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Adult Diagnosis & Treatment This forum is for the discussion of issues related to the diagnosis of AD/HD

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Old 01-27-17, 09:01 PM
Pirandello Pirandello is offline

Join Date: Jan 2017
Location: Italy
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Exclamation European, already diagnosed, I need help urgent help in finding a new doctor

Hello to everyone,

First, I'm sorry about not introducing myself in the appropriate section before posting this but saying that I'm in a hurry would be an understatement. I'll make sure to do it later.

Just for reference, I'm Italian, 30 y.o. and got diagnosed with ADHD just a year ago, in London, after having lead a pretty miserable life up to that moment, as is sadly the case with many undiagnosed adults.

(I went to London as a last resort, since I suspected that I had ADHD for basically the previous TEN years but, as you can guess, no one of the many psychiatrist and therapist who "helping me” since I was 14 y. o. ever took that possibility seriously, instead, if they ever heard about it, they ignored it or outright mocked me for suggesting it).

Since our attention spans are limited, I'll jump straight to the point and to providing the minimal amount of information tio make myself understood and I'll add my own circumstances after that, under a "quote" named "MyCircumstances".

What I need help with is to find a reliable, competent psychiatrist in Italy who would be willing to prescribe Dexamphetamine if, after the assessment, he were to confirm the ADHD diagnosis (I always stress this to avoid possible misunderstandings about my motivations)

or, at the very least, I'd like to know if someone familiar with Spain's health care system (or those of other EUR countries were Dexedrine is available, expect maybe Germany since I expect treatment there to be almost as expensive for an Italian as in UK) allows for the prescription of controlled medication to people who resides in other EU-countries.

This is a critical piece of information for me since I already found some doctors in Spain but I have no way to contact them to ask something like that.

I'm so adamant about dexamphetamine since both methylphenylidate and non-stimulants which increase noradrenaline worsen my condition (I have a co-morbid and, I may add, really strong anxiety disorder). Also, but for different reason altogether, even Vyvanse/Elvanse is, actually, bad for me and that's because it makes me extremely aggressive. I expounded on all this in second half of the topic which I marked as a "quote”.

I was under treatment in London but I could not stay in the care of the Brit psych because of the huge amount of money that doing so required out of me and my own family (since, as of now, I'm still unable to completely provide for myself on a financial level).

I tried to get treated in Italy, where dexamphetamine isn't available (but which could be legally imported if a specialist were to state that the other treatments available in Italy are not viable for me, unfortunately I found NO TRACE of anyone willing to even discuss said option) but, as I also recount later, that went really badly for me.

Right now I'm without meds once again, losing the grip on the progresses I made in the last half of a year and, to top it all, I have just began to attend an advanced course in software programming for which I applied months ago (without knowing, at the time, if I'd been accepted) and that would be an huge occasion for me to begin getting my life back on track (and, to make it worse, also an once in a lifetime opportunity since I was already at the age limit for admission) so I'm, in truth, pretty desperate right now.

Lastly, I ask this here because, even if I got no answer for association and individuals who proclaim to care for the interests of people with ADHD, I'm pretty sure that, somewhere in Europe and even in Italy, or at least in Spain, there are adults who got diagnosed with ADHD who respond badly to MPH and non-stimulants (I read that's actually already fairly common for someone with ADHD alone to not respond well to one of the type of stimulants and also that, amongst those disorders that can have com-morbidity with ADHD, GAD/social phobia is one of the most common ones).

Aside from people who live in Italy, I'm asking help from those that live in Spain because, after long research, I discovered that Spain is one of the few countries in Europe (and the nearest one to Italy, both in term of physical location and of expenses to be seen by private specialists) that makes Dexamphetamine available as a treatment for ADHD. Some others accept only Elvanse, which, as I already side, is also bad for me.

That being said, I'm addressing this help request to Italians, Spanish or those people that know about Italians and Spanish adults with ADHD on this forum (I really hope that there is someone) but I''ll be REALLY thankful to all Europeans willing to give me just an hint to follow, since frantic days of googling and mailing gave me almost nothing. If you're unwilling to or is not allowed to speak about specialist on the forum, please contact me with a PM.

That's all, I'm truly sorry if I said something that I shouldn't have, I feel that I may have sounded arrogant or at least conceited, I don't know, but please understand. Whatever you can help me or not, if you read this, THANK YOU.

Originally Posted by MyCircumstances
I tried to keep the babblering about my own circumstances to a minimum but, in the end, almost everything still came out. Sorry about that.

As I was said, I got diagnosed in London but to do so I had to resort to a private psych (given the long waiting times of the NHS) and, between staying there and paying the psych and the meds, my (few) life savings went down the drain. Still, I think it was worth it.

During my stay in London I was treated with Dexedrine, up to 15 mg split as 10 mg in the morning and 5 mg in the afternoon and I did, or at least I think I did, more than well, at least compared to the rest of my life.

Unfortunately I didn't manage to make a living in London that would have let me sustain my stay there in autonomous way so, when my savings where almost depleted, I had to go back to Italy.
At the time of my last check-up with the specialist who diagnosed me first, just before going back to my country of origin, he opted to switch my medication to Elvanse 30mg (as you can guess, the British name of Vyvanse), a single dose in the morning, since he told me that it'd be less expensive for me to buy compared to 3 tbs of Dexamphetamine Sulfate IR.

After I went back, my family helped me cover the cost of the meds but, when it was almost time to go back to London in order to be seen again by the Brit psych (that is to say, after 6 months had elapsed from the time of my last check-up with the him), it became painfully obvious that the expenses to do so were too much to sustain for me and my family.

Also, aside from that, even if I refused to notice it for a long time, instead calling it “assertiveness”, not long after I began to take Elvanse my aggressiveness skyrocketed, even if (thanks Heavens) only in a verbal manner. That was even more obvious for those few really close to me who knew me as meek, more often than not passive person.

At last I chose to address both problems at once and, given how expensive it was to be treated by a British psychiatrist, I decide to look for an Italian specialist in Adult ADHD even if my Brit psych warned my against doing so because, in his own words: "since you also have a serious anxiety disorder, both methylphenidate and Strattera are unsuitable for you, and those two treatments are the only one available in Italy for ADHD right now".

Actually, at the time I was already pretty convinced that he didn't lie to further his own interests since it perfectly matched with what I read online about the poorly understood mechanism trough which the different type of first-line treatments fight back ADHD.
Even so, I still hoped that the Italin specialist which I contacted (which, by the way, works in Pisa, Toscana) may have agreed to authorize me to import the meds from other countries where they were legally available (as I already said, it's perfectly legal to do so... as long as you ever manage to find an Italian doctor willing to make the realted paperwork) or even that, in the end, MPH would have been an acceptable alternative for me. Sadly, I was wrong.

Anyway, this Italian “specialist “of adult ADHD, aside from appearing to me as someone not entirely there himself (he basically insulted both the Brit doc and myself by saying loudly to his assistant while sitting across me during the assessment that the Brit doc "found himself a fool to take money from") chose to completely disregarded how well it went with Dexedrine (by saying that "since it's amphetamine it'd make everyone feel good and, because of that, you will end up taking more and more of it”, what I think is something pretty offensive toward those that are/were treated with Dexedrine for their ADHD and haven't/didn't become addicts).

Aside from that he told me that I was "hyper" at time (and, regarding that, I now admit that he must have been right and also that I may actually also have co-mobird bipolar disorder, as he affirmed) so he prescribed me Depakote 600mg/day and switched the Elvanse 30mg/day to Equasym 30mg/day (an 8 hrs. duration extended-release formulation of Ritalin).

Setting aside the bad impression he gave me, I chose to trust him at first since I begrudgingly accepted that my rage outbursts were out of control and also that my judgment could have been impaired by being "hypomaniac" at the time, as the Italian doctor himself said, because I was taking Elvanse.

Unfortunately, just a few days after I switched meds, things began going downhill in an entirely different manner. Soon I became what I called a "pendulum", shifting rapidly and in an almost symmetric manner from being utterly depressed to being extremely aggressive and “hyper” with very brief “free intervals” between the two extremities. Aside from mood shifts, I had (once again) paralyzing anxiety, at least for the eight hours which followed the ingestion of Equasym, something that Dexamphetamine fought back way better (it didn't made it go away entirely, of course, but anxiety became far more manageable).

After going back to the doctor to report about this and the fact that all the progresses I made in the last year were being reduced to nothing, he told me that I actually improved, instead, since now, at the very least, I “stayed still" (actually, at the time, I was very much paralyzed by an HUGE anxiety attack that I was still in full swing right before him and I managed to speak just a few words).

Anyway, he switched me to Ritalin 10mg in the morning and 5 mg in the afternoon while raising the Depakote to 900mg daily. Still, I saw no improvements. On the contrary, my condition kept worsening.

The last time, I went to a check-up with him, last December, I told him that and also that, while taking Dexedrine, I faced why less side effects but he retorted by saying that “they are the same thing” and that if things were like that I could not take stimulants. So he told me to stop taking Ritalin and to take clonidine in the evening, which he described as a non-stimulant which supposedly helped with ADHD while also reducing anxiety but, for me, it may have been of very little with ADHD but it definitely didn't help with anxiety. Actually, it worsened it, at least if I compare it to taking only Depakate, something that happened just a week later, when I finaly decided that I had enough of this so-called "doctor".

After that, I was so full of it all that I opted by myself to switch back to Elvanse (I had some leftover from my last prescription of it) but to do so without stopping taking Depakote, just to see how it went but that ended up in failure.

I became extremely aggressive in the very same manner I became when I began taking it the first time around, expect that now I acknowledge that such uncontrollable anger was something unacceptable no matter how I tried to rationalize it.

I even tried to open the capsules and take as far as 1/4 of their content (roughly 12,5mg of Elvanse) but it made no difference concerning aggressive behaviour while making it almost useless against ADHD symptomps (concerning this behavior of mine, I only did so because I previously read in the lefleat that accompains i it that it was fine to open the capsule if you so wished, since doing so doesn't impact the effect of the meds; it is encapsulated only to be easier to ingest).

Lastly, despondent and almost resign to never been able to get better, I switched back to Dexedrine, of which I brought back an handful of tbs from London (once again. I did so without stopping taking Depakote, since I fear that taking too much initiative on my own would be even more dangerous). I also chose from the jet go to take LESS of it. As far as 1,25mg twice a day (that would mean, a quarter of the 5mg tbt, which I cut with a small blade especially design to split apart medications in tablet form). Somehow, it worked. I ended up being, for more than a week, not overly aggressive, not overly anxious and even if ADHD wasn't entirely fought back, I was somewhat functional. A sort of middle ground that is not perfect but somewhat worked.

But, right now, I don't have any more Dexedrine tablets left and I refuse to experiment further. I just want to be treated by a professional which should have the adequate preparation to help me. But, even if I disregard that comptely, dexamphetamine is one of the most strictly controlled substances in the world and I cannot get hold of it on my own (I know that there are illegal ways but I refuse to consider them... my life in on the line, in a way, still I cannot accept it) so, no matter how much despondent I feel about the fact that my fate rests entirely on the good will of a doctor, I need to find one who is actually a serious professional to get back the file I didn't have up till now. But I don't know where to find one.

I do not have the courage to blindly trust Italian specialists anymore. Even if you contact them before-hand (as I have already done) to ask if, in the case they confirm the ADHD diagnosis, they will be willing to consider prescribing me to import Dexedrine, they will not give you an answer, willingly ignoring your question or outright calling out for asking something that you're not supposed to ask. As an example, the last answer I got whose from the only other psychiatrist in Italy that I could found that says explicitly that he treats adult ADHD (by the way, he also works in Toscana) I wrote to his staff and, once again, the answer was non-committal.

That means that there are good chances that I may waste time, money (Adult ADHD is not contemplated at all by the National Health System of Italy, by the way) and a part of my dwindling sanity to go there and undergo another hours-long assessment, just to be (probably) prescribed Strattera or some antidepressant together with psychotherapy.

I have also written to the Italian association for Families with ADHD in order to ask for the name of a reliable specialist. A week went by and I still haven't got an answer. I also did the same with the local spokesperson of said association, still no answer. I also wrote to a Swiss ADHD Association (before I realized that dexamphetamine isn't available there) to ask the same. Still no answer. I feel incredibly alone in all this.

That is all, I just hope that, indeed, there is hope for everyone, me and all the others still undiagnosed sufferer included or, at the very least, that “they” may let us create hope for and by ourselves. If you got all the way down here, thanks again for reading ALL this.
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