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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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Old 09-13-18, 03:40 PM
andyb1205 andyb1205 is offline

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Psychiatrist Outdated on ADHD, Lacking Empathy

Hey there, I am writing in regards to my brother and needed a place to vent.

My brother is 17 years old and was diagnosed with PDD-NOS, high functioning autism, many years ago. I will skip the details of how it's taken a year and half for my brother to get to this point, from being denied trial of ADHD medication despite a diagnosis from a psychologist, thrown to a pediatrician, referred back to a psychiatrist, only for an emergency situation and school intervention landing him at the hospital to cut across the running around and finally begin treatment by the psychiatrist there. This was a few months ago and since then has worked with the family doctor and saw his new psychiatrist for the second time yesterday.

He has had failed trials with Biphentin (Concerta), Vyvanse (up to max dose of 70mg), and Strattera (prematurely stopped after 3 weeks). He responded best to Adderall.

In the first meeting with a psychiatrist very out of touch with what ADHD is and its impact on one's life, a month ago, he was advised to go off of stimulants and instead take fish-oil and magnesium supplements. We declined. He diagnosed him with anxiety (despite previous psychiatrist noting he doesn't have anxiety but hyperactivity) and began trial of 5mg Lexapro. While I mentioned that I myself have had a bad experience with Lexapro as it cancelled out my stimulants, suggesting Zoloft which I take instead, he wanted to try Lexapro first.

As my brother's ADHD was returning over the past few weeks as even 5mg Lexapro cancelled out the Adderall, becoming frustrated as school has begun he exploded and had a violent meltdown. Mind you the GP had increased the Adderall from 30mg but it didn't work, not 35mg or 40mg. Anyways, for his safety, for the first time ever, I called the police. They escorted him to the hospital, put him on anti-anxiety sedatives, and discharged him a few hours later the same night. Besides the harm to mental health, there was damages of probably around $200 as he flushed my medications down the toilet and cracked the window in my washroom. In his mind he was punishing me for putting restrictions on the PS4 as he was too bored to do homework and playing video games late at night.

The GP was kind enough to prescribe the necessary medications, despite being a controlled substance. Mentioned that it's important for me to let my brother speak as he's almost an adult and independent. I understand, but the consequence of my brother's difficulty communicating effectively can negatively impact his own treatment, which is why he gives me permission to often speak for him as I monitor him. The GP was about to discontinue all medications and simply prescribe him Seroquel to control his moods! My brother had recently been feeling more energetic, staying up for hours at night playing video games. Thankfully I intervened and explained his moods were well controlled on Adderall, this is common with hyperactivity, hyperfocus and ADHD. He is currently only on Adderall 30mg.

Yesterday we saw the psychiatrist again. Me and my brother were interested in trialing combination therapy, adding Intuniv to the Adderall to reduce stimulant anxiety and provide 24/7 coverage for impulsivity. I brought in research from peer-reviewed journals that showed its efficacy for a subset of patients. The idea was to fine-tune treatment for the ADHD so we can better assess and treat symptoms unrelated to ADHD. However, the psychiatrist said he has never prescribed Intuniv and is not comfortable prescribing it as he wouldn't know how to monitor it, mentioned the doctor's motto "do no harm." This was confusing as he said he has given Clonidine to some patients to help with hyperactivity. As I explained Intuniv is simply Guanfacine extended release, and very similar to Clonidine, he still did not budge.

Instead recommended we go to an ADHD clinic in a further away city to be treated for complex ADHD and autism, with his name as a reference. As my brother has just begun Grade 12 his well-being and future depends on finding the best treatment for him now and not be dragged by further waiting times. He prescribed Ativan to be used for emergency situations if my brother has a meltdown, and I got a script for Clonidine anyways. It wouldn't take much for the doctor to go out of his way to trial Intuniv, the dosing is easy, effectiveness and side-effects similar to Clonidine. He's just too old, behind the times, and unwilling to improve his knowledge to better his patients.

The good news is that we got Ativan to be used rarely if needed, and can continue trying to find a good fit for a psychiatrist in the long-term. I will ask the family doctor if he can, in light of the evidence and out of empathy, work with us to trial Intuniv. It's the safest route before trialing other anti-depressants, such as low dose 25mg Zoloft. Or Buspar. Just something to take the edge off the Adderall, to complement it.

Thanks for listening. I am admittedly worried about my brother because of my own experiences. Working hard got me into a top University but I dropped out and failed every time I tried again. That was 8 years ago. ADHD diagnosis was missed by a psychiatrist 4 years ago. Was sober for a year only to again fall into self-medication with marijuana and alcohol, now I've hit my record and am two and half years clean from marijuana and over one year two months clean from alcohol. Just got the nicotine to go, that's a tough one. Having hit 28, the more years go by before proper treatment of ADHD the more depressed, anxious, and full of regret one becomes. I do not want to see this for my brother who is a hard working kid.
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Old 09-14-18, 12:48 AM
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Re: Psychiatrist Outdated on ADHD, Lacking Empathy

Hi there: That really sucks. Is there another local doctor you can see? This one doesnt seem to have his facts straight. Congrats on being sober! I am 6 years sober.
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