Hi all,

I have a very weird story. I was seeing a therapist in the summer and was diagnosed with ADD among depression and eating disorder (bulimia). The bulimia and depression are getting better but the ADD comes and goes. I'm taking Wellbutrin XL 300 mg and that is working for 2/3 but I started seeing a psychiatrist to manage my medication. He upped my WB to 450 mg (visit #1), and that was too much for me. Next he suggested Strattera (visit #2) but I told him I didn't know much about that medication and wanted to research, so he said to come back in 2 weeks and talk about it. I researched and found that Strattera is not very effective, is the newest, can have GI side effects, and there is a warning on Medline not to take with wellbutrin!! I saw him again today (visit #3) and began explaning this and he said well I think you should try Strattera. And I said I know, but I am not comfortable taking that and you asked me to research it...so he said that he wouldn't have accepted me as a new patient if he knew i was ADHD and that he was not comfortable prescribing anything but Strattera, and that he had enough patients on adderall. He offered to give my co-pay back so I took it!!!

Umm...can someone please help me figure out what this is about?? I finally found a reason for why I've felt all over the place for 15 years and have admitted to a weakness and was looking forward to some help and he basically accused me of asking for Adderall or Ritalin. He expressed concern for those medications and eating disorder history, but I am taking Wellbutrin and that is contraindicated for eating disorder and i'm fine. I am mad, frustrated, and in a worse state of mind than when I began going to see him in the first place. I don't understand why he didn't tell me this on the first visit, not the THIRD. Help I am so confused and distraught!! :confused:

...so he said that he wouldn't have accepted me as a new patient if he knew i was ADHD and that he was not comfortable prescribing anything but Strattera, and that he had enough patients on adderall
so - he said that if he had known that you had ADHD he would NOT have accepted you <-> he has enough patients on adderall[/quote]

*trying to compute* .... * +++ OUT OF CHEESE ERROR +++ redo from start

That does not make any sense to me.
The only option that is logically possible though irrational is .. eh .. he does not want ADHD patients .. because he has more than enough as it is?
But the man is a psychiatrist, not a stamp collector?

and have admitted to a weakness
-- no need to answer .. but have you had an addiction problem? If so, that might explain his reluctance to prescribe stimulants ..

and he basically accused me of asking for Adderall or Ritalin.
Don't get this either although I hear this reverberate all over this forum in what people experience .. plus, that my first psych did her utter best to plant this idea of 'bad bad naughty person should not ask for ritalin *whack*' in me as well ... since when is it a crime to ask - especially when you are ADD and these meds are in the first line to try?

It sounds as you have to find another psychiatrist. There can be a world of difference between one and another. I hope your next experience is a bit better! Or, rather, a lot better.

Before my psychiatrist put me on Concerta, he knew full well my past addiction issues. However, I did have the added advantage that I was dealing with a doctor versed in stimulants. He knew, that if it was truly adhd that the stimulants would be *far* from addicting (to say the least).

Now, I am getting into the same boat you're in.

My psychiatrist is leaving and while he's convinced he's found "the right solution for me" he's passed on the prescribing rights to my family doctor. She on the other hand (who also knows my past history) is dead set against it. Granted, my psychiatrist will be sending her an official letter stating his instructions and dosage to prescribe, she doesn't want anything to do with it.

Some doctors, unfortunately, are in the "gotta cover my *****" mode and won't prescribe anything other than antibiotics.

In a month and a half, I have no idea whether she will honour my psychiatrist's wishes or leave me high and dry. It truly is a sad state of affairs when it comes to these types of medications and doctors.

Some, just can't grasp the fact that these medications DO work and for add/adhd, they are NON-addicting. In your case (as like mine) it may be better in the long run to find the appropriate doctor to help you. I know I'll have to.

**** that. I made a post and it got eaten by a server error.

First: get another doctor. Any doctor that 'dumps' you like that isn't worth his salt.

I think you've made some errors, though. It's great you're concerned and have investigated but, maybe rethink some of your judgements about Adderall and Strattera.

Adderall and Wellbutrin are contra-indicated, for the same reason as Strattera and Wellbutrin: Adderall increases norepinephrine and dopamine, Strattera increases norepinephrine. Considering Wellbutrin also increases dopamine and norepinephrine, the two drugs can have a synergistic effect for both the good and the bad of each drug.

Wellbutrin is a contraindiction only because it does the same thing as Adderall. It's possible to mix them, but physical side effects of both drugs might be amplified (e.g. appetite loss, jaw clenching, motor tics, insomnia).

It isn't a strict contraindication. A strict contraindication would be: never take stimulants if you have blood pressure problems.

Stratterra has mild appetite suppression activity.
Wellbutrin has mild appetite suppression activity.
Ritalin has strong appetite suppression activity.
Adderall has strong appetite suppression activity.

If you have an eating disorder I'd advise against taking stimulants (Ritalin & Adderall). I eat healthily normally but when on stimulants I have to force myself to eat. Sometimes I get physically almost sick because of a sort of revulsion to the idea of eating (nothing to do with taste or image problems).

Why did you find an increased dose of Wellbutrin 'too much'? It could be helpful to know this, as Wellbutrin is sometimes prescribed as an ADHD medication when others fail or if the patient has depression as well.

I'd say find another doctor, but also consider trialling Strattera. Ask your doc, but I'm pretty sure the contraindication is purely because of the similar mode of action rather than danger.

Of course, you could find that with Adderall or Ritalin your ADHD symptoms are under control and you feel better about yourself because of this, reducing your depression. 50% of people with ADHD are depressed, likely due to their ADHD symptoms. Perhaps tackling ADHD will help get depression under control?

Have a read over these, and remember they have to write about the worst case scenarios. Not all the side-effects will happen to you and in general these medicines are very safe.

Straterra: http://en.wikipedia.org/wiki/Atomoxetine
Wellbutrin: http://en.wikipedia.org/wiki/Bupropion
Adderall: http://en.wikipedia.org/wiki/Adderall
Adderall (75% of Adderall is dex): http://en.wikipedia.org/wiki/Dextroamphetamine
Ritalin: http://en.wikipedia.org/wiki/Methylphenidate

P.S.: I had to basically tell my doctor to give me dexamphetamine because it was the only reason I came to him. He was extremely suspicious because he didn't believe I had ADHD. In the end he conceded, but I suspect it was only due to my record of taking dex for ADHD as a child. I think I'll change doctors because he doesn't seem to believe in adult ADHD, and seems wary of prescribing stimulant medication. I don't think he'd be willing to increase my dose above the current 10mg per day.

I am currently as seen below taking both Wellbutrin and Straterra. The short version is I was depressed and GP prescribed Zoloft. Was not working so IC recommended a Pdoc. Pdoc said Zoloft was too low a dosage, and I told him I did not like one of the side effects, and it was not sex related, even though that was also an issue. He recommended Wellbutrin and started me on 150 per day, 4 weeks bumped to 300 per day. 2 months later depression better, ADHD diagnosed and started Straterra.

I can't take the stimulents as I am on blood pressure meds and have had some minor heart issues. The major side effects of the two in tandem for me is, now I have a low tolerance to caffeine and can only drink one cup in the morning. I also get major cotton mouth and now always have some kind of mints or something to put in my mouth. Have had no real sexual side effects of the two in tandem.

The two have helped me for depression and ADHD in spite of a relapse after the first of the year, due to some other issues in my life and the addition of Lexapro.

With the DEA watching everything doc are prescribing, I could see the Pdoc's point in trying Straterra first. Also if all he was prescribing was stimulents the DEA may question that in his mind which was my first thought of the comment he made.

All that said, sounds like he was NOT the doc for you and I agree you should seek a new one.

I lost focus in the replies, but I had to post this much. When discussing meds with my doctor (a regular doctor mind you, not psychiatrist), her exact words were (well, sort of... ) " Let's start with Adderall, AN OLDIE BUT A GOODIE ".

I think your doctor is just being paranoid, and did you a favor to boot. Find a new doc that is more interested in his patients than his personal butt covering.

Thank you all for your feedback. I was really feeling crazy when I left the doctor's office yesterday. I felt like I was doing something wrong and that maybe I was being too pushy. But honestly, I am 28 years old, and I have been dealing with these issues for a long time. I have never been quick to pop pills, but only recently have I considered giving them a try. I'm not looking for a way to get high or in need of diet pills, I want to be a better person to everyone in my life!! I called my primary doc to talk to him about the situation and waiting for him to return my call. I think that doctor was very unprofessional, almost bribing me with co-pays not to make him take responsibility for treating me. It's so odd to me, but I don't have much experience with psychiatrists, so maybe I was the fool for being so naive.

Dear brewskijmu,

I had a similar experience when I saw my first psychiatrist after being dx'd with ADHD by an ADHD specialist/psychologist. In fact, I have had "problems" since I was a teen - usually dx'd with depression - or sometimes probably just dx'd an "@$$hole" (there are a lotta crappy people working in the mental health field) - and EVERY TIME I've seen a PSYCHIATRIST they've done NOTHING for me other than tell me I'm fine.

I read somewhere (maybe here?) that in many cases, if one doesn't have a dx a very obvious/noticeable mental health disorder (such as constant or frequent psychotic episodes and/or constant/frequent aggressive or disruptive "acting out" behaviors) then a psychiatrist will not do anything for you. Whenever I've been strongly advised by my therapist/psychologist to see someone for medication (for either depression, anxiety or later - ADHD) the only times I've actually received a rx after therapist's advice is when I've seen either my P.C. OR if there is a psychiatric nurse prescriber that works for the same mental health agency that my therapist works for.

Maybe it's a regional thing. I'm in Northeast U.S. myself.

Ugh. I feel your pain. BUT DON'T GIVE UP ON YOURSELF!!! Finding relief is worth all of this humiliating hassle!!!

Sincerely,
Sue

Something a lot of people are "guilty" of is assuming that someone that takes responsibility for the health and well being of others is going to be professional and honest in that position.

He's a doctor, but he's also being a dill weed and you shouldn't feel bad for assuming he was going to do his job PROPERLY!

I wouldn't even try to 'convince' a doctor that I had attentional issues.

I messed around with going to doctor's for help with anxiety and learning issues, since I was a teenager.

Get Testing if you can.

They can't DISPUTE neuropsych testing findings...and the Psychologist's REPORT.

NB stimulants (even Wellbutrin & probably MAOIs) are 'contraindicated' in EDs. Not sure how to get around that. I'd imagine the Doc would want to hear _what you are ACTIVELY doing about your ED recovery_ B4 Rxing a trial of stimulants.

I wouldn't even try to 'convince' a doctor that I had attentional issues.


They can't DISPUTE neuropsych testing findings...and the Psychologist's REPORT.

NB stimulants (even Wellbutrin & probably MAOIs) are 'contraindicated' in EDs. Not sure how to get around that. I'd imagine the Doc would want to hear _what you are ACTIVELY doing about your ED recovery_ B4 Rxing a trial of stimulants.

I actually have spent quite a bit of money and time on getting tested, but at a psychologist. It ran me up near $1000 but I finally did get a diagnosis and she recommended wellbutrin for ADHD and depression, which is being filled through my primary doc. I had to stop going to see her because it was costing me a fortune. So I went to the psychiatrist hoping to have him take care of my medicine and discuss the ADHD in more detail. But he never took me seriously. The thing that bothers me is that I initially increased my dose of wellbutrin to 450 mg at his recommendation. After a week on it I felt like I was going to have a seizure one time and stayed at work an extra 2 hours because I didn’t feel ok to drive. He blew that off and just went on to suggest Strattera instead. It was like he didn’t care what I did. So I didn’t expect that reaction from him at all. It was very odd and I think he is a great example of a quack.

I have always been up front about the ED and don't want to put myself at any risk, but I think I am also entitled to try something if I can benefit from it.

So what did the Testing say? Usually they have very extensive lists of what your deficits are, etc. (in Percentages)

e.g. "Executive Function in the xth Percentile"; working memory in the Xth percentile; auditory memory in the xth percentile; etc.

At the end, the report should give you the written diagnosis of "ADD".

If you can PROVE diagnosis, and this MD still gives you problems... Take that report to another Doctor to get meds.

Some Docs are addiction-o-phobes (in the face of legitimate conditions). Some just choose not to Rx stimulants.


Most psychiatrists know jack about Adult ADD and Rxing stimulants to Adults. (I've only been able to find Adult ADD Psychiatrists at Post-Secondary student health clinics, myself. If you are a postsecondary student, I'd suggest hooking up with your school's health centre's counselling/psychiatry dept. for more info)



NB A Psychologist usually does not recommend the specific NAMES of medications given. They are not physicians or pharmacists... and do not have prescribing privileges for a reason (thank god!).

If your ED is stable, and you have no true addiction history, I'd think you deserve a trial of stimulant meds.

American doctors are really under the microscope when it comes to prescribing medication. I've really seen a difference in how medical systems work by reading posts on this website. It is no wonder that American doctors are so paranoid, they can be investigated at any time for being drug dealers, which is hypocritical since they are in fact licensed drug dealers.

-- no need to answer .. but have you had an addiction problem? If so, that might explain his reluctance to prescribe stimulants ..


i overlooked this the first time i read - sorry - no i haven't had an addiction problem, not even close, it's just that i admit a weakness to feeling disorganized, chronically late and inconsistent with the completion of mundane, daily tasks. it's not been easy to admit to weakness i.e. flaws, i.e. incompetency, yes? that is what i meant. i don't intend to abuse the drug in the least, just looking for that assistance that others on here are so thankful for.

i don't intend to abuse the drug in the least, just looking for that assistance that others on here are so thankful for.


I love deciphering emotion via text. It's a passion of mine. I'm 100% certain Luthien was in no way shape or form implying you had a penchant for abuse, and was only offering the question for you to ponder. (I think..)

After re-reading your post, I'd bet 20 bucks your doctor is sporting some fancy new gizmo as a thank you from his local Straterra pharmaceutical rep.

His reactions to you were unprofessional. As the patient, and person that has to actually INGEST the recommended meds, YOU have the final say as to whether or not you want to take it. Perhaps he assumed you'd only find glowing reviews and reports on this new med and would be overjoyed to take it.

You're not at all in error for deciding it's not for you, after doing exactly as he asked and researching.

Ask him for copies of your medical records and move on.

bulimia + stimulants = bad?

I don't know much about that kind of thing but maybe that was the reason he didn't want to prescribe you stimulants? By artificially blocking your appetite you could somehow avoid the bulimia but never really deal with it. Instead you might start upping the stimulants when the appetite effects get reduced over time and it might lead to addiction?

Again - I don't know much about this but just thought I'd add what I was thinking.

American doctors are really under the microscope when it comes to prescribing medication. I've really seen a difference in how medical systems work by reading posts on this website. It is no wonder that American doctors are so paranoid, they can be investigated at any time for being drug dealers, which is hypocritical since they are in fact licensed drug dealers

Yeah this dude makes a good point. Some doctors have patient limits for certain drugs because they can get in trouble if they prescribe too much.

You're lucky you live in a free country :) You have the option to choose another doctor and I recommend you do that. A specialist that deals with ADD would be the best.

I love deciphering emotion via text. It's a passion of mine. I'm 100% certain Luthien was in no way shape or form implying you had a penchant for abuse, and was only offering the question for you to ponder. (I think..)

After re-reading your post, I'd bet 20 bucks your doctor is sporting some fancy new gizmo as a thank you from his local Straterra pharmaceutical rep.

His reactions to you were unprofessional. As the patient, and person that has to actually INGEST the recommended meds, YOU have the final say as to whether or not you want to take it. Perhaps he assumed you'd only find glowing reviews and reports on this new med and would be overjoyed to take it.

You're not at all in error for deciding it's not for you, after doing exactly as he asked and researching.

Ask him for copies of your medical records and move on.

THANK YOU for this post. You have expressed my thoughts perfectly. Unprofessional is absolutely it and it made me very defensive - that may be why I interpreted Luthien's comment the way I did because I was in a very defensive and sensitive state yesterday. That a-hole doctor really ruined my day. I did, however get all $90 of my co-pays back, with a receipt, and I'm not looking back.

ED – eating disorder ??? Been watching to many Viagra commercials on TV}



i don't intend to abuse the drug in the least, just looking for that assistance that others on here are so thankful for.


Thank you for the clarification!

I didn't see Luthiens comments as any thing but simply asking for clarification which btw is better than simply making assumptions.

Honestly I didn’t understand what you mean by weakness either – weakness when unspecified often means to infer addition or at the very least a strong attraction to

examples– I have a "weakness" for chocolate – I have a "weakness" for read heads ect . . . .

{umm this thread is about ADD treatment with stimulants and a doctors reaction to the request - do realize when emotionally upset some times we fail to include little details in our writing that can cause a great deal of confusion in the reader}


I think ozchris has a valid point here I can see where stimulants and an eating disorder may be a problem for some doctors.

Perhaps this will help explain what happened

Addressing Disordered Eating Patterns in Women with ADHD (http://www.chesapeakeadd.com/pdf/adhd/eating_disorders.pdf)



Medication. Stimulant medication alone does not effectively alter the disordered eating habits of individuals with ADHD. While good results are sometimes seen initially because stimulant medication temporarily causes appetite suppression, this side effect is typically short-lived. For most adults, the appetite suppressing effect of these medications is temporary and disappears unless the dose is repeatedly increased. This is entirely contrary to the way stimulant medications are used in the treatment of ADHD, where there is no evidence of a tolerance effect.


Appropriate use of stimulant medication can set the stage for change, but does not by itself alter strongly ingrained patterns of abnormal eating behavior. It is critical to separate this clinical practice from the debacle which occurred during the ‘50s and ‘60s, where stimulants were commonly used in treatment of obesity. Amphetamines were liberally prescribed to diminish interest in food by using the side effect of appetite suppression.


Before any trial of stimulant medication is begun with someone with a history of disordered eating, it is critical to carefully and thoroughly examine the possible contribution of ADHD. It is irresponsible to continue prescribing stimulant medication in relation to disordered eating without ongoing supervision and monitoring of dietary compliance, since the potential for abuse is probably higher than in the general ADHD population. While medication can be an effective adjunct to treatment of patterns of disordered eating in someone with ADHD, it should never be used in the absence of ongoing behavioral treatment. In this context, medication is used to improve executive functioning that, in turn, impacts on the ability to control eating behavior. It is critical to be alert to the client's possible abuse of the medication as an appetite suppressant, rather than as a means of helping to control symptoms of ADHD.


There are few people with expertise in both ADHD and disordered eating. As a result, an adult with ADHD and disordered eating patterns may need to seek out two different professionals, a psychotherapist expert in ADHD issues and an eating disorders specialist, who are willing an interested in working in consultation with one another. A collaborative process of problem solving can produce positive results.


Eating disorder specialists need to become better educated about the need to screen for the possibility of ADHD in clients who demonstrate particular difficulty in sticking with recommended changes in diet and exercise, and ADHD specialists need to routinely explore the possibility of disordered eating patterns in their adult ADHD clients. A combined treatment approach using stimulant medication, ADHD-focused cognitive-behavioral therapy, and a structured ADD-friendly approach to improving daily eating patterns can greatly increase the chances for successful change.{End Quote}



As you can clearly see having an eating disorder greatly complicates ADD treatment. Personally I think he could have been a little more honest and simply told you flat out he didn't feel qualified to treat you - but in this society it isn't exactly like honestly is rewarded especially in the medical profession - not only do doctors have to worry about the DEA investigations with drug prescribing - they have to worry about law suits by patents.

I hope this helps answer you question