Hello members. I have recently been diagnosed with ADHD. I have some questions which you may be able to answer.
Some background -- I am a 30 year old male also being treated for depression fairly successfully with Welbutrin. And, although I have suffered ADHD symptoms for as long as I can remember, I have only recently sought treatment. This is based on two reasons
the urging of my immediate family members I have, unknowingly, developed behavior modifications of my own to compensate -- but which my family insist are methods of coping with undiagnosed ADHDI am currently facing a few issues regarding my treatment.
First, my medical practitioner (psychiatric nurse practitioner) said she made an arbitrary diagnosis of ADHD, but that I technically do not meet the clinical definition. She moved forward with the diagnosis based on my reported family concerns. Her evaluatory process was fairly direct -- a simple interview and series of questions. Some of the questions I knowingly responded with contraindicative answers, however these were simple yes or no questions, and she did not want me to elaborate or go into details. Thus the question, which I fully don't remember it's specifics, but the point is, "Are you organized?" I responded with, "Yes." Similarly, I don't often lose things.
The problem is that it's taken most of my life to both become organized and to not lose things. My highschool days and early college seemed to be a comical series of events related to lost keys. So, I'm forced to ask if this style of diagnosis my be somehow disadvantageous for me?
The second issue centers around medication. I was prescribed stimulant therapy, specifically generic ritalin, the sustained release. Unfortunately I'm not exactly certain what I should be looking for as far as therapeutic effects. For the first few days I seemed to have a lot more motivation, focus and energy, but that seems to be abating a bit. Is this common, or do I simply need an adjustment in dosage or a new medicine entirely?
Also, I'm uncertain how treatment should be progressing -- I was given a prescription for seven days (I have two days of medication left) but will not have another appointment for two weeks. Is it normal to medicate a patient for a few days and then have them discontinue treatment? I'm concerned because I may not be able to adequately explain my treatment experience if I'm not able to discuss it in a reasonable amount of time (I tend to forget things, sometimes quickly. I decided to keep a treatment journal just for this reason).
Finally, I am in a somewhat rural area, and am concerned that I may not have found someone qualified to treat me. I did previously see a psychiatrist that told me I was fat because I eat too much and not because of medication, and that because I'm a junior in college I couldn't possibly have ADHD. He diagnosed me with depression and anxiety, which I already knew. This was a particularly bad day, as I felt my concerns had basically been dismissed. I by no means want to sound insulting, but I was a little concerned with his age and his professional ability - he completed medical school in 1949. (I don't mean to generalize about age -- I am certain there are some very qualified professionals out there who are in their 70's... but when he said, "Oh and there's a new one, sim, simba, something..." . "Cymbalta?" I prompted. "Yes, that's the one I don't know very much about." I became rather dismayed.) Is this a common practice?
After moping a couple of days I steeled my resolve and began looking for another practitioner (neither I nor my partner are from this area, having moved here about 18 months ago). Which leads me to my current situation. My current practitioner seems more preoccupied with goal setting exercises and counseling than with medication management which is what I very clearly expressed when I scheduled my first appointment. I'm not opposed to cognitive behavior therapy or even personal counseling, but I would like to cover the medication aspect before delving into the recesses of my life. Again, is this common practice?
I want to thank you in advance for reading and posting your thoughts, and understand the irony of such a long post on an ADHD forum. ;-)
Welcome. You will find help and support here through this journey. I kind of skipped through your post a bit so my response may be a bit disjointed.
The strict diagnostic criteria is not as useful for diagnosis of adults, as it was based on children (and the disorder changes with maturity). This will probably change when the criteria is updated.
Meds are started low, and then increased to the most effective dose. My daughter had some good effects at her starting dose and they were gone by about a week. The next dose was a good one for her. This normally indicates that the med is beneficial (good to know in the beginning) and that the dose will need to increase until the effects do not go away with time.
Some practitioners will give a trial med dose to confirm the diagnosis. If you see positive effects, chances are you are ADHD. This is an old, and not so good method, but is still used. It is easier to do with adults because they can report back the response better than kids can.
Once you are diagnosed and treatment started, any doctor can continue the med management. A good psychiatrist is best at med management, but you need to work with what is available. If you respond well to basic ritalin, then treatment may be relatively easy (with luck) and med managment easy for a different doctor. While you are working with the current proffesional, start looking for a doctor willing to take over your med managment so you can switch without starting all over. Doctors are all different and you need to find one that fits you. My daughters doctor is older, but has been the department head of a large psych ward in a large teaching hospital. He is absoluteley wonderful and keeps up on all the current research. I hope you can find a good doc as well.
You have a number of important questions and they all deserve to be answered at some point. However, unfortunately your journey has begun in the worst possible way. If you were diagnosed and given a script in one visit then your provider didn't even come close to meeting minimum diagnosing guidelines.