View Full Version : Bad Psychiatrist, or am I the Problem?

02-11-09, 06:52 PM
In January I started seeing a psychiatrist after having a minor breakdown last semester, although it has been ongoing all my life. At our first meeting, and first glance, she asked me if anyone had talked to me about ADHD because I was showing clear signs of it in the first five minutes we were together. I told her no, but that I had always suspected it might be an issue. She pulled out a few surveys that she had me fill out about my symptoms. Once done, she took a look and told me that she wanted me to go home and look up Bipolar-II and ADHD. She also wanted me to look up Lamictal and Vyvanse. She asked me to research and see which one I felt I identified with the most.

I researched like she asked, and while I had a few things in common with Bipolar-II, I could tick off almost every symptom of ADHD-Combined type. When I returned I told her what I thought, and she told me she would start me on Vyvanse 30mg. My first few days on it were great, but at the end of the first week I felt that my symptoms were not being managed at all. So she suggested for me to double my dose for the next week. 60mg made me feel horrible, panicky, easily upset, and didn't manage my symptoms very well.

I returned to her after two weeks on Vyvanse, and when I told her how I had felt she looked at me strangly and said, "I don't know why it worked well for a few days and then you felt nothing. It is a mystery. Are you sure you have ADHD?" Needless to say, I was shocked. Why would a pdoc let her patient self diagnose and then just hand out a medication if they didn't agree with how the patient felt? If she didn't think I had ADHD, what self respecting doctor would just give me ADHD medication?

I asked if I could try an inbetween dose of Vyvanse to see if that worked better, and she told me if it didn't work at 30 or 60 that it probably wouldn't work between that. I asked if an IR med would work better, and she told me she doesn't do IR meds unless necessary because, "If they can't remember to do anything else, how will they remember to take their pills?". She then put me on Concerta 18mg. I asked her couldn't another med from the same family as Vyvanse produce better results, and she told me that if one didn't work that the others probably wouldn't either. So now I feel like if this one doesn't work, I only have one more option (non-Stimulant) before she gives up completely without letting me try other things or take things together to see how they work.

After my meeting I was really unhappy and I started questioning myself really harshly. I felt like maybe nothing is wrong with me at all, and maybe I am just making it up in my head. Maybe I'm just a lazy, unmotivated, immature loser? Maybe all the things I've experienced since I was little are just normal, and there is nothing that can be done. But part of me knows that no normal person feels like I do, or reacts like I do, or has the same trouble that I do. I have been bounced around from person to person for years, and each one feels like I have something different, and when the first med or treatment doesn't work they seem to give up and insist either I do it their way, or that I must not have anything wrong with me.

I already have some questions with my Concerta because after taking it, I got so tired that I slept for a few hours even though I had 8 hours of sleep last night, plus a good breakfast. However, I'm so afraid to call my doctor because I don't want her to get upset with me for even suggesting that something is off with the medications, or to even ask what is normal and what isn't.

I know that mental health is not an exact science, but I feel like I need to find out what is really and truly the matter with me so that I can correct it and get my life in order. I don't want to continually have breakdowns every few months because no one can figure out what is wrong. But in reality, could it just be that I'm the problem, or could it be that my pdoc is wrong?

02-11-09, 07:05 PM
Hi there, I just skimmed through as I am really tired. But: This pdoc seems really bad to me. Any doctor who treats ADHD should know that the response to medication can change quickly over days. This is at least partly due to rapid changes in sensitivity of the receptors the medication work at and also changes in the chemical balance in the brain. On a personal level I can tell you that I had nothing less than a terrific effect both when I started with methylphenidate and Strattera. Both times the effect diminished greatly over a course of days to a week. Very disappointing. Well, do I not have ADD, then? I donīt know, but I surely have a lot of inattentive symptoms, and the fact that they suddenly disappeared at least shows that something is not in balance which should be.

I think you should get another doc. Trust is essential, and this one demonstrated a) lack of respect, b) lack of knowledge.

02-12-09, 12:03 PM

Regarding meds- for some insane reason, finding a pshrink that understands why titration is important is tough. Apparently, so is finding one who actually understands how the drugs they prescribe work.

Vyvance is the newest kid on the Shire block. For some insane reason, the thinking has been that it must work for everyone. Maybe it does. I don't think I would do as well on the time release meds- I take Adderall IR.

I have heard about the extreme sleepiness on Concerta. I am guessing that it may not be the optimal solution for you. I have a similar reaction to Ritalin.

Do you have the option of seeing a different pshrink? If you do, start there. You aren't nuts, you have ADHD. You aren't incompetent, you have to set reminders for things. You are doing all the right things to be responsible in reporting to your prescriber about the effects of the medication they are giving you. Don't let this pshrink minimize you or your needs.

My experience has been that I had to be on the med for several weeks to really stabilize on it. When I began the Adderall, I titrated slowly to 30 mg and stayed there for a month. When it didn't seem to be really dialed in, we moved to 40 mg. That seems to be the best dose for me. Still, it was a process.

Regardless, you deserve to be validated and supported by the person you are paying to help you manage your ADHD. As Olavia says, trust is essential. You need to be able to build a relationship with your prescriber, not be torn down. And you certainly should not be afraid to discuss issues with the meds.

It seems sometimes like I end every post I make this way, but it is true. You deserve to be treated better than that. You are worth all of the difficulty of the process to get to appropriate treatment. It might be worth contacting your local CHADD affiliate and requesting a list of docs in your area that understand ADHD and can help you to find the right med for you.

Let us know how it goes.