I had my second visit to a psychiatrist yesterday.

The first visit was really expensive. It lasted about 45 minutes and it was just general screening questions like medical history, family history, etc. I told her I wanted to be treated for ADD and that I'd like to try Adderall again, which has helped me in the past. She told me she would need proof that I was taking it, so (as directed) I gave her secretary the number for the doctor I had in college. The psychiatrist gave me Lexapro and told me to come back in 3-4 weeks.

So yesterday, I'm at my second appointment, right on time. I had to wait for at least 15 minutes. I sometimes get panic attacks in waiting rooms and the doctor knows this. I managed to be ok, and I go into her office. She asks me a few questions about the Lexapro and enters some stuff into her computer. She barely even looks at me. Then she goes into my file and said "It doesn't look like your doctor responded to us about the Adderall". I tell her I wish you would have told me that before I came here! She gives me a supply of Strattera samples and tells me to call my last doctor myself and come back in 5 weeks :mad: I don't want to take Strattera because there is no generic for it and I tell her this and she says she doesn't like to prescribe stimulants and that Strattera is the only approved medication for Adult ADD.

My second appointment lasted only 15 minutes - I was watching the clock. Everytime I volunteered information (like told her stuff about my symptoms of ADD) she just smiled patronizingly and said "Uh-huh".

Also, they make me pay in cash BEFORE I see the doctor.

Anyway, is this standard for a psychiatrist? 15 minute visits? Aren't they supposed to talk to you? I know it's not therapy, like seeing a psychologist, but still....

I'm going to be looking for a new psychiatrist, because I'm pretty sure this one sucks. Since I'm pretty inexperienced with them, could you tell me what I'm supposed to expect from a psychiatrist?

My SO is a psychiatrist here in Canada.

A standard 'psychiatric hour' (at least here in the province of Ontario) is 46 minutes.

I don't know how billing works in your state, but the rate here is about $120/hr. (Remember that with your "hour" -- she also has to do dictation on your app't or write her chart notes, too [whichever way she does it], etc.)

A 'half hour' app't would be ~23 mins, i think. [I have never heard of less than a 1/2 hr slot for a psychiatric app't.]

re: Strattera
Her information is incorrect, AFAICT. (She may only be reading drug company advertisements and literature?)

Strattera is not the only 'approved' med for adults with ADD. I think ELI LILLY [the drug maker] likes to claim this, however. I think it may be approved for "ALL ADULTS" b/c it is not abusable by people with a History of drug abuse [where amphetamines would be contraindicated]. ;)

Lots of adults on here take or have taken stimulants, myself included.

If you want to get stimulants, I'd suggest getting neuropsych. testing completed via a Testing Psychologist.

NB I am not clear about your medication situation. I would not mix Strattera (a Serotonin drug) and the new Lexapro (a cousin of the SSRI Celexa) until I discussed it with a Pharmacist. I've known people to get into trouble with using two Serotonin drugs together.

Thanks for your reply, Queens. I haven't started taking the Strattera yet, and I plan on taking your advice about asking the pharmacist. I was pretty sure she was wrong about stating that Strattera is the only med approved for adults. I have taken stimulants in the past, as an adult.

is it standard for a psychiatrist to tell you how long your appointment will be?

Can you or anyone else tell me how I can get testing from a psychologist? How do I find someone who will do this? What does it involve?

I don't have any insurance, so I'd like to get treatment for my ADD in the cheapest way possible.

Huh. I don't know a whole lot about psychiatrists in general, but a few things stand out about your experience, if I understand your situation right. Kind of long, but I hope (if you manage to get through it..) it helps a little - the whole thing can be so confusing.

Duration of appt.
Appointments do tend to be short. I didn't know about the 'psychiatric hour' QUGirls described; but it makes a lot of sense; they do (and should!) take time to actually update your chart, make notes, etc. This is a good thing.

So they kind of have to get to the point quickly. It's no biggie if the point gets made.. but still I'd say yours was too short. My first meeting with my current doc was about an hour, and they're 25 minutes now. It feels way too short, but it's still perfectly adequate.

I wouldn NOT think it was OK if he ever made me feel like he was chasing me out, or that he was watching the clock more than me.. like if I still had something to say, I think he would sit there and hear it. You know? It's one thing to be brief, another to be a bad doctor. Trust your gut, I'd say.

Price
The costs of medical practice are sooo high (at least in the U.S.) - and the rates doctors charge reflect that. It's a deplorable situation, but so it is.

I don't know what the typical rate is. But it might help you if you compared whatever yours charges with what mine does? I saw two doctors for what ended up being my ADD dx (comparison shopping of sorts on my part - I just had no idea what to expect and didn't want to end up wasting time with the wrong person). Their charges, respectively: $300/350 for the initial consult, $250/250 for subsequent visits.

If yours charges significantly less, that may explain the rush job. If it's a subsidized clinic or something like that, they are probably under enormous pressure to move things along, and have wayyy more patients than they could ever devote enough time to. Again, terrible state of affairs, but it might be an explanation.

Meds
Prescribing certain drugs - stimulant ADD meds among them - is a complicated deal.

(1) Medically speaking, there is the drugs' potential for creating dependence. So, doctors are (rightfully) on the lookout for those for whom prescribing addictive drugs would be a legitimately bad choice.

(2) Administratively speaking, ADD meds are closely regulated by the (federal U.S.) government. While all drugs are monitored by the government, certain drugs, including some prescription meds, are regulated by the DEA - a governmental entity that only deals with drugs. The DEA classifies drugs into 5 'schedules'; schedule I has the heavy hitters (heroin and the like), while schedule V has things like prescription cough syrup. To put it into perspective, ADD meds (of the Ritalin family), are classed as schedule II drugs - as close to the illegal drug category as you can get. What this means is.. a lot of paperwork for doctors who choose to prescribe them.

So, in the best situation, a doctor would evaluate your medical history, prescribe accordingly, and not mind the hurdle of extra paperwork. In a worse situation, a doctor would not want to go through the trouble. There's always some guesswork/ risk for the doctor - some just don't have the time/ inclination for the process.

What ends up happening, especially when doctors are stressed for time, is that they reach for the non-stimulant meds. Non-stimulants are a perfectly appropriate choice in some cases.. but can also be questionable medical practice, imo. Drugs should be prescribed to help a patient find an appropriate course of treatment, not to help the doctor avoid hassle/ play it safe.

Strattera is one such non-stimulant (I *think* it's schedule V, or at least far less scrutiny than the stims). There's nothing wrong (that I know of) with Strattera per se; it's just another drug with both good and bad potential effects on any individual. The point is not that Strattera is bad, or good - but that its classification and (advertised, at least) lesser potential to create dependency makes it sort of a handy choice for the unsure doctor.

SO when you say your doc "doesn't like to prescribe stimulants," that annoys the **** out of me. No doubt there are some perfectly legitimate reasons for not prescribing stims, but it's not up to the doctor to like (as in, what, enjoy??) prescribing a particular course of treatment. I'd say either (1) such a doctor is woefully uninformed, or (2) is so condescending as to not bother to tell you why he/she feels this way and how it pertains to you. You are entitled to know why medical decisions are being made about you.

Neuropsych testing
Can't help you much, but I can tell you it's not covered by insurance in the U.S. Also, just from what I've seen, it costs a bundle. The adult ADHD clinic in my area charges something like $2,500 for a battery of tests.

But you don't need it for a dx. (That's why no insurance coverage, bc it's "not diagnostic"). There are many other (good) reasons you would want/ need it -- I just don't know enough to tell you anything about how to get it.

Red flags
1. Again, "I don't like prescribing.." is not exactly medical terminology. If it's not followed up by an explanation, I consider it unacceptable to say to a patient. If your doc did indeed just brush you off like that, forget it. Respect is the minimum you deserve.

2. Despite reticence to prescribe [one drug], to freely distribute samples of [another drug]? Fishy. All drugs are potentially dangerous. A doctor making a snap decision not to prescribe a particular drug is irritating - but a snap decision to prescribe is dangerous, imo.

3. "[Strattera] is the only approved drug for adult ADD" is a silly thing to say for a doctor. Technically, there is no such thing (in the U.S. - no idea otherwise). A doctor should know this - and respect you enough not to mislead you otherwise. There are lots of opinions on "approved" and "drug" and "ADD" - but that's not an individual doctor's province, imo.

Drugs get marketed as all sorts of things; logically, based on what they're thought to be good for. So an antidepressant, say, could be "approved" for use as a treatment for ADD.. meaning it's used to treat ADD because there's some reason to think that it will makes sense to do so. It doesn't directly have anything to do with being approved in the sense that it's "OK to prescribe it," where another drug would not. ADD (and many, many other things one would take drugs for) is just too nebulous a diagnosis to KNOW of a universally approved treatment.

Drugs get "approved" for prescription purposes because some regulatory agency (the govt, esp. the FDA) determines there is enough information (research, testing) to go on to be somewhat sure that the potential benefits in some respect outweigh the potential detriments. That's all. The DOCTOR determines if a drug "approved" as such is appropriate for a particular condition/ patient. A doctor's saying otherwise is either ignorant (bad) or disrespectful (worse), and contributes to the confusion that surrounds ADD treatment.

Don't get me wrong, there are plenty of reasons to deny/ encourage one drug over another. BUT it's ridiculous for a doctor to make such sweeping generalizations as "only" and "adult." No matter what the *ultimate answer* may turn out to be, there is no medically accepted consensus like that.

So
Your initial visit sounds about right - were you OK with that one, but then cooled off after the crappy second visit?

Why were you prescribed Adderall in college? Was it for ADD? Did you go to this doctor specifically to get Adderall for your previously dxed ADD? This might have some bearing on whether you got the condescending brush-off or not.

If you're paying out of pocket anyway, can you find a specialist in your area? There are (thankfully) pleanty - they just don't tend to take insurance. But since you have no choice but pay, you might as well get the very best evaluation there is.

Leah,

thanks so much for your post. you make good points about this doctor and her behavior. lots of good information.

to answer your questions:

I was wary about this doctor after the first visit. It just seemed way too general and impersonal. Like she wasn't interested at all in my personal history or current day to day life. Just the mandatory basic stuff. The second visit got me really ****ed, mostly because I waited a month to go back, thinking they'd have my records from my college doctor and she didn't even bother to check to see if they got them until I showed up again, and now I'm supposed to wait another 5 weeks. eff that. it took me months of suffering to even get the courage to go back to the doctor (because they scare the crap out of me and i get panic attacks while waiting).

I was prescribed Adderall in college for ADD. I was seeing a general practioner and a therapist because I was getting into a lot of trouble with impulsivity and they decided it was best for me. When I was a kid, my teachers thought I might have a problem and gave my parents referrals, but my parents refused to take me to a psychiatrist.

I have been looking around online and calling psychiatrists. I found one that says he treats adult ADD, so I'm going to call his office tomorrow. I definitely don't want to go back to other one... I just feel like she is wasting my time and money. It's a shame because at first I was really excited about getting help. Hopefully that feeling will return once I find a new psychiatrist.

Cool, good luck. Sorry your doctor experience hasn't been good, but I hope you do keep looking.

Also, I'd keep an open mind about meds - even though Adderall worked for you in the past, there may be some good reason to try another drug. Especially if you get to a doc who specializes in treating adult ADD, he/she may be a great source of info.

And it's totally appropriate to ask how long the appt. will be. The doc probably won't volunteer the information, but it's not a secret or anything.

Most importantly, I forgot to say that my doc requires a follow-up appointment two weeks after first starting a new med (for other appts, about a month or so). This is to keep a reasonably close eye on the new med's effects, while allowing some time for adjustment. I don't know if that's customary, but it makes sense to me -- so I'm kind of put off by your doc's being so cavalier about letting so much time pass after prescribing you Lexapro, and then Strattera. A lot can happen in 5 weeks, it'd be nice if a doctor was keeping an eye on things. Just something to keep in mind when you find a new doc.

Good luck!

My first appointment was well over an hour, but ever since they haven't lasted that long until this month. I brought up some things that he felt he needed to address right then. He's pretty good at staying until i don't have much more to say...if I keep talking, he keeps sitting. At first, I was real shocked the meetings were so short after the first, but I've come to realize he's not a therapist...and he seems to think I don't need one because I've asked him if he thinks I should talk to someone on a regular basis. Oh and I always pay before I go in to see the doctor...that's pretty standard around here. As far as how much it is supposed to cost...I have no idea. I pay my copay, but I did look on my insurnace website he charged them 356 dollars.

I wonder if the panic attacks in the waiting room are a way that your body is talking to you about this doctor? :) e.g. 'run'

[...] and she says she doesn't like to prescribe stimulants and that Strattera is the only approved medication for Adult ADD.[...]

This sounds an awful lot like my first psych. She had the same attitude towards stimulants, and was adamant to work through the whole list of nonstimulants, starting Strattera. I had asked about the reasons for not wanting to prescribe ritalin or another stimulant, and she answered that they "give you a buzz" and that was that. This is not only untrue, it also made me feel like I was a drug addict begging for a fix :mad:
After 7 weeks of Strattera and horrible drowsiness on only half the target dose, she wanted to switch to Effexor, at which point I had enough of her .. she was also quite patronising at times, even rude.
By then I had learned that the first line of medications for ADD are definitely the stimulants, and certainly if you have not been a drug abuser, which I never was. And what's more, she was not up to date with the current findings that Strattera is not really all that successful. It seems to help some people as I have read here, but it is not the first choice med for ADD.

In weeks I found another psychiatrist, who is awesome. He is friendly, warm, witty, comforting and gentle. He diagnosed me again and does not have this silly stimulantphobia.

I think you should never stay with a psych that you don't feel comfortable with.

From the ADD101 on this forum:
Ask yourself, "Can I work with this person?" If the answer is "no," you need to look elsewhere. Even after choosing a clinician, vigilance is needed. Some clinicians verbally accept an ADD diagnosis, but do not prescribe the most accepted medications. If this occurs, ask your clinician for an explanation.

I had asked about the reasons for not wanting to prescribe ritalin or another stimulant, and she answered that they "give you a buzz" and that was that. This is not only untrue, it also made me feel like I was a drug addict begging for a fix :mad:

You should have asked for Desoxyn, just to observe her reaction :D