View Full Version : Frustrated after initial psychiatric session. Prescribed Citalopram and not ADHD meds


brentdotcom
02-25-12, 09:59 PM
I have dysthymia (mild, chronic depression), social anxiety and ADHD. All three are based on a diagnosis, however the latter diagnosis occurred when I was 12 (25 now) and the former two were a bit more recent. In regard to the ADHD, 12-year-old me was prescribed Adderal and then Ritalin, for my impulsivity and class clowning, but both meds turned me into a zombie, so I stopped taking them in short order. Since then, I never forgot about my ADHD, but relegated it to the back of my mind assuming it was somehow strictly an academic ailment and that I was treatment-resistant anyways. This last assumption was confirmed in my mind when I got my hands on some Adderall in college and experienced horrible mental fog, lack of concentration, and nausea the couple of times I took it. This was a pretty low dose too (5mg and 2.5mg respectively).

Meanwhile I've been doing whatever I can about the dysthymia and social anxiety, but my resources have been limited so its been difficult. I live in the U.S. and don't have mental health insurance so I've had to be frugal in my approaches. This has mainly involved a ton of research online, trying to gather the relevant information and subsequent treatment plan myself, rather than having a professional do it for me at a premium that I can't afford. What baffled me though, was how I was able to spend so much time and energy in this endeavor and consistently come out at the end of the day feeling like I had accomplished nothing. It was around this time that I began looking into ADHD and the puzzle pieces fell together.

At this point, I think I have a pretty decent idea of what I need to do to overcome my dysthymia and social anxiety. I'm not happy with my life and I know what I want to change. The problem, I believe, is that my ADHD gets in the way. I have all of the classic symptoms and they hinder any progress I might make with the aforementioned issues.

So I decided to suck it up and pay out of pocket for professional help in getting me out of this cycle. Specifically I need some medication, and I need it to come from a doc who understands the implications of my concurrent issues as well as the fact my previous forrays into ADHD meds were not constructive. This is why I wanted to talk to a psychiatrist and not a general practitioner. My search criteria essentially involved: 1. positive reviews from others, 2. works on a sliding scale. Yesterday I found “the guy” and due to a last minute cancellation, he had an opening for later on that day. I took it.
The appointment was on the long side and we spent more time talking about things that to me seemed irrelevant. He asked my about my early life and what I studied in college and why I studied that, also what my relationship was like with the rest of my family. Don't get me wrong that's important stuff, but I feel it should be reserved for the therapist's office. I was there for my symptoms, not resolving deep inner turmoil.... He had me repeat the words: “sky, nine, statue of liberty” several times back to him. I had to draw two overlapping polygons to mirror his version of the same, read a short paragraph and follow the contained within to fold the piece of paper and return it with my left hand. So I did. Later on he asked me what the 3 words were that I had previously had to repeat to him. The whole thing just felt silly.

Basically, I had wanted to go in there, describe my symptoms and receive a script based on his superior expertise. Instead, I feel like too much time was wasted and in retrospect I worry that I didn't communicate my symptoms 100% effectively. In the end he told me that he didn't think it was ADHD, but rather anxiety and wrote me a script for Citalopram (Celexa). Yes I have social anxiety, but I personally think its a result of my dysthymia (and consequently low self esteem) and besides, its mild anyways. Also he kept on repeating that he doesn't like to prescribe “controlled substances” and (when I expressed some dismay at his conclusion) that if I wasn't happy I should get a second opinion until I got what I wanted. This seemed unnecessarily defensive.
Now I'm feeling extremely frustrated because I'm worried that not only am I being sent on a wild goose chase with the wrong type of medication here, but I also wasted a bunch of time and money. I don't know if I should take him up on getting that second opinion (more money) and whether I should stick it out with the Citalopram. I've already wasted so much time and I feel like my life has been derailed for too long now. So I don't want to wait on something that I have little hope in. I should also probably mention that I've tried a series of other anti-depressants before: Fluoxetine (prozac), effexor, welbutrin, st. john's wort, 5-htp, etc., but none have ever been effective. This gives me even less faith in the trial-and-error pharmacuetical process. WAHHHHHH.


TL;DR Psychiatrist prescribed Citalopram for anxiety despite my belief that I need something to target my ADHD. Yes, I have Social anxiety, albiet mild, and depression (mild as well), but it is my belief that my ADHD is what's standing in the way of me making the life-improvements to overcome the other issues. Also, I'm a broke recent-college graduate living in the U.S. with no mental health coverage. Now I'm frustrated and disappointed and I don't know what to do.

If you have any helpful personal experience you can relate, advice, direction, or whatever, please let me know. Thank you.

P.S. sorry for the Wall O' Text. I had initially wanted to make this as concise as possible, but after many false starts, I finally decided that I was incapable of accomplishing this task. The truth is, there's so much background that I feel is important and relevant, which I couldn't justify leaving out. Oh god. Probably no one has read this...

oneup
02-26-12, 12:28 AM
Some docs don't like to prescribe controlled substances. I'm not sure why, its stupid. Maybe he figured if you made it through college your ADHD must not be too bad and maybe your more depressed. I always get asked this....

Maybe he wasn't sure what to Rx since you didn't respond well to ritalin or adderall in the past, so his line of thinking might have been maybe its not ADD/ADHD but more a depression thing. His eval seemed kinda strange but every doc is going to be different.

His questions about your personal life weren't meant to be invasive, part of the dx process is to see how it is affecting different aspects of your life. Usually ADHD affects social relationships + work + school + personal organization to varying extent.

ginniebean
02-26-12, 01:22 AM
You may have run into a pdoc who doesn't believe in adhd.

unfocus
02-26-12, 03:01 AM
Did you ask the doc in advance whether he knows anything about adhd?
If is any consolation, story of professionals' errors and ignorance echos stories of very many other people with ADHD (myself included).

Marla911
02-26-12, 03:37 AM
When i had neuro-psychological testing done i had to do similar exercises to what you just described (regarding the paper, drawings, repeating words etc). That's part of assessing your cognitive function.

Irrespective of that though I think you got a dr that didn't really want to consider what you thought was the problem - for whatever reason. Regardless of whether you have add or not, you have to have a dr that is receptive to what your most concerning symptoms are - not just listen to a few lines and then take their line of questioning down a path that proves their presumptions and discounts any personal evaluation you've made.

Within a few minutes of meeting you he'd likely formed and opinion about what the problem was - I think a lot of drs get on the back foot when they come across patients that can actually clearly articulate their symptoms/verbalise/label their problems- after all if everyone was like that they'd soon be out of a job.

I've faced that several times before and i hate to say it but I think it's more likely to happen when you're visiting a 'free' or 'discounted' health service.

Sorry you had to go through all this - but unfortunately it happens a lot. If the citrolapram is cheap/free you might as well give it a go I suppose (assuming you aren't too sensitive to the side affects and got a few repeats since it's going to take a few weeks just to work) because it can help with social anxiety but maybe even more significantly: It can help your next foray into professional psychiatry. I've tried things in the past that I didn't think would work just so that I could genuinely say that I'd given it a go with no result - and half heartedly hoping for some miracle result anyway. In the long term this can make a difference - when you get a decent dr.

Feel free to pm me if you like cause I've definitely been through what you're going through.

sarahsweets
02-26-12, 04:11 PM
stimulants along with behavior mods are the best defense against adhd. get a second aopinion.

i41agree
04-07-16, 04:45 PM
Well, stimulants have a notorious public reputation now, so you're bound to find some reluctance to prescribing them, even if the evidence says they are the most likely to work. In a similar vein, I've met some doctors who hand out benzodiazepines like candy and others who flat out refuse to prescribe them.
When I first started wondering about ADHD, I asked my family doctor how I could go about getting tested. His answer was that ADHD interferes with a person's ability to succeed in life, and because I'm a highly educated professional, he "could tell" that I didn't have it.
So I decided to see a forensic psychiatrist and I told him the difficulty that I was having: discomfort, short attention span, trouble getting things done, self-medicating even. He sent me a written test for Adult ADHD which I completed honestly and accurately. The same day I had a prescription for a low dose of Ritalin for a month. "Try it" he said, "I'm in favor of whatever works." So I've been on it for a week.
Others have described what it feels like to have the fog lifted, so I won't even try. But it's been a week like no other.
Not only do I feel better than I ever have, I have no inclination to self-medicate anymore. Two birds with one stone!
In other words, it's worth a second opinion.

roflwaffle
04-09-16, 07:06 PM
My psychiatrist did the same thing with Lexapro. On my next visit, she prescribed Wellbutrin, and the visit after that, Ritalin. In my case, the psychologist who evaluated me thought I could have ADD or BiPolar, and since I was also anxious, my psychiatrist started with something for anxiety/depression.

I've already heard/read that anxiety disorders can also present as problems with attention, so the particular problems and how they respond to treatment are what's important. I'd take the prescription, keep on eye on how you feel, and if your problems with attention persist, talk about it with your psychiatrist on your next visit.

TheGreatKing
04-09-16, 09:08 PM
Second opinions don't hurt :)

Steppe
04-12-16, 09:30 PM
I have dysthymia (mild, chronic depression), social anxiety and ADHD.
(...)
The appointment was on the long side and we spent more time talking about things that to me seemed irrelevant. He asked my about my early life and what I studied in college and why I studied that, also what my relationship was like with the rest of my family. Don't get me wrong that's important stuff, but I feel it should be reserved for the therapist's office. I was there for my symptoms, not resolving deep inner turmoil.... He had me repeat the words: “sky, nine, statue of liberty” several times back to him. I had to draw two overlapping polygons to mirror his version of the same, read a short paragraph and follow the contained within to fold the piece of paper and return it with my left hand. So I did. Later on he asked me what the 3 words were that I had previously had to repeat to him. The whole thing just felt silly.
(...)



Sincerely wondering if you were able to remember “sky, nine, statue of liberty” ... ?

Just got diagnosed with severe ADD at age 56. Three month wait for
the test. 25 tests lasting four hours. Then Minnesota Multi Phase Index and
ADD checklists and topical essays as take home work. Waited two
weeks for follow up visit. Came home with permanent medical records copy.

A clinical specialist with a 12 year PHD in Neuropsychology (Psy.D ) is what
you are looking for. Clinical Nueropsychologist and Psy.D are search keys.

My therapist fought me every step of the way and tried to diagnose me with
Schizoaffective Disorder instead of ADD & Cyclothymia.
When you have dual diagnosis it gets complicated.
I insisted on a referral to a specialist. She agreed I have severe ADD.

Once you have the paperwork it relieves the prescriber of responsibility.

If you were able to remember “sky, nine, statue of liberty” then your
working memory was available. He distracted you with family details,
gave you three key words to remember, then distracted you with visual
puzzles. If you remembered the “sky, nine, statue of liberty” sequence his
symptom readout sketch would read "working memory passed test."

When I was tested, they did verbal math problems first, to measure IQ
before my working memory decayed to near zero and silent embarrassment.

I always wondered if I had simple schizophrenia or a rare seizure disorder.

Best to you, good luck getting help, stay strong and committed to finding
a reliable, believable answer you can come to peace with.

sarahsweets
04-13-16, 05:05 AM
So I decided to suck it up and pay out of pocket for professional help in getting me out of this cycle. Specifically I need some medication, and I need it to come from a doc who understands the implications of my concurrent issues as well as the fact my previous forrays into ADHD meds were not constructive. This is why I wanted to talk to a psychiatrist and not a general practitioner.

I hear you on wanting to waste your money but from the doctor's perspective maybe he wanted you to just see if the antidepressant would help. What you described is a little like depression and its hard tp tell which is depression and which is adhd. I do believe you need someone more open minded.

The appointment was on the long side and we spent more time talking about things that to me seemed irrelevant. He asked my about my early life and what I studied in college and why I studied that, also what my relationship was like with the rest of my family. Don't get me wrong that's important stuff, but I feel it should be reserved for the therapist's office. I was there for my symptoms, not resolving deep inner turmoil
He has to take a thorough personal history whether you think its necessary or not. If he doesnt know much about you how can you expecthim to just write
a script for a stimulant? I dont think he wanted to have you resolve inner turmoil.

.... He had me repeat the words: “sky, nine, statue of liberty” several times back to him. I had to draw two overlapping polygons to mirror his version of the same, read a short paragraph and follow the contained within to fold the piece of paper and return it with my left hand. So I did. Later on he asked me what the 3 words were that I had previously had to repeat to him. The whole thing just felt silly.
it sounds like he was checking what your memory and executive function is like.

Basically, I had wanted to go in there, describe my symptoms and receive a script based on his superior expertise. Instead, I feel like too much time was wasted and in retrospect I worry that I didn't communicate my symptoms 100% effectively. In the end he told me that he didn't think it was ADHD, but rather anxiety and wrote me a script for Citalopram (Celexa). Yes I have social anxiety, but I personally think its a result of my dysthymia (and consequently low self esteem) and besides, its mild anyways.

Your expectations were just that- an expectation. You wanted a script and didnt like the process he used. There are no tests for adhd, its based on your backround, history, symptoms and impairments.

Also he kept on repeating that he doesn't like to prescribe “controlled substances” and (when I expressed some dismay at his conclusion) that if I wasn't happy I should get a second opinion until I got what I wanted. This seemed unnecessarily defensive.
Red flag. He already had his mind set on not prescribing big, bad stimulants so find a new doc.
Can you find a doctor that is more basic as in, a smaller practice with less overhead or the need to order expensive tests and charge a fortune for tests that play no role in an adhd diagnosis?
Yes get a second opinion but do not go to any place or doctor that he would recommend.