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Old 03-06-18, 02:44 PM
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Are there non-mental health care providers who do ADHD medication?

I visit a clinic separate from the main clinic because they accommodate my hours outside of work. I use to see an NP for two years who worked with people. After she left they assigned a doctor.

I’ve seen him twice. The second appointment he identified himself as a psychiatrist and I was told basically “his” treatment plan. Part of his plan is I am not to involve my PCP anymore, there is supposed to be an increase visit frequency, and I am only to go to this particular location for “mental health” services. It was also mentioned that because the psychiatrist does the prescribing, the PCP would not prescribe the medications (the PCP previously recommended and managed side effects as needed).
I have not consulted with the PCP, but the staff was adamant about this process. If I raise a question, it is not received well. When I mentioned my boundaries, the staff said they didn’t know if the psychiatrist would agree. I feel like I’m supposed to fall in-line to "his" program. I think he forgets that he is providing a service and if I disagree or question his methods, it’s not a partnership. I’m not there to see a "mental health" practitioner. If the clinic did not have extended hours, I would have never attended the location.

I am not interested in "mental health" services. I am exploring new provider options outside of the clinic that have the hours accommodating to my work schedule. I have located a few, but if I have to limit it to "mental health", the options are considerably limited to almost non-existent. When I look up ADHD medication providers, it only lists mental health locations. I only discovered that ADHD fell under 'mental illness' two months ago due to FAA restrictions. I know cholesterol medication doesn't have to be provided by cardiology or that dermatology and pediatrics can prescribe birth control.

It’s my only medication, my condition is mild, and judging by the difficulty others have encountered in other forums, it seems like it’s an uphill struggle and mental health doesn’t treat people like if they were trying to work together like with birth control or cholesterol treatment plans.

When I go to inquire and make contact, I do not want to call the wrong place or make incorrect assumptions (i.e. assuming the PCP is the team leader, but really there is no collaboration outside of his department).

Any suggestions for non-mental health care providers?
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Old 03-06-18, 03:08 PM
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Re: Are there non-mental health care providers who do ADHD medication?

It's reasonable for a psychiatrist who is prescribing ADHD meds to request that you not also get ADHD meds from your PCP. It's reasonable (and standard-of-care) to suggest therapy in addition to medication. It's reasonable to visit a mental health clinic for ADHD treatment. But cutting any PCP out of the loop entirely (instead of collaborating with them), and imposing a treatment plan on you without your input and without adquately addressing or even acknowledging your concerns, do seem like potential red flags.

In general, psychiatrists, neurologists, internists, family docs, and pediatricians (and in some cases, NPs associated with any of the above) are the clinicians who typically prescribe ADHD medications.

However, the structure of your health care coverage (HMO, PPO, other...?) -- assuming you're not willing/able to pay out of pocket -- may strongly influence the options available to you. (For example, some plans require referrals or jumping through other hoops to see a particular type of clinician for a particular type of treatment.) Do you currently have a PCP, or did the NP who left fill that role for you in the past?

Also...it wasn't clear from the way you mentioned the FAA...are you a commercial pilot? I don't know if this is a concern, but the requirements for disclosure to licensing agencies are likely to be the same, regardless of whether you get your health care / ADHD meds from a "mental health" clinic or a more general clinic.

In any case...if I were you, and I felt like the extended-hours mental health clinic was disregarding my needs and concerns and stripping me of agency in the treatment process, I'd seek a second opinion. Whether you choose to see a different psychiatrist or a general practitioner of some sort may depend on your means and the availability of doctors in your area. The type of doctor may be less important than their experience in treating ADHD in adults, their attitude/bedside manner, and their approach to working with you. (Unfortunately, it can be hard to suss that out in advance of paying for an intake appointment...)

Best wishes!
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Old 03-06-18, 03:40 PM
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Re: Are there non-mental health care providers who do ADHD medication?

I feel a few ways about what you wrote:


Quote:
I’ve seen him twice. The second appointment he identified himself as a psychiatrist and I was told basically “his” treatment plan. Part of his plan is I am not to involve my PCP anymore, there is supposed to be an increase visit frequency, and I am only to go to this particular location for “mental health” services. It was also mentioned that because the psychiatrist does the prescribing, the PCP would not prescribe the medications (the PCP previously recommended and managed side effects as needed).
Yes you should only get your meds from once doctor, and yes that doctor should be a psychiatrist. An increase in visits from what to what?were you only going a couple times a year and now he wants you monthly. I know with my doc and most once the initial eval and stabilization of meds occurs I have to see her once every three months unless there is a problem.
You have every right to involve your pcp if you want, in fact it could be a good form of checks and balances.


Quote:
I have not consulted with the PCP, but the staff was adamant about this process. If I raise a question, it is not received well. When I mentioned my boundaries, the staff said they didn’t know if the psychiatrist would agree. I feel like I’m supposed to fall in-line to "his" program. I think he forgets that he is providing a service and if I disagree or question his methods, it’s not a partnership. I’m not there to see a "mental health" practitioner. If the clinic did not have extended hours, I would have never attended the location.
He does seem rather fixed in his guidelines but adhd is a mental health disorder whether you like it or not so you are in the right place at least in that respect.

Quote:
I am not interested in "mental health" services. I am exploring new provider options outside of the clinic that have the hours accommodating to my work schedule. I have located a few, but if I have to limit it to "mental health", the options are considerably limited to almost non-existent. When I look up ADHD medication providers, it only lists mental health locations. I only discovered that ADHD fell under 'mental illness' two months ago due to FAA restrictions.
It has always fallen under mental health. Are you worried about your job?


Quote:
I know cholesterol medication doesn't have to be provided by cardiology or that dermatology and pediatrics can prescribe birth control.
Yes but a good pcp would have you see a cardiologist or obgyn before continuing to prescribe you meds for it.

Quote:
Any suggestions for non-mental health care providers?
Im confused as to why you are so adament to avoid the mental health care field.
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Old 03-06-18, 04:15 PM
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Re: Are there non-mental health care providers who do ADHD medication?

The FAA is very strict.
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Old 03-06-18, 08:42 PM
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Re: Are there non-mental health care providers who do ADHD medication?

I was dx just a few years ago from a neuropsychologist. The PCP recommended medication. I requested a second opinion and it was confirmed with a neurologist. Before seeing my PCP again, someone mentioned I could ask so & so (an NP at the clinic that offered extended hours) to see if she could prescribe the medication. No doctor referral, no instructions to see a mental health provider, no indication of anything I need to know out of the "norm".

I called and asked if she could, where she responded, "sure". I still saw my PCP at the regular clinic. After a few visits, she replied I only needed to come in twice a year. After a couple years she left and the new "doctor" appeared to have "taken over". His treatment plan were not requests, but more like demands. I was not particularly keen on severing ties with my PCP as a team participant with treatment. He wants me to come in 4x a year because that's "what he does". Working with him does not feel like a partnership. Increasing the frequency should have a medical validity to it in my opinion. I wouldn't wait for an appointment if there is an issue and if there was an issue, I would think it would have manifested itself by now.

I am not a pilot, I have flown and still interested in completing my pilot's license and flying with a particular organization that benefits the community. That is how I discovered ADHD was a mental illness. I was not informed by a provider. It's been a "learning as I go" type process. Apparently you can have Alzheimer's and Parkinson's and fly, but ADHD is an automatic denial.

I do not have any issue receiving any medications from one provider. I would prefer only one stop shop. Although I am not typically accustomed to taking medications regularly, involving and including the PCP I felt was normal. I regarded the PCP as the team leader and if I had any issue (regardless of what), he was the point person to find a resolution. Now it seems "typical" to exclude PCP collaboration with other departments (and only work with the psychiatrist in this case). The PCP has never prescribed me medications. We have discussed recommendations and management only. I have been pretty healthy. Urgent care has done antibiotics and the person who did my colonoscopy prescribed their cocktail. It is rare to visit my PCP.

I travel for work often and unless it’s important, need tests, or an annual physical, I don’t have a need to visit my PCP at the normal clinic. The extended hours of the other clinic are more accommodating. However from now on it is strictly only for ADHD appointments. I am not trying to avoid the mental health care field per se, I was asking about non-mental health providers because it opens up more options (accessibility) at other locations/clinics. It is not a complex prescription. It doesn’t need changes or adjustments. I am aware that other medications are not limited to certain providers so I thought I would ask. Like I said, it's been a "learn as you go" type process.

I could consider having frequent visits with a psychiatrist bordering on possible overkill. Clearly their talents could be used more efficiently. Unless there is an issue with medication at every single appointment, it would be like requiring a cardiologist to perform blood pressure checks. Sure the specialist has knowledge and experience, but the duties were essentially performed by a nurse before them.

Namazu mentioned an intake appointment. I did not think of that. I guess I will have to look into that if I change locations. Something new to find out thanks! Sarah mentioned an initial eval, I am not sure if she meant the same thing as an intake or the neuropsychologist testing.

I was used to the idea of a health care system using a team approach, decrease frequency as stability increases, and open communication. I thought psychiatrists were specialists and handled complex mental health problems instead of just acting as a refill nurse. If seeing a psychiatrist is the only option, then with the few available, it is what it is.
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Old 03-06-18, 09:21 PM
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Re: Are there non-mental health care providers who do ADHD medication?

My family Dr. a D.O. does ADHD evaluations and provides continued treatment with medications.

She has the best personality the most caring and probably the sharpest physician, I’ve ever met. Besides being a D.O. she also has a masters degree in genetics and something else.

She diagnosed me when no other physicians or specialists could for 10 years and never considered ADHD. She’s the best.
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Old 03-07-18, 11:27 AM
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Re: Are there non-mental health care providers who do ADHD medication?

Hi Bud, Don't know if you've moved on w/ this Doc, but I expect any Doc (or any provider of services to me) to explain to my satisfaction why their treatment (service) is appropriate. For example the not involving the PCP, I would tell him why I think that is inappropriate and then ask him to explain why he believes that it is. If he can convince me that it is appropriate or to "try it his way" we move on together. If he can't convince me or he is unwilling to try, I may ask more questions to help me make/confirm my decision, but I would likely end-up thanking him for his time and inform him I will be moving on w/o his services. If I found the experience upsetting, I would wait until I calmed myself and make sure I was/am evaluating the situation rationally.

In general I think it is on him to convince you that his approach is the best one, but OTOH it would be unreasonable to expect him to spend 10 hours holding your hand to explain it. If still stuck, maybe tell him so and ask where you can study his approach on this matter to evaluate whether it is right for you. Books, papers, your PCP, someone you trust on matters like this (minister, rabbi, the NP you used???). GL, -LN
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Old 03-07-18, 01:18 PM
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Re: Are there non-mental health care providers who do ADHD medication?

I have not moved on yet. I just started looking for options. Accessibility is an issue and by limiting it to only mental health hinders the search results. Nobody is taking new patients or the hours are outside of my availability at this time. I also questioned when I read other people having difficulty about why they didn’t leave and now I have a better understanding why they put up with their situation.

I will give him a chance for now. I don’t know what really to expect because I really don’t have experience with seeing a psychiatrist. So far it has been two 15 min appointments and he's only asked two medication (at the last appointment) related questions like sleep and how's it working? The other questions I would refer to as customer service questions like occupation (asked twice), name of employer, how long I have lived in town, etc… I share the same information I would with a dentist or optometrist, but I guess when you charge by the minute you have to have some stock questions to fill the time.

Not intending to change the topic of the thread, but since it was mentioned that it is best to see a psychiatrist for ADHD medication, I would appreciate what a typical visit would be (omitting any other affliction of course like mood, anxiety or other reason to visit) so I know what to expect or understand as a "normal" visit. Maybe I will create a new post (in the appropriate place) sometime.

When I originated this post, I naively viewed getting ADHD medication similar to getting any other prescription. I didn’t realize it so provider specific. I wasn’t too concerned about who the provider was as long as one was available. I knew I couldn't be too picky given the parameter constraints. I thought of ADHD like dyslexia, it just meant we were born different. I never thought of it as a mental illness and nobody expressed it as such. Nobody in my family has it nor do my children. It wasn’t looking for it when I got diagnosed. I have limited experiences with doctors compared to some people and I really have appreciated everyone's input on this post.

Most things I have seen on the net are broad and generic. It is terrible to search for questions because the keywords take you in a different direction. For example I was reading a thread this morning talking about someone having to take a drug test for a medication they are prescribed. They made it seem obvious and typical, but yet I don’t understand it. I thought drug tests were for drugs you weren't supposed to take. But you can't google that without it going in a different direction. These forums are so much more informative.
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Old 03-07-18, 04:50 PM
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Re: Are there non-mental health care providers who do ADHD medication?

Every psychiatrist I have visited has required me to have an appointment every three months ...

Stimulants are in the category of controlled medications ... far more regulated than the vast majority of medications. Stimulants are like narcotics, which are monitored by the DEA for doctor abuse, patient abuse and pharmacy abuse.

Stimulants have a wide range of side effects, including increased blood pressure, heart issues and they can be abused. So visiting a doctor every three months is quite moderate and overwhelmingly reasonable.

You aren't taking Tylenol when you get an ADHD prescription. Stimulants are potent and strictly regulated by the DEA. Just a slight exaggeration (though not in the DEA sense) ... instead of regular medication, think more along the lines of long-term Oxycontin. That's the neighborhood of the med you're taking, according to the DEA.

Here is a passage from the DEA regulations:

Schedule II/IIN Controlled Substances (2/2N)

Substances in this schedule have a high potential for abuse which may lead to severe psychological or physical dependence.


Examples of Schedule II narcotics include: hydromorphone (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®). Other Schedule II narcotics include: morphine, opium, codeine, and hydrocodone.

Examples of Schedule IIN stimulants include: amphetamine (Dexedrine®, Adderall®), methamphetamine (Desoxyn®), and methylphenidate (Ritalin®).

Other Schedule II substances include: amobarbital, glutethimide, and pentobarbital.

https://www.deadiversion.usdoj.gov/schedules/#define


Now, this psychiatrist does sound controlling. And I admit: I don't "get" him--in that of course, you have to tell your PCP about the medication you get from the psychiatrist. You have to! How would he know anyway? Your PCP needs to know all that you're on so they can be aware of potential interactions should you later go on a different med. And that PCT might at some point notice an odd side effect related to your ADHD medication.

So you have to ignore that--if that's what he means.

ADHD stimulants are mental health medications. Doesn't matter if the prescribing doc is generalist or a psychiatrist. Just as is the case, as you mention, say with statins, which are heart medications--doesn't matter who prescribes them.

It's always best to find a doctor you are comfortable with ... But rare in my experience are the doctors who prescribe ADHD medications and are comfortable with seeing you two times a year. I think that's considered poor practice and supervision when it comes to ADHD medications. Plus, PCP folks are kinda paranoid about prescribing powerful meds that they don't really know a lot about.

Short answer: your psychiatrist is being fully reasonable and responsible in wanting appointments 4x a year. The block against involving your PCP is unreasonable. ADHD meds are mental health meds, no matter who the prescriber is. Just as a narcotic is a narcotic whether prescribed by a dentist, a PCP or an anesthesiologist pain specialist.

Tone
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Old 03-07-18, 08:17 PM
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Re: Are there non-mental health care providers who do ADHD medication?

Medical marijuana is even worse according to the DEA.
It’s classified as a schedule I.
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Old 03-08-18, 04:41 AM
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Re: Are there non-mental health care providers who do ADHD medication?

Quote:
Originally Posted by Budkeiser View Post
Not intending to change the topic of the thread, but since it was mentioned that it is best to see a psychiatrist for ADHD medication, I would appreciate what a typical visit would be (omitting any other affliction of course like mood, anxiety or other reason to visit) so I know what to expect or understand as a "normal" visit. Maybe I will create a new post (in the appropriate place) sometime.
Assuming this psyche doctor of yours is not a total jerk in general evals are usually an hour or so long. They involve a thorough history of childhood and beyond as far as how long you have had issues with examples to back them up. (its a good idea to write this down beforehand). The doctor will want to know what your impairments are now and what you do to mitigate them. Records from the doc you were getting meds from will be super helpful as well as anything you may have floating around from school (not a must just helpful). There are no tests for adhd. You can google "conner's scale for adhd" which is something they sometimes use for screening purposes for you and loved ones that live with you.
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