I'm afraid it'll be a nine months wait and when I finally get there I'll have to pay $900 to be told that I did too well in school to have ADHD and just keep taking the Prozac. Should I just do a general follow-up with my doctor and say that I like the meds, they're helping, but my ADHD is worse? I'm just afraid of being labeled as drug seeking and/or not being believed, especially with the shortage, and that's making something that should be easy feel so daunting I cannot bring myself to do it.
I don't have records from the previous clinic or doctor, besides one little sheet that lists the diagnosis and has the doctor's signature on it. I keep thinking that they're going to send me to a psychiatrist and I'll need to be reassessed. It wouldn't be super easy for me to sign a release and have the previous records sent over since I'm in an entirely different city now. For those that have gone back on ADHD meds after time off, what did that look like? Is there something I can say to my GP to get her to just get me the meds? I keep thinking of maybe just sending her a message on MyChart asking if she would prescribe ADHD meds or if I would need to see a psychiatrist, but I'm not sure that's the best course of action.
I'm probably overcomplicating this, but with the state of healthcare plus my not quite under control ADHD, this feels super daunting. Thanks in advance for your help.
You are over complicating this. You have ADHD. It was diagnosed. You were previously perscribed meds with good effectiveness. You moved, lost providers, got depressed, and disorganized. That's fairly classic ADHD there ( maybe not so much the depressed part but still common enough). It's now very apperent that ADHD meds would be helpful so you are trying to restart.
Start with your GP, tell them you are aware you might need a referral but start with the above. See what they say and go from there.
In general being off meds for awhile you may start on a lower dose than your last perscribed dose but it should look fairly similar to the first time around without the assessment pieces.
posted by AlexiaSky at 5:40 PM on May 27 [11 favorites]
Start with your GP, tell them you are aware you might need a referral but start with the above. See what they say and go from there.
In general being off meds for awhile you may start on a lower dose than your last perscribed dose but it should look fairly similar to the first time around without the assessment pieces.
posted by AlexiaSky at 5:40 PM on May 27 [11 favorites]
see your GP, for sure. going on & off ADHD meds has never been a challenge for me, either way. there was a bit of a shortage for a while, may or not still be so. whether or not, you'll need a script.
You are over complicating this.
100% agree & 100% empathy. a MyChart message saying you need a refill, that'll help you & your GP. especially with COVID on an upswing, any GP worth their salt is dealing with a lot right now. i always appreciate Thoreau's maxim: simplify, simplify
good luck!
posted by HearHere at 5:51 PM on May 27
You are over complicating this.
100% agree & 100% empathy. a MyChart message saying you need a refill, that'll help you & your GP. especially with COVID on an upswing, any GP worth their salt is dealing with a lot right now. i always appreciate Thoreau's maxim: simplify, simplify
good luck!
posted by HearHere at 5:51 PM on May 27
one little sheet that lists the diagnosis and has the doctor's signature on it
That's your ADHD diagnosis. You don't need to get re-assessed. ADHD is for life.
posted by heatherlogan at 5:59 PM on May 27 [6 favorites]
That's your ADHD diagnosis. You don't need to get re-assessed. ADHD is for life.
posted by heatherlogan at 5:59 PM on May 27 [6 favorites]
First, empathy. This is a completely typical thing that happens that your doctor will have heard before and is unlikely to judge you for. I have been in a similar position in the past.
I think people have the talk to your GP piece down, so I am going to address your other concerns.
1) Medical Records: most medical records transfer is done electronically these days. If you call your old GP’s office and ask, they can probably do all of this over email. Your new GP’s office will almost definitely be able to help facilitate this with a form you can fill out while there so that that piece is less daunting. You may also be able to do this over email.
2)Assessment: if you are still low-moderate income, there may be a place near you that does this kind of assessment either for sliding scale or in a way that takes your insurance. Near me, there is a place that does sliding scale affiliated with a university and a number of places that take insurance and will do the assessment for the cost of a co-pay, especially if you only need to be assessed for ADHD and not the full spectrum of syndromes that neuropsychiatrists evaluate for.
3) Meds: you may find that your GP will prescribe the meds as long as you take the referral and find a psychiatrist to manage them long term. I have had GPs do this in the past.
In the unlikely event that you do need a new evaluation, please feel free to send me an memail and I am happy to help you research affordable options in your area.
posted by eleanna at 6:12 PM on May 27 [1 favorite]
I think people have the talk to your GP piece down, so I am going to address your other concerns.
1) Medical Records: most medical records transfer is done electronically these days. If you call your old GP’s office and ask, they can probably do all of this over email. Your new GP’s office will almost definitely be able to help facilitate this with a form you can fill out while there so that that piece is less daunting. You may also be able to do this over email.
2)Assessment: if you are still low-moderate income, there may be a place near you that does this kind of assessment either for sliding scale or in a way that takes your insurance. Near me, there is a place that does sliding scale affiliated with a university and a number of places that take insurance and will do the assessment for the cost of a co-pay, especially if you only need to be assessed for ADHD and not the full spectrum of syndromes that neuropsychiatrists evaluate for.
3) Meds: you may find that your GP will prescribe the meds as long as you take the referral and find a psychiatrist to manage them long term. I have had GPs do this in the past.
In the unlikely event that you do need a new evaluation, please feel free to send me an memail and I am happy to help you research affordable options in your area.
posted by eleanna at 6:12 PM on May 27 [1 favorite]
Disclaimer this is what I'd do based on my experience, but doctors vary and some are misinformed. In any case, take it one step at time.
Talk to your GP (book an appointment and go in person if possible), tell them the condensed medical history with the general time frames, specialist you saw, medication you took and dosage. Tell them that the medication was helpful and you want to go back to taking it. They may ask you about the symptoms you are experiencing now. Tell them about those, making clear that they're not new and exist whether or not you're depressed or anxious. Let them lead the way and ask questions, consider writing down your concerns and having them ready to check if you get overwhelmed.
If they are unwilling to prescribe on that basis, perhaps ask them if they need your medical records to confirm the assessment before they prescribe medication.
In many places, it is normal for GPs to manage ADHD meds so I wouldn't assume it's not possible. I wouldn't even ask about whether they need you to be assessed again, it's already happened.
Start there. If they say you need an assessment or psychiatrist referral, tell them you'll think about it and come back here to ask for more help.
posted by lookoutbelow at 9:30 PM on May 27
Talk to your GP (book an appointment and go in person if possible), tell them the condensed medical history with the general time frames, specialist you saw, medication you took and dosage. Tell them that the medication was helpful and you want to go back to taking it. They may ask you about the symptoms you are experiencing now. Tell them about those, making clear that they're not new and exist whether or not you're depressed or anxious. Let them lead the way and ask questions, consider writing down your concerns and having them ready to check if you get overwhelmed.
If they are unwilling to prescribe on that basis, perhaps ask them if they need your medical records to confirm the assessment before they prescribe medication.
In many places, it is normal for GPs to manage ADHD meds so I wouldn't assume it's not possible. I wouldn't even ask about whether they need you to be assessed again, it's already happened.
Start there. If they say you need an assessment or psychiatrist referral, tell them you'll think about it and come back here to ask for more help.
posted by lookoutbelow at 9:30 PM on May 27
I just did this. In my case, I didn’t even have the piece of paper with my diagnosis, but I did have an email exchange with my former psychiatrist (who lives far away in my old city across the country) about dosing and scheduling a follow up appointment.
What I did:
1) Emailed my former psychiatrist asking if he could email me a copy of my formal diagnosis. (You can skip this part since you already have it!) Despite having not worked with him since 2016, getting a copy was no problem.
2) Told my current GP that I have had an ADHD diagnosis since 2015, and since the pandemic, I’ve been struggling substantially more and would like to try meds (Adderall) again. I mentioned that I had documentation of the diagnosis and was happy to share it with him.
3) At my GP’s request, I forwarded the diagnosis email.
4) I discussed starting dosage with my GP, and he called in a prescription. No problem in filing it.
I had a lot of the same anxieties, including worries that I wouldn’t be believed, that I was too “high functioning”, that I would have to go through the whole process again, etc. None of those turned out to be a problem. I’d strongly recommend reaching out to your GP with a copy of the diagnosis you have.
posted by suviko at 12:24 AM on May 28 [1 favorite]
What I did:
1) Emailed my former psychiatrist asking if he could email me a copy of my formal diagnosis. (You can skip this part since you already have it!) Despite having not worked with him since 2016, getting a copy was no problem.
2) Told my current GP that I have had an ADHD diagnosis since 2015, and since the pandemic, I’ve been struggling substantially more and would like to try meds (Adderall) again. I mentioned that I had documentation of the diagnosis and was happy to share it with him.
3) At my GP’s request, I forwarded the diagnosis email.
4) I discussed starting dosage with my GP, and he called in a prescription. No problem in filing it.
I had a lot of the same anxieties, including worries that I wouldn’t be believed, that I was too “high functioning”, that I would have to go through the whole process again, etc. None of those turned out to be a problem. I’d strongly recommend reaching out to your GP with a copy of the diagnosis you have.
posted by suviko at 12:24 AM on May 28 [1 favorite]
Talk to your GP about ADHD, your depression meds may be able to be optimized. Depression lies and tells you that everything will be terrible. Some things will, in fact, be terrible, but only some. The federal government has made ADHD meds hard to get, and it may vary by state, but give it a shot. I can't take ADHD meds because of complications, coffee helps some - 2 - 3 cups (measured cups, not giant mugs) a day really helps. I notice on days when it's just 1 cup. I struggle with having a strong daily routine, but it does help when I manage it, along with exercise and using my gmail calendar for everything, even a reminder to take my meds promptly.
posted by theora55 at 9:40 AM on May 28
posted by theora55 at 9:40 AM on May 28
Having the signed diagnosis sheet is really helpful! Agree to start with your primary care provider.
- If your GP needs more documentation, yes, contact the previous doctor's office
- You can also look up the clinic online for a 'request records" page, and follow its directions to send your patient file directly to your current doc
- Request a separate copy of your records for your own files
- If you have an old, labeled prescription bottle with your most-recent dosage, bring that to your GP appointment, too. If your prescriptions were filled outside the clinic, most pharmacy chains can pull your customer record.
posted by Iris Gambol at 2:15 PM on May 28
- If your GP needs more documentation, yes, contact the previous doctor's office
- You can also look up the clinic online for a 'request records" page, and follow its directions to send your patient file directly to your current doc
- Request a separate copy of your records for your own files
- If you have an old, labeled prescription bottle with your most-recent dosage, bring that to your GP appointment, too. If your prescriptions were filled outside the clinic, most pharmacy chains can pull your customer record.
posted by Iris Gambol at 2:15 PM on May 28
Response by poster: Thanks for the replies. I definitely am overthinking it, probably because I've had enough insanely yet needlessly difficult situations in our current healthcare system and now always expect the worst. I made an appointment for a month from now with my GP (the soonest I could get in) and am going to show up with the sheet listing the diagnosis and an old pill bottle of Adderall. Hopefully that's enough.
posted by Amy93 at 4:47 PM on May 28 [1 favorite]
posted by Amy93 at 4:47 PM on May 28 [1 favorite]
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That’s what i did, and it was my first go with them. This will vary hugely from provider to provider. Having any backup that they were prescribed before and helped will be helpful.
posted by supercres at 5:37 PM on May 27