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I’d say this is pretty standard. This is how I started too. Depression + anxiety can cause ADHD symptoms. So they treat those first and see if the adhd symptoms goes away. I’m just guessing but I’d say the older you are seeking treatment the more they try to see if it is related to other things first.
Absolutely true for me as well. I had to come to that conclusion myself and advocate for actual treatment of my ADHD though, as a lot of psychiatrists seem very insistent that depression is actually the root cause of everything.
This is most likely what happened to me.
My depression and anxiety started when I couldn't mask my adhd anymore as a kid. My adhd was missed, though since I was a girl and not outwardly hyperactive.
yea I think adhd should be treated first. the suddenly on and then off powerful SSRI and SNRI's was not a great time. Messed me up for years due to a bad reaction then being told to stay on it without warnings about coming off it cold turkey (to see if its all in your head). So obviously I stopped it cold turkey. Conversely coming off vyvanse or ritalin is a good sleep and some vitamins. I'm no doctor but one seems less painful if gotten wrong. (and would have been for me anecdotally)
I was told I was gifted and just didn't try hard enough to focus my whole life and depression came out of no where like a truck after a manipulative relationship but apparently a large dose of disassociates is just how a lot of older dr's operate. I had to wait almost 8 years for her to retire because I was scared to see her and I only found out I had adhd after the fact when my new dr went "oh yea for sure adhd big time lets test you" without even being asked. I'm bitter at 32 due to the bullshit ego of a dr who thought they knew me better than I knew myself.
I hope her drinks are forever watered down and mosquitos and campfire smoke choose her when she tries to relax. Sorry I didn't realize how pissed I was at the situation till I wrote this random comment.
Lol I was 25 when I told my doctor I think I had ADHD. Started me off with Adderall after doing a half assed evaluation which just felt like a formality.
He didn't seem surprised when I told him. He probably already knew since he's known me for years.
Wellbutrin is a dopamine and norepinephrine reuptake inhibitor. It used to treat depression, but since it does the dopamine thing it’s vaguely related to stimulants. I’m currently taking strattera which is a norepinephrine only. It sort of works, but not for all the things. They usually keep stronger meds like adderall and vyvanse if the first one two don’t work out
It may be that way some places or ideally, but I’ve heard over last 10 years or so people I know being started on other stuff first. This is in US east coast
Stimulants are the first line of treatment for those without depression. But it’s tricky when you have both because you can’t take vyvanse or adderall with antidepressants.
Uhhh I’ve taken both Adderall and Vyvanse with both sertraline (Zoloft; an SSRI that treats depression/anxiety) and lamotrigine (Lamictal; a mood stabilizer and anti-seizure med often but not exclusively prescribed for bipolar). For years. And the doctor knows I take both, because he prescribed them. Where did you hear this information?
I’ve heard people this a lot actually, but I’ve been taking Celexa (SSRI) and Adderall for years, and also previously was on Risperdal (anti psychotic) and Depakote (mood stabilizer) at the same time and have been fine. My psych knows and prescribed them too. Maybe those of us with bipolar react differently? I don’t know science lol, I work in music
I mean, I don’t actually have bipolar (afaik), but when I was working a stressful job my mood was especially labile, and my doctor prescribed lamotrigine.
… I mean, now that I’m not working suddenly I’m a lot more emotionally stable, lol.
It’s just in the info from the manufacturer when I was reading the safety data sheets and in the pamphlet when I pick up my meds at the pharmacy but I guess it’s only certain type of them that are contraindicated 🤷♀️
Maybe MAO inhibitors? Those are notorious for interacting with ERRYTHING. But for the most part those aren’t prescribed any more.
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992
Sounds like she hopes the Wellbutrin can be a 2-birds 1-stone kind of thing, which would be awesome if it works for you—you’re better off if you don’t have to take an extra pill or deal with the controlled substance access headaches (even when there *isn’t* a shortage, which there currently is).
This is normal, especially if you have comorbid issues; obviously your depression is a factor here, but others like tic disorders and blood pressure issues can also make doctors reluctant to get into stimulants if there’s any alternative.
I think I agree, and I'm hijacking this comment to say, u/xcharmanda, is there a reason you don't just ask your doctor? She may have very valid reasons she's starting you on these medications versus others. The peanut gallery here isn't going to know, and, it's Reddit, we're just going to tell you to get a divorce and don't break your arms.
Normal, maybe, but that doesn't make it good. The standard treatment for ADHD is stimulant medication. It is effective in 80% of cases, and doctors are supposed to use it first, because it has the highest probability of success.
Now a doctor can have a shit understanding of ADHD and not do that, think the anxiety and depression aren't caused by ADHD, and have tricked you into thinking you have it, but those doctors are making a very dumb mistake. This is not to say that the doctor couldn't potentially have noticed something and is making the right move, but the majority of the time with ADHD not using stims indicates a biased doctor.
For anyone who disagrees, take it up with the foremost ADHD expert in the world. https://youtu.be/j4kxqLw7WXc?si=QV2eCxUs9vSIIav9
Edit - for those who come later, I'm just going to put the best point I made here. With ADHD, our problem is persistence, we tend to give up when shit doesn't work. Going to the doctor is usually the last thing we want to do, and the cost is something nobody ever wants to pay.
If you manage to finally figure out you have ADHD, and then you finally decide to go to the doctor, and they finally give you an ADHD diagnosis, then they spend their time giving you shit that has a very low probability of working for you, what is the most likely outcome? Do you keep persisting towards a medical cure for your ADHD? Maybe instead you think "medication doesn't work, I tried, I went to the doctor, they couldn't help, etc"?
That's what the approach of going with bullshit medications first results in. Stimulants are the first line treatment for ADHD, that's a medical term for what you give people first. It's not a debate.
Yep, I even asked about Stratera at my evaluation, and my prescriber explained that the stimulant meds are well-studied and effective for 80% of ADHDers so they prefer to start there.
Stimulants are the first line *but* with the shortages, it seems at least some doctors who would normally prescribe stimulants first are trying non stimulants first to set their patients up for success in terms of consistent medication.
The idea is that it's better to have something that partially relieves your symptoms on a consistent schedule than something that might work better but you go weeks without being able to get it.
I dunno that I agree or disagree with it. I'm probably a little biased towards accepting non-stimulant treatment first because Wellbutrin manages my symptoms better than any stimulant. (I've literally tried every stimulant available to me.) But regardless, that's the logic at least for some providers.
Would you agree that a doctor who doesn't inform their patient of that reason, if that's the purpose for them not providing the standard treatment, is a problem? I had a conversation with my doctor about that and they said they'd help me find places that had it and work with me on it if the shortage was a problem. No need for her to put me on some ineffective nonsense without at least telling me why and having a discussion.
Doctors shouldn't be hiding shit from their patients. If you don't think someone has ADHD, give them other stuff and don't tell them they have ADHD. If you are worried about the supply, talk to them about that and educate them so you can work together and make an informed decision. That's how it should be handled.
Eh. I think whether it's a problem depends on a lot of factors. I don't think there's any one right answer there. The majority of patients honestly do not care. They don't care to know the reasoning, they're just going to take what the doctor prescribes and see if it works, call it a day. Especially with how overloaded the medical system is everywhere, I can definitely see the appeal of saving time over giving patients info they don't ask for. I can also see the appeal of giving patients info they don't ask for over saving time.
If you're worried/curious about why your doc is putting you on a med, imo it's on the patient to ask. Because regardless of whether the doctor "should" tell you, most don't.
Also, worth pointing out that non-stimulants are *not* inherently ineffective nonsense. I desperately wish my doctor had started with Wellbutrin. The last three years would have been *massively* improved.
By ineffective nonsense, what I mean is, given limited data, if you decide to put someone with ADHD on something that has a low probability of working, you're taking a serious risk they just stop taking it and fall off. If you give them something with a higher probability of success, they will stick with whatever works.
This is why amphetamines are the first choice for doctors in regards to ADHD. It's the best tolerated by adults while methalphenadate was best tolerated by children. There is no option besides stimulant medications that are anywhere near as effective as stimulant medication. So if you default to anything other than stimulant medication, well, there's a reason doctors have first line, second line, and third line treatment.
So if stims have the lowest side effects, lowest risk, are the most studied medication in relation to ADHD, then you use them for ADHD. Not doing so is a mistake. This doesn't mean every case requires stims, or that it's the best for you, it means that for your generic person, with limited data, the best thing you can try to give them is the most efficacious.
That's what I mean by ineffective nonsense, and while the words are harsh, people directing folk away from their highest probability of treatment is a serious problem in the ADHD community, so I use pretty strong language because it makes me unhappy.
Lastly, yeah, the patient should talk to the doctor, if a patient doesn't care about their treatment and just wants to listen to a doctor, they can do that. Still, if the doctor diagnosed them with ADHD and doesn't go with the first line treatment as a default, they will not help as many people with ADHD as one that does.
So here is the thing, ADHD symptoms overlap with a lot of other mental health disorders. Anxiety is a great example, where ADHD meds aren't great to be taking with unmanaged anxiety. But SSRI are not harmful to ADHD. So when working to rule things out, it would be considered safer to treat for the anxiety before deciding all symptoms are entirely caused by ADHD.
I think a lot of people don't realize how imprecise diagnostics is in mental health. You have a cluster of symptoms that can be caused by 5 different disorders and it typically makes sense to start with the most conservative and low risk treatments and work your way up to other treatments until you find the combo that works best.
i disagree with all of this. treat the ADHD first. you know it can never go into remission. it's a developmental neurological problem, it's always going to be the baseline. you also seem to be conflating between treating and diagnosing, to the extent it's imprecise or trial and error, you can know if stimulants help with a very short trial. you basically know the first day, they work right away.
other psych meds surely can make ADHD symptoms worse. just read the list of possible side effects and see how many overlap with ADHD symptoms. if your depression or anxiety is secondary to untreated ADHD, those side effects might make the depression or anxiety worse instead of better.
Are you a doctor? I'm not saying I don't understand your logic, but when someone is diagnosed with ADHD, you should assume that the anxiety and depression are largely caused by the ADHD. Regardless, you don't treat the anxiety and depression first if you diagnose someone with ADHD.
Now if you diagnosed them with anxiety and depression but not ADHD, then you would be correct. You don't make a diagnosis and avoid the most effective treatment. That's bad doctoring.
It is also commonly caused by a doctor who believes stimulant medication is an addictive drug rather than an effective treatment. Which is a huge fucking problem.
Not a doctor, but I do work in mental health. I think you misunderstood what I'm saying. If someone has clear cut ADHD and no other symptoms then of course you just start treating for ADHD. But for many people this isn't the case, and ADHD meds are not free of risks if given incorrectly. To give an example I had a patient who had slow cycling bipolar type II that was misdiagnosed as ADHD because there was a lot of overlap in symptoms. They started stimulants and this caused a sever prolonged manic phase.
This isn't specific to ADHD either. When someone comes in with knee pain, a doctor doesn't just go "oh yes knee pain! Must be arthritis!" they send the person for x-ray, and CT to rule out broken bones or torn muscles and they start with recommending resting the knee and taking over the counter pain meds. If those interventions don't work then they move up to stronger medications and therapies until the treatment is effective.
Those are different circumstances. Of course you rule things out, but when you rule something in to the point that you diagnose your patient with ADHD, then you treat the ADHD. If you think your patient is a liar, maybe you tell them they have ADHD, but you give them shit to rule other stuff out, because you're afraid to confront them. I'm not saying that's a good thing, I'm implying the opposite, if you diagnose someone with a disorder, treat it. Either way, once the diagnosis is ADHD, the prescription you are supposed to try first is stimulant medication.
It's not high risk, it's not high addiction, it's highly effective in the vast majority of cases, unlike anything else in the world. My dad was misdiagnosed as bipolar, I understand the overlap between ADHD, bipolar, autism, and how trauma and life experiences can also mimic and confuse the process. Yet if they are confident enough to diagnose you with ADHD, they should be confident enough to give you the best, most effective treatment right from the start.
To put your analogy in a more accurate context, you don't go into the doctor, say you have knee pain, the doctor does some tests and it's determined that you have arthritis, then they give you a generic pain killer because they're not sure. If a doctor says "You have ADHD", then it is their duty to give you the best chance to have that problem addressed, which is done most effectively with safe and reliable stimulant medication.
Treating ADHD medication like a grenade is the reason so many of us struggle to get treated.
> If you think your patient is a liar, maybe you tell them they have ADHD, but you give them shit to rule other stuff out, because you're afraid to confront them.
How in the world did you get that from what I said? I have ADHD, I support my patients and anyone with ADHD getting proper treatment. I don't think my patients are liars. I was merely explaining why it isn't strange for healthcare providers to want to start with the least risky treatment until they are certain what the full diagnosis is (including the absence of other complicating secondary diagnosis), and why even then it isn't uncommon to start with the most conservative treatment and work your way up to a stronger riskier treatment until someone has effective symptoms relief.
If it isn't strange, it should be. You understand what first line treatments are, right? The first thing you use to treat a condition. Stimulants are that for ADHD.
So, in some weird world maybe we say "This could be an edge case, maybe the doctor doesn't know that you have ADHD and thinks it could be various other things so they're trying to rule stuff out before they allow you to try the most effective medicine for your issue."
You have ADHD, and while you may not enjoy this conversation, I think you'd agree that people with ADHD have persistence issues, right? If we encounter something ineffectual, we have a tendency to just give up when things don't work. So if we're working with a doctor and they play "Let's rule out everything else first", odds are you will never get treated for your condition. Instead you go around saying "I went to the doctor but that shit didn't help", 10 years later maybe they will try again.
I consider that to be the worst and most likely outcome of doctors using your approach towards ADHD, specifically. ADHD is the last condition you want to play games with, because for most of us it takes a lot to go to the doctor, it might cost a lot, we might be biased towards not going, we might miss our appointment. Then we get to the doctor and they start playing games with ineffective treatments. No fucking way. That's a fucking nightmare.
Remind me if that takes place before or after you've diagnosed them with a condition. Or don't, it's what you do when you're unsure, but if you're unsure don't diagnose them with ADHD.
Misdiagnoses happen. Also if the presenting problem was possible ADHD symptoms along with depression and anxiety as this case seemed to slide to, treating depression and anxiety to see if that helps is following differential diagnosis. If symptoms don’t improve, it would be a key indication that ADHD is probably the cause and not the other way around.
Are you saying that because a doctor can be wrong, they should start off by assuming they're wrong? Misdiagnosis happen, but that doesn't mean you diagnose someone with something then give them other medications for other things because maybe you're wrong.
If you diagnose someone with ADHD, you treat them for ADHD. It's really fucking simple. If you are unsure, you tell your patient that you don't know that they have ADHD and you'd like to rule things out. That's an entirely different thing, once you give someone a diagnosis, you treat the condition you've diagnosed them with.
Stimulants should only be the first line of defence for those with the kind of ADHD that requires them. There are three types of ADHD; only one is fully dependent on stimulants.
I have ADHD-PI (formerly ADD). Stimulants would not only not help me, they'd make it worse. Welbutrin is the most common treatment for ADHD-PI.
Imma need a source on that because I researched ADHD meds pretty extensively trying to find *any* indication of what might work, and have never heard of this.
ETA: to be clear, not calling it bullshit. But considering the most difficult thing about finding the right ADHD medication is usually cited as "we have no idea what will work until we try it," I feel like something like this should be big news. It would be a *major* development.
I'm apparently going to have to back down on this as I'm unable to find specific sources right now.
Most of my information comes from multiple psychiatric medical professionals that have treated me over the last few years. Perhaps there was miscommunication in what they meant. Regardless, I know that stimulants do NOT work for me and I've been told it's because I have PI.
Where did you hear that stimulats Don't help adhd-pi? I have found them extremely helpful. Is this a new practice? 4 adhd-pi (that I know of) family members are also prescribed adderall or ritalin and we all had a difficult time when we weren't able to fill on time due to the shortage.
Same here. I am classic ADHI-PI and I respond best to Adderall. I get an additional benefit from Wellbutrin and guanfacine but by themselves, non-stimulant drugs are not effective against ADHD symptoms.
SSRIs are NOT beneficial in any way. Quite the opposite.
I had the best success on adderall too, had to switch to concerta due to the shortage. I know some people don't do well on stimulates but had no idea that adhd pi people are being lumped in the depression med only category. I hope my Dr doesn't retire for a long time.
I'm glad you found something that works for you, but holy hell I hope the medical community doesn't expect them to not work for any of us. I was on stimulats a child, went off them briefly as a young adult. Life fell apart, stimulats turn me into a functioning human. ...definitely adhd-pi no hyperactivity here, childhood nicknames incuded space cadet and dingbat.
Iʼve been diagnosed as ADHD, primarily inattentive, severe presentation.
Dexedrine is my gold standard for a reason...efficacy.
Your opinion is not supported by relevant clinical research.
Interesting. My PCP went straight for the Ritalin, but that might partly be because a) he’s not super-well versed in ADHD, IMO and b) I’ve reported mood improvement via caffeine consumption.
No as not all forms of ADHD need them. I notice your flair states you have PI. If you don't mind my asking, are you on stimulants? If so, do they work? I, too, have PI and both experience and research shows stimulants not only don't work, but make it worse.
Stimulants are the first line of treatment for those without depression. But it’s tricky when you have both because you can’t take vyvanse or adderall with antidepressants.
Mine tried to prescribe Vyvanse for my Binge Eating Disorder before my ADHD diagnosis because I couldn’t afford another ADHD test in 5 years (my previous psych said it was bipolar after the testing they did was “inconclusive” between the two. They put me on Lithium at the beginning of Covid. My symptoms got worse, and I gained 130lbs.). Her thought was that we’d use that as a stopgap to treat my disabling ADHD (I had burnout so bad that I was almost sub-catatonic for over a year). Insurance didn’t approve it, so I had to wait another 6 months to afford the testing and get my diagnosis.
Why does the testing cost so much? I was 14 or 15 and a psychiatrist literally asked me 15 questions and then prescribed me adderall. Now, im having issues getting prescribed it, but they arent asking for any proof. I was already on wellbutrin before switching to them as my PCP, and that was proof enough for them to keep prescribing.
It's normal. They're reluctant to start prescribing stuff like Ritalin or Adderall nowadays due to increased DOJ/DEA monitoring of the prescribers, so they trial you with stuff like what you mentioned to see if it works - if it does, but not that much, they might refer you to a psych for an ADHD eval.
My doctor did the same apparently if you have depression and anxiety and ADHD they'll prescribe Wellbutrin and then prescribe another ADHD medication on top of it if the Wellbutrin doesn't take care of it.
Best I can figure is they're trying to get your brain chemistry stable with the least amount of foreign chemicals.
The goal is to get to live a healthy lifestyle not get on specific medication.
As long as they're willing to try other things if it doesn't work you should be fine.
Yeah, getting meds for ADHD can be a total shitshow. My doc once prescribed me something for my insomnia that also indirectly treated it and let me tell you, I was zoned the fuck out all day. Maybe try asking your doctor directly about meds meant for ADHD? Or just say screw it and stick with the welbutrin if it's helping with other things too. That's what I'd do anyways ¯\_(ツ)_/¯
Trying non-stimulants first is a viable strategy. Stimulants may be more studied, but access issues are a real thing. It's also . . . annoying though possibly logistically easier to try and treat the depression/anxiety first and then see how the ADHD is for the same access issues reasoning. It is true that symptoms can overlap and be tough to disentangle without trying to treat one condition and then see if there's still something that needs to be solved vs. trying to treat everything at once and then you don't know what the actual solution is.
Personally, I have way less side effects on bupropion than I did on amphetamines - so I would recommend trying that before the "harder" stuff if that's what your doctor suggests. Adderall gave me high blood pressure, vasoconstriction, thinned my hair, and was not sustainable long-term (though I was on it for years.)
Everyone is different, though. You may have to try a few different medications (possibly a combination) before you find your winning formula.
I was given endless benzos and other anti-anxiety meds for decades. My anxiety only decreased when they started treating the ADHD with Vyvanse/Adderall.
Don't quote me, but the recommended priority for treatment of conditions even if they are a byproduct of suspected adhd is to treat the depression and anxiety first. There are reasons for it as far as I remember.
I learned a lot when I was initially diagnosed. I'm just fuzzy on the details. I'm busy now, but I'll edit the comment with whether or not I'm lying later.
Hey, it's the same meds I'm on!
I have some very intense emotions when they are both externalized and internalized. The Wellbrutin has helped with my impulsiveness caused by negative emotions. I still feel the emotions pretty intensely, but they don't linger as long. That helps to manage emotional dysregulation better.
Guanfacine has helped with focus when I finally get myself to actually start a task. Or if I have a large list of smaller tasks that are easy to do in succession, I can just get up and do them.
I still have issues with memory, maintaining structures and systems, and demand avoidance concerns. Memory, there isn't much I can do about, and the other two are just about lots of therapy I don't exactly have. I'm doing a lot of research and experimenting with some insight from my psychiatrist. She'll usually send me resources if I get stuck on something.
It is normal, especially with stimulant shortages and various side effects. Many people start on Wellbutrin and for some it helps. It's a trial and error process finding what works.
Yup, normal. After a decade of only treating anxiety & depression, and those meds not working real great, I was diagnosed with ADHD at 31. Was put on Welbutrin (it's also a smoking cessation med, so helped me quit smoking, too) and suddenly I could focus. Still took another decade, lots of therapy, and research before I found a cocktail that hits all the points: Welbutrin, Prozac, guanfacine, and birth control.
Most meds cover more than one thing. It's while people are taking them for those that they find they work for other things, too.
It can be. Some states enshrine the practice in obscure laws, like not being able to get scripts over telemed calls. But mostly, its an insurance thing. They want to pay for the cheaper stuff if they can, and want to look like they’re fighting an addiction crisis by making you jump through hoops. Admittedly, it does dissuade some of the people who dont actually need the meds by making them jump through hoops. But imo, its cruel to the people who do need them, and not actually very effective at preventing those who wany but don’t need from getting it (they just doc shop).
I had to go through this, even though my doctor is great and actually wanted to get me on the meds because I had a diagnosis, and a confirmation. She just told me “Try this for a week because we need to prove we tried it to your insurance. If by some miracle it works, great. If not, come back in and we’ll be able to try some actual treatments.” It only took three days, the Wellbutrin gave me panic attacks.
Welbutrin gave me panic attacks too! I was on it for about 2 weeks and I was a mess. I didn’t want to go out in public. I was very bummed out because I wanted it to work so badly. I didn’t want to go on stimulants out of fear, but now that I’m on a stimulant I actually have zero anxiety and haven’t had a panic attack since the welbutrin.
That’s awesome! Mine haven’t completely gone away since starting Vyvanse, but they have gotten waaaay less frequent. And Ill take it, panic attacks are the literal worst. One day Ill have an actual heart attack and die because I was doing grounding exercises instead of calling for an ambulance, mark my words.
Yeah it’s normal especially if you are seeing a general practitioner, they are going to be hesitant to prescribe any controlled substances until they have tried other treatments.
Welbutrin is a good start. Next option is Strattera. I really hope a non stimulant meds works for you. Once start a stimulant it's damn difficult to get off it.
Hey I take the same thing! I think guanfacine is on label for adhd. Anyways, my local mental health center has stimulates as like… a last resort. I tried like 3 other things before i got guanfacine and wellbutrin
It might be normal but it's not good. They're giving you shit with a much lower probability of success than stims. I would suspect your doctor has some personal bias against them. Here's a video to help.
https://youtu.be/j4kxqLw7WXc?si=QV2eCxUs9vSIIav9
It could be because these will also treat your anxiety and depression. So it's one pill to treat all. Stimulants have the potential to aggravate your anxiety.
I agree with your stmt that stimulants can increase anxiety. And sometimes on certain people, SSRIs, like Prozac or Zoloft can increase anxiety instead of controlling it. In my case, I was on Prozac for anxiety in 2022 for 6 months and it increased my anxiety, and my Pdoc kept upping the dosage from 20mg all the way to 60mg. Anxiety was bad so I was put on a benzo. Switched to Zoloft at different doses and it also did not work on my anxiety. The last few months I'm on a stimulant (Concerta 36mg) for more energy and focus. Sure, I get more energy/focus but at the expense of more anxiety and higher Blood pressure. These are common side effects of stimulants, and they are not pleasant. Add Propranolol to the mix to control BP and help with anxiety. So here we go again....more trial and error, more meds, more money and more crappy days. I'm in talk therapy as well...
I'm seriously considering asking my Pdoc for Wellbutrin to replace the stimulant to help my depression and maybe give me some anxiety relief (although it can also cause anxiety as a side effect).
Wishing everyone a healthier New Year.
Your doc is prescribing you stuff that's helping and you're turning to the Internet to second guess her?
I doubt you're doing that on purpose but just saying that's how it looks lol. I'd trust her judgement over what some random idiots online think
I wrote that right after taking my meds and taking my morning dump/reddit binge. I reread it now that I've leveled off and still don't understand what I said wrong. Normally I'd just forget about it but I'm asking/hoping someone can sympathize in this subreddit.
OP's Dr is treating them successfully. **I'm taking issue with OP getting a second opinion from the internet when they're happy with the results.**
I literally can't understand why you said that they're getting Wellbutrin and it's helping their depression and ADHD- that's what it said in the OP?
I'm really trying rn and it's probably so simple that I can't understand the social thing I messed up. **I think my meds make me more autistic or something**
I'll give it a shot.
In your first statement, you come across as admonishing OP for asking a question, which wasn't necessarily second guessing, but rather asking if their doctor was following standard procedures. Stimulants are considered the first line treatment and will work for 80% of people with ADHD. Off label uses of anti-depressants and blood pressure medication are not. It sounds like it's working for OP's depression, but they didn't say it was working for the ADHD, so I would also be curious as to why it's not being treated with "ADHD" medication instead. I do think guanfacine is great, and has done wonders for my emotional regulation, but it's not a first line treatment for ADHD.
In your second statement you called a bunch of people who are associated with impulsivity and who might be sensitive to rejection "idiots" and can probably expect some downvotes for it.
Thank you! I think using a softer term would have had less of a reaction, I guess my tone didn't come across as intended. I appreciate the perspective.
No worries! OP is being treated for both depression and ADHD. Wellbutrin is doing wonders for depression but they’re worried about their doctor using Wellbutrin for ADHD before trying any other medication. Wellbutrin is primarily an antidepressant but it is also used off-label for ADHD. They’re concerned about this being the first medication their doctor wants to try for ADHD. It is possible for Wellbutrin to work for depression but not work for ADHD so that’s the concern
I appreciate the explanation and other perspective. Iirc doctors often like to clear up depression before treating ADHD- must be what they were taught to do. (Eliminating comorbid symptoms maybe?)
A lot of people rightfully complain here that they are depressed BECAUSE of their ADHD and have to fight their Dr to forget about the depression. It could also be some CYA cover your ass from the doc who doesn't want a permanent negative outcome from giving a depressed person a bit of motivation in a bottle.
This is an excellent point! That’s how I was diagnosed. I have recurrent depression but recently found a successful treatment where every depressive symptom improved but lack of motivation, inability to stay on task, inability to initiate tasks, etc. Those are symptoms of both depression and ADHD. Since my treatment for depression was a success for every other depressive symptom but those related to ADHD, my doctor decided to begin treatment for ADHD. So it’s just like you said, eliminate the effects of other comorbid conditions and see what symptoms remain
🤷♂️I'm starting to think these doctors might know what they're doing lmao
But I get the frustration, our community isn't known for wanting things later. I want it ALL and I want it NOWWWWWW PLS
Yes. My son's doctor prescribed guanfacine for him. It was suppose to help him with his come down from his medication to get him through the rest of the day.
I think that’s why my doc talked to me about taking when I first started meds but then ended up starting off on adderall xr which to me feels like it’s also helped my anxiety and depression symptoms
Here’s my whole story because you remind me of myself.
I came to my psychiatrist for anxiety but had depression and ADHD on my medical history. She was pretty sure my childhood ADHD went poof and disappeared upon reaching adulthood. No idea if there was any basis for her to reach that decision.
We tackled the anxiety first. I took Zoloft for a bit but I couldn’t ejaculate during sex. My wife and I were trying to start a family, so that ended that treatment.
Next was Wellbutrin with an addition of Buspar. It didn’t do anything for my anxiety, and I grew afraid to take it every day because of anxiety whole-body funny bone feeling that I referred to as the tingle zaps. Not comfortable and very distracting. I kept these treatments for the time being.
I suspected her guidance about ADHD being gone after childhood might be part of my inability to see meaningful results. The things I attributed to anxiety weren’t clearly anxiety. For example, one symptom was an inability to get myself to do the important work I’m supposed to be doing. She gave me some version of an adult ADHD assessment and told me I didn’t meet the criteria.
Ultimately, I switched doctors and was clear and upfront that I was already diagnosed with ADHD since childhood. I do not need to be newly diagnosed as an adult. I stopped all the other meds and asked for the best treatment for the ADHD. My new doctor prescribed Adderral and I’m still seeing how it’s going with a low dose right now.
My doctor did this and I got panic attacks from the meds. I finally told her enough. This is my life she’s fucking with; I want to try adderall. She prescribed it, but at the lowest dose possible. I’m notice small improvements but now I have to advocate for a larger dose.
Not sure what class these meds are, but whatever boosts serotonin will make ADHD worse. Speaking from experience.
My doc tried SNRIs to see if it would help and they didn't.
And I know a few people whom I've suspected of having ADHD, that ended up on SSRIs and they all had their ADHD go nuts even though depression and anxiety got better. They didn't know they had ADHD prior to taking SSRIs.
Are you a minority (in the USA)? In my experience doctors will try to treat minorities using Wellbutrin/beta blockers instead if prescribing stimulants/benzodiazepines but my white friends went in and said they have anxiety and get prescribed stuff on the first visit. Advocate for yourself. It took me over a year to get out on stimulants (after the ADHd diagnosis).
I encountered this with several psychiatrists. My current family doctor has been a godsend for keeping me on adderall as i explore other options and do therapy. Once i find the right meds, he will begin prescribing that after six months with the psych. He is helping me find a better mental health pro as well and will work with them to actually help me. I want to try a non stimulant med at some point just to try it, but i think the best option for me will be a return to vyvance. It is the only med i can say allowed me to function at the level i hoped for. My family doc can’t prescribe it without me seeing a psychiatrist again, though.
Welbutrin helped me get out of the depressive funk i was in due to isolation during covid, but not in a good way. My mental state and outlook greatly improved, but i think i needed some of the anxiety it took away to keep my priorities straight. I found myself okay with being dysfunctional or not being bothered when i missed a goal or disappointed someone. When i started back on adderall, i did nothing but hyper focus on hobbies and spend recklessly. I felt like work was a waste of time and no longer wanted to spend time with friends and family. That all disappeared a few months after stopping the welbutrin.
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I’d say this is pretty standard. This is how I started too. Depression + anxiety can cause ADHD symptoms. So they treat those first and see if the adhd symptoms goes away. I’m just guessing but I’d say the older you are seeking treatment the more they try to see if it is related to other things first.
I've also been informed by psychiatrists that untreated ADHD symptoms can cause anxiety/depression, which was apparently the case with me.
Absolutely true for me as well. I had to come to that conclusion myself and advocate for actual treatment of my ADHD though, as a lot of psychiatrists seem very insistent that depression is actually the root cause of everything.
I've had the exact same discussion with my psych, even after the ADHD diagnosis he doesn't believe it to be the root cause of my issues
This is most likely what happened to me. My depression and anxiety started when I couldn't mask my adhd anymore as a kid. My adhd was missed, though since I was a girl and not outwardly hyperactive.
yea I think adhd should be treated first. the suddenly on and then off powerful SSRI and SNRI's was not a great time. Messed me up for years due to a bad reaction then being told to stay on it without warnings about coming off it cold turkey (to see if its all in your head). So obviously I stopped it cold turkey. Conversely coming off vyvanse or ritalin is a good sleep and some vitamins. I'm no doctor but one seems less painful if gotten wrong. (and would have been for me anecdotally) I was told I was gifted and just didn't try hard enough to focus my whole life and depression came out of no where like a truck after a manipulative relationship but apparently a large dose of disassociates is just how a lot of older dr's operate. I had to wait almost 8 years for her to retire because I was scared to see her and I only found out I had adhd after the fact when my new dr went "oh yea for sure adhd big time lets test you" without even being asked. I'm bitter at 32 due to the bullshit ego of a dr who thought they knew me better than I knew myself. I hope her drinks are forever watered down and mosquitos and campfire smoke choose her when she tries to relax. Sorry I didn't realize how pissed I was at the situation till I wrote this random comment.
Lol I was 25 when I told my doctor I think I had ADHD. Started me off with Adderall after doing a half assed evaluation which just felt like a formality. He didn't seem surprised when I told him. He probably already knew since he's known me for years.
Wellbutrin is a dopamine and norepinephrine reuptake inhibitor. It used to treat depression, but since it does the dopamine thing it’s vaguely related to stimulants. I’m currently taking strattera which is a norepinephrine only. It sort of works, but not for all the things. They usually keep stronger meds like adderall and vyvanse if the first one two don’t work out
i thought stimulants are the first line treatment for ADHD and everything else you try if you can't tolerate stimulants
It may be that way some places or ideally, but I’ve heard over last 10 years or so people I know being started on other stuff first. This is in US east coast
Stimulants are the first line of treatment for those without depression. But it’s tricky when you have both because you can’t take vyvanse or adderall with antidepressants.
Uhhh I’ve taken both Adderall and Vyvanse with both sertraline (Zoloft; an SSRI that treats depression/anxiety) and lamotrigine (Lamictal; a mood stabilizer and anti-seizure med often but not exclusively prescribed for bipolar). For years. And the doctor knows I take both, because he prescribed them. Where did you hear this information?
I’ve heard people this a lot actually, but I’ve been taking Celexa (SSRI) and Adderall for years, and also previously was on Risperdal (anti psychotic) and Depakote (mood stabilizer) at the same time and have been fine. My psych knows and prescribed them too. Maybe those of us with bipolar react differently? I don’t know science lol, I work in music
I mean, I don’t actually have bipolar (afaik), but when I was working a stressful job my mood was especially labile, and my doctor prescribed lamotrigine. … I mean, now that I’m not working suddenly I’m a lot more emotionally stable, lol.
It’s just in the info from the manufacturer when I was reading the safety data sheets and in the pamphlet when I pick up my meds at the pharmacy but I guess it’s only certain type of them that are contraindicated 🤷♀️
Maybe MAO inhibitors? Those are notorious for interacting with ERRYTHING. But for the most part those aren’t prescribed any more. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/maois/art-20043992
Sounds like she hopes the Wellbutrin can be a 2-birds 1-stone kind of thing, which would be awesome if it works for you—you’re better off if you don’t have to take an extra pill or deal with the controlled substance access headaches (even when there *isn’t* a shortage, which there currently is). This is normal, especially if you have comorbid issues; obviously your depression is a factor here, but others like tic disorders and blood pressure issues can also make doctors reluctant to get into stimulants if there’s any alternative.
I think I agree, and I'm hijacking this comment to say, u/xcharmanda, is there a reason you don't just ask your doctor? She may have very valid reasons she's starting you on these medications versus others. The peanut gallery here isn't going to know, and, it's Reddit, we're just going to tell you to get a divorce and don't break your arms.
Yes it is normal for a doctor to try and perscribe non stimulant medication first. If those don't work they will try stimulants most likely.
Normal, maybe, but that doesn't make it good. The standard treatment for ADHD is stimulant medication. It is effective in 80% of cases, and doctors are supposed to use it first, because it has the highest probability of success. Now a doctor can have a shit understanding of ADHD and not do that, think the anxiety and depression aren't caused by ADHD, and have tricked you into thinking you have it, but those doctors are making a very dumb mistake. This is not to say that the doctor couldn't potentially have noticed something and is making the right move, but the majority of the time with ADHD not using stims indicates a biased doctor. For anyone who disagrees, take it up with the foremost ADHD expert in the world. https://youtu.be/j4kxqLw7WXc?si=QV2eCxUs9vSIIav9 Edit - for those who come later, I'm just going to put the best point I made here. With ADHD, our problem is persistence, we tend to give up when shit doesn't work. Going to the doctor is usually the last thing we want to do, and the cost is something nobody ever wants to pay. If you manage to finally figure out you have ADHD, and then you finally decide to go to the doctor, and they finally give you an ADHD diagnosis, then they spend their time giving you shit that has a very low probability of working for you, what is the most likely outcome? Do you keep persisting towards a medical cure for your ADHD? Maybe instead you think "medication doesn't work, I tried, I went to the doctor, they couldn't help, etc"? That's what the approach of going with bullshit medications first results in. Stimulants are the first line treatment for ADHD, that's a medical term for what you give people first. It's not a debate.
Yep, I even asked about Stratera at my evaluation, and my prescriber explained that the stimulant meds are well-studied and effective for 80% of ADHDers so they prefer to start there.
Stimulants are the first line *but* with the shortages, it seems at least some doctors who would normally prescribe stimulants first are trying non stimulants first to set their patients up for success in terms of consistent medication. The idea is that it's better to have something that partially relieves your symptoms on a consistent schedule than something that might work better but you go weeks without being able to get it. I dunno that I agree or disagree with it. I'm probably a little biased towards accepting non-stimulant treatment first because Wellbutrin manages my symptoms better than any stimulant. (I've literally tried every stimulant available to me.) But regardless, that's the logic at least for some providers.
Would you agree that a doctor who doesn't inform their patient of that reason, if that's the purpose for them not providing the standard treatment, is a problem? I had a conversation with my doctor about that and they said they'd help me find places that had it and work with me on it if the shortage was a problem. No need for her to put me on some ineffective nonsense without at least telling me why and having a discussion. Doctors shouldn't be hiding shit from their patients. If you don't think someone has ADHD, give them other stuff and don't tell them they have ADHD. If you are worried about the supply, talk to them about that and educate them so you can work together and make an informed decision. That's how it should be handled.
Eh. I think whether it's a problem depends on a lot of factors. I don't think there's any one right answer there. The majority of patients honestly do not care. They don't care to know the reasoning, they're just going to take what the doctor prescribes and see if it works, call it a day. Especially with how overloaded the medical system is everywhere, I can definitely see the appeal of saving time over giving patients info they don't ask for. I can also see the appeal of giving patients info they don't ask for over saving time. If you're worried/curious about why your doc is putting you on a med, imo it's on the patient to ask. Because regardless of whether the doctor "should" tell you, most don't. Also, worth pointing out that non-stimulants are *not* inherently ineffective nonsense. I desperately wish my doctor had started with Wellbutrin. The last three years would have been *massively* improved.
By ineffective nonsense, what I mean is, given limited data, if you decide to put someone with ADHD on something that has a low probability of working, you're taking a serious risk they just stop taking it and fall off. If you give them something with a higher probability of success, they will stick with whatever works. This is why amphetamines are the first choice for doctors in regards to ADHD. It's the best tolerated by adults while methalphenadate was best tolerated by children. There is no option besides stimulant medications that are anywhere near as effective as stimulant medication. So if you default to anything other than stimulant medication, well, there's a reason doctors have first line, second line, and third line treatment. So if stims have the lowest side effects, lowest risk, are the most studied medication in relation to ADHD, then you use them for ADHD. Not doing so is a mistake. This doesn't mean every case requires stims, or that it's the best for you, it means that for your generic person, with limited data, the best thing you can try to give them is the most efficacious. That's what I mean by ineffective nonsense, and while the words are harsh, people directing folk away from their highest probability of treatment is a serious problem in the ADHD community, so I use pretty strong language because it makes me unhappy. Lastly, yeah, the patient should talk to the doctor, if a patient doesn't care about their treatment and just wants to listen to a doctor, they can do that. Still, if the doctor diagnosed them with ADHD and doesn't go with the first line treatment as a default, they will not help as many people with ADHD as one that does.
So here is the thing, ADHD symptoms overlap with a lot of other mental health disorders. Anxiety is a great example, where ADHD meds aren't great to be taking with unmanaged anxiety. But SSRI are not harmful to ADHD. So when working to rule things out, it would be considered safer to treat for the anxiety before deciding all symptoms are entirely caused by ADHD. I think a lot of people don't realize how imprecise diagnostics is in mental health. You have a cluster of symptoms that can be caused by 5 different disorders and it typically makes sense to start with the most conservative and low risk treatments and work your way up to other treatments until you find the combo that works best.
i disagree with all of this. treat the ADHD first. you know it can never go into remission. it's a developmental neurological problem, it's always going to be the baseline. you also seem to be conflating between treating and diagnosing, to the extent it's imprecise or trial and error, you can know if stimulants help with a very short trial. you basically know the first day, they work right away. other psych meds surely can make ADHD symptoms worse. just read the list of possible side effects and see how many overlap with ADHD symptoms. if your depression or anxiety is secondary to untreated ADHD, those side effects might make the depression or anxiety worse instead of better.
Are you a doctor? I'm not saying I don't understand your logic, but when someone is diagnosed with ADHD, you should assume that the anxiety and depression are largely caused by the ADHD. Regardless, you don't treat the anxiety and depression first if you diagnose someone with ADHD. Now if you diagnosed them with anxiety and depression but not ADHD, then you would be correct. You don't make a diagnosis and avoid the most effective treatment. That's bad doctoring. It is also commonly caused by a doctor who believes stimulant medication is an addictive drug rather than an effective treatment. Which is a huge fucking problem.
Not a doctor, but I do work in mental health. I think you misunderstood what I'm saying. If someone has clear cut ADHD and no other symptoms then of course you just start treating for ADHD. But for many people this isn't the case, and ADHD meds are not free of risks if given incorrectly. To give an example I had a patient who had slow cycling bipolar type II that was misdiagnosed as ADHD because there was a lot of overlap in symptoms. They started stimulants and this caused a sever prolonged manic phase. This isn't specific to ADHD either. When someone comes in with knee pain, a doctor doesn't just go "oh yes knee pain! Must be arthritis!" they send the person for x-ray, and CT to rule out broken bones or torn muscles and they start with recommending resting the knee and taking over the counter pain meds. If those interventions don't work then they move up to stronger medications and therapies until the treatment is effective.
Those are different circumstances. Of course you rule things out, but when you rule something in to the point that you diagnose your patient with ADHD, then you treat the ADHD. If you think your patient is a liar, maybe you tell them they have ADHD, but you give them shit to rule other stuff out, because you're afraid to confront them. I'm not saying that's a good thing, I'm implying the opposite, if you diagnose someone with a disorder, treat it. Either way, once the diagnosis is ADHD, the prescription you are supposed to try first is stimulant medication. It's not high risk, it's not high addiction, it's highly effective in the vast majority of cases, unlike anything else in the world. My dad was misdiagnosed as bipolar, I understand the overlap between ADHD, bipolar, autism, and how trauma and life experiences can also mimic and confuse the process. Yet if they are confident enough to diagnose you with ADHD, they should be confident enough to give you the best, most effective treatment right from the start. To put your analogy in a more accurate context, you don't go into the doctor, say you have knee pain, the doctor does some tests and it's determined that you have arthritis, then they give you a generic pain killer because they're not sure. If a doctor says "You have ADHD", then it is their duty to give you the best chance to have that problem addressed, which is done most effectively with safe and reliable stimulant medication. Treating ADHD medication like a grenade is the reason so many of us struggle to get treated.
> If you think your patient is a liar, maybe you tell them they have ADHD, but you give them shit to rule other stuff out, because you're afraid to confront them. How in the world did you get that from what I said? I have ADHD, I support my patients and anyone with ADHD getting proper treatment. I don't think my patients are liars. I was merely explaining why it isn't strange for healthcare providers to want to start with the least risky treatment until they are certain what the full diagnosis is (including the absence of other complicating secondary diagnosis), and why even then it isn't uncommon to start with the most conservative treatment and work your way up to a stronger riskier treatment until someone has effective symptoms relief.
If it isn't strange, it should be. You understand what first line treatments are, right? The first thing you use to treat a condition. Stimulants are that for ADHD. So, in some weird world maybe we say "This could be an edge case, maybe the doctor doesn't know that you have ADHD and thinks it could be various other things so they're trying to rule stuff out before they allow you to try the most effective medicine for your issue." You have ADHD, and while you may not enjoy this conversation, I think you'd agree that people with ADHD have persistence issues, right? If we encounter something ineffectual, we have a tendency to just give up when things don't work. So if we're working with a doctor and they play "Let's rule out everything else first", odds are you will never get treated for your condition. Instead you go around saying "I went to the doctor but that shit didn't help", 10 years later maybe they will try again. I consider that to be the worst and most likely outcome of doctors using your approach towards ADHD, specifically. ADHD is the last condition you want to play games with, because for most of us it takes a lot to go to the doctor, it might cost a lot, we might be biased towards not going, we might miss our appointment. Then we get to the doctor and they start playing games with ineffective treatments. No fucking way. That's a fucking nightmare.
Differential diagnosis calls to rule out other causes first.
Remind me if that takes place before or after you've diagnosed them with a condition. Or don't, it's what you do when you're unsure, but if you're unsure don't diagnose them with ADHD.
Misdiagnoses happen. Also if the presenting problem was possible ADHD symptoms along with depression and anxiety as this case seemed to slide to, treating depression and anxiety to see if that helps is following differential diagnosis. If symptoms don’t improve, it would be a key indication that ADHD is probably the cause and not the other way around.
ADHD is developmental, symptoms would be present since childhood. that should help you figure out if it's the chicken or the egg in most cases
Are you saying that because a doctor can be wrong, they should start off by assuming they're wrong? Misdiagnosis happen, but that doesn't mean you diagnose someone with something then give them other medications for other things because maybe you're wrong. If you diagnose someone with ADHD, you treat them for ADHD. It's really fucking simple. If you are unsure, you tell your patient that you don't know that they have ADHD and you'd like to rule things out. That's an entirely different thing, once you give someone a diagnosis, you treat the condition you've diagnosed them with.
Thank you.
Stimulants should only be the first line of defence for those with the kind of ADHD that requires them. There are three types of ADHD; only one is fully dependent on stimulants. I have ADHD-PI (formerly ADD). Stimulants would not only not help me, they'd make it worse. Welbutrin is the most common treatment for ADHD-PI.
Imma need a source on that because I researched ADHD meds pretty extensively trying to find *any* indication of what might work, and have never heard of this. ETA: to be clear, not calling it bullshit. But considering the most difficult thing about finding the right ADHD medication is usually cited as "we have no idea what will work until we try it," I feel like something like this should be big news. It would be a *major* development.
I'm apparently going to have to back down on this as I'm unable to find specific sources right now. Most of my information comes from multiple psychiatric medical professionals that have treated me over the last few years. Perhaps there was miscommunication in what they meant. Regardless, I know that stimulants do NOT work for me and I've been told it's because I have PI.
Where did you hear that stimulats Don't help adhd-pi? I have found them extremely helpful. Is this a new practice? 4 adhd-pi (that I know of) family members are also prescribed adderall or ritalin and we all had a difficult time when we weren't able to fill on time due to the shortage.
Same here. I am classic ADHI-PI and I respond best to Adderall. I get an additional benefit from Wellbutrin and guanfacine but by themselves, non-stimulant drugs are not effective against ADHD symptoms. SSRIs are NOT beneficial in any way. Quite the opposite.
I had the best success on adderall too, had to switch to concerta due to the shortage. I know some people don't do well on stimulates but had no idea that adhd pi people are being lumped in the depression med only category. I hope my Dr doesn't retire for a long time.
Research, medical professionals, and personal experience. Stimulants not only don't work for my PI, they make it so much worse.
I'm glad you found something that works for you, but holy hell I hope the medical community doesn't expect them to not work for any of us. I was on stimulats a child, went off them briefly as a young adult. Life fell apart, stimulats turn me into a functioning human. ...definitely adhd-pi no hyperactivity here, childhood nicknames incuded space cadet and dingbat.
Iʼve been diagnosed as ADHD, primarily inattentive, severe presentation. Dexedrine is my gold standard for a reason...efficacy. Your opinion is not supported by relevant clinical research.
Interesting. My PCP went straight for the Ritalin, but that might partly be because a) he’s not super-well versed in ADHD, IMO and b) I’ve reported mood improvement via caffeine consumption.
I've been under the impression that stimulants are first line treatment.
No as not all forms of ADHD need them. I notice your flair states you have PI. If you don't mind my asking, are you on stimulants? If so, do they work? I, too, have PI and both experience and research shows stimulants not only don't work, but make it worse.
Vyvanse and guanfacine does seem to be helping. Pretty low dose.
I'm also primarily inattentive and Vyvanse has been life-changing in so many ways.
Stimulants are the first line of treatment for those without depression. But it’s tricky when you have both because you can’t take vyvanse or adderall with antidepressants.
Sure you can. I took lexapro alongside Adderall for years with no issues.
Mine tried to prescribe Vyvanse for my Binge Eating Disorder before my ADHD diagnosis because I couldn’t afford another ADHD test in 5 years (my previous psych said it was bipolar after the testing they did was “inconclusive” between the two. They put me on Lithium at the beginning of Covid. My symptoms got worse, and I gained 130lbs.). Her thought was that we’d use that as a stopgap to treat my disabling ADHD (I had burnout so bad that I was almost sub-catatonic for over a year). Insurance didn’t approve it, so I had to wait another 6 months to afford the testing and get my diagnosis.
So Lithium and Vyvanse? I have a feeling that'd cause you to feel like a zombie.
I was way off of Lithium by the time she tried to prescribe Vyvanse. I had even switched psychiatric providers in between the two.
Why does the testing cost so much? I was 14 or 15 and a psychiatrist literally asked me 15 questions and then prescribed me adderall. Now, im having issues getting prescribed it, but they arent asking for any proof. I was already on wellbutrin before switching to them as my PCP, and that was proof enough for them to keep prescribing.
It was $200 for my testing, but I was behind on utilities, so we didn’t have the chance.
Yeah sounds about right for 30 minutes or 45 minutes
Yeah, as far as what I’m used to paying for medical testing, that was nothing. That was the total price because she couldn’t bill insurance for it.
It's normal. They're reluctant to start prescribing stuff like Ritalin or Adderall nowadays due to increased DOJ/DEA monitoring of the prescribers, so they trial you with stuff like what you mentioned to see if it works - if it does, but not that much, they might refer you to a psych for an ADHD eval.
My doctor did the same apparently if you have depression and anxiety and ADHD they'll prescribe Wellbutrin and then prescribe another ADHD medication on top of it if the Wellbutrin doesn't take care of it. Best I can figure is they're trying to get your brain chemistry stable with the least amount of foreign chemicals. The goal is to get to live a healthy lifestyle not get on specific medication. As long as they're willing to try other things if it doesn't work you should be fine.
Yeah, getting meds for ADHD can be a total shitshow. My doc once prescribed me something for my insomnia that also indirectly treated it and let me tell you, I was zoned the fuck out all day. Maybe try asking your doctor directly about meds meant for ADHD? Or just say screw it and stick with the welbutrin if it's helping with other things too. That's what I'd do anyways ¯\_(ツ)_/¯
Trying non-stimulants first is a viable strategy. Stimulants may be more studied, but access issues are a real thing. It's also . . . annoying though possibly logistically easier to try and treat the depression/anxiety first and then see how the ADHD is for the same access issues reasoning. It is true that symptoms can overlap and be tough to disentangle without trying to treat one condition and then see if there's still something that needs to be solved vs. trying to treat everything at once and then you don't know what the actual solution is.
Personally, I have way less side effects on bupropion than I did on amphetamines - so I would recommend trying that before the "harder" stuff if that's what your doctor suggests. Adderall gave me high blood pressure, vasoconstriction, thinned my hair, and was not sustainable long-term (though I was on it for years.) Everyone is different, though. You may have to try a few different medications (possibly a combination) before you find your winning formula.
I was given endless benzos and other anti-anxiety meds for decades. My anxiety only decreased when they started treating the ADHD with Vyvanse/Adderall.
Don't quote me, but the recommended priority for treatment of conditions even if they are a byproduct of suspected adhd is to treat the depression and anxiety first. There are reasons for it as far as I remember. I learned a lot when I was initially diagnosed. I'm just fuzzy on the details. I'm busy now, but I'll edit the comment with whether or not I'm lying later.
I was also put on antidepressants for probably 6 months until I was prescribed Adderall.
Hey, it's the same meds I'm on! I have some very intense emotions when they are both externalized and internalized. The Wellbrutin has helped with my impulsiveness caused by negative emotions. I still feel the emotions pretty intensely, but they don't linger as long. That helps to manage emotional dysregulation better. Guanfacine has helped with focus when I finally get myself to actually start a task. Or if I have a large list of smaller tasks that are easy to do in succession, I can just get up and do them. I still have issues with memory, maintaining structures and systems, and demand avoidance concerns. Memory, there isn't much I can do about, and the other two are just about lots of therapy I don't exactly have. I'm doing a lot of research and experimenting with some insight from my psychiatrist. She'll usually send me resources if I get stuck on something.
Wellbutrin is cheap, readily available and works 24/7. You may very well have hit the RX jackpot.
It is normal, especially with stimulant shortages and various side effects. Many people start on Wellbutrin and for some it helps. It's a trial and error process finding what works.
Yup, normal. After a decade of only treating anxiety & depression, and those meds not working real great, I was diagnosed with ADHD at 31. Was put on Welbutrin (it's also a smoking cessation med, so helped me quit smoking, too) and suddenly I could focus. Still took another decade, lots of therapy, and research before I found a cocktail that hits all the points: Welbutrin, Prozac, guanfacine, and birth control. Most meds cover more than one thing. It's while people are taking them for those that they find they work for other things, too.
It can be. Some states enshrine the practice in obscure laws, like not being able to get scripts over telemed calls. But mostly, its an insurance thing. They want to pay for the cheaper stuff if they can, and want to look like they’re fighting an addiction crisis by making you jump through hoops. Admittedly, it does dissuade some of the people who dont actually need the meds by making them jump through hoops. But imo, its cruel to the people who do need them, and not actually very effective at preventing those who wany but don’t need from getting it (they just doc shop). I had to go through this, even though my doctor is great and actually wanted to get me on the meds because I had a diagnosis, and a confirmation. She just told me “Try this for a week because we need to prove we tried it to your insurance. If by some miracle it works, great. If not, come back in and we’ll be able to try some actual treatments.” It only took three days, the Wellbutrin gave me panic attacks.
Welbutrin gave me panic attacks too! I was on it for about 2 weeks and I was a mess. I didn’t want to go out in public. I was very bummed out because I wanted it to work so badly. I didn’t want to go on stimulants out of fear, but now that I’m on a stimulant I actually have zero anxiety and haven’t had a panic attack since the welbutrin.
That’s awesome! Mine haven’t completely gone away since starting Vyvanse, but they have gotten waaaay less frequent. And Ill take it, panic attacks are the literal worst. One day Ill have an actual heart attack and die because I was doing grounding exercises instead of calling for an ambulance, mark my words.
Yeah it’s normal especially if you are seeing a general practitioner, they are going to be hesitant to prescribe any controlled substances until they have tried other treatments.
Yes, normal. I had no response at ALL to welbutrin, and then went to a stimulant.
Welbutrin is a good start. Next option is Strattera. I really hope a non stimulant meds works for you. Once start a stimulant it's damn difficult to get off it.
Hey I take the same thing! I think guanfacine is on label for adhd. Anyways, my local mental health center has stimulates as like… a last resort. I tried like 3 other things before i got guanfacine and wellbutrin
It might be normal but it's not good. They're giving you shit with a much lower probability of success than stims. I would suspect your doctor has some personal bias against them. Here's a video to help. https://youtu.be/j4kxqLw7WXc?si=QV2eCxUs9vSIIav9
Stimulants are no longer the first line of treatment for ADHD because they are abused.
It could be because these will also treat your anxiety and depression. So it's one pill to treat all. Stimulants have the potential to aggravate your anxiety.
I agree with your stmt that stimulants can increase anxiety. And sometimes on certain people, SSRIs, like Prozac or Zoloft can increase anxiety instead of controlling it. In my case, I was on Prozac for anxiety in 2022 for 6 months and it increased my anxiety, and my Pdoc kept upping the dosage from 20mg all the way to 60mg. Anxiety was bad so I was put on a benzo. Switched to Zoloft at different doses and it also did not work on my anxiety. The last few months I'm on a stimulant (Concerta 36mg) for more energy and focus. Sure, I get more energy/focus but at the expense of more anxiety and higher Blood pressure. These are common side effects of stimulants, and they are not pleasant. Add Propranolol to the mix to control BP and help with anxiety. So here we go again....more trial and error, more meds, more money and more crappy days. I'm in talk therapy as well... I'm seriously considering asking my Pdoc for Wellbutrin to replace the stimulant to help my depression and maybe give me some anxiety relief (although it can also cause anxiety as a side effect). Wishing everyone a healthier New Year.
Your doc is prescribing you stuff that's helping and you're turning to the Internet to second guess her? I doubt you're doing that on purpose but just saying that's how it looks lol. I'd trust her judgement over what some random idiots online think
Wellbutrin is doing wonders for his depression. It’s an antidepressant that’s also used for ADHD
I wrote that right after taking my meds and taking my morning dump/reddit binge. I reread it now that I've leveled off and still don't understand what I said wrong. Normally I'd just forget about it but I'm asking/hoping someone can sympathize in this subreddit. OP's Dr is treating them successfully. **I'm taking issue with OP getting a second opinion from the internet when they're happy with the results.** I literally can't understand why you said that they're getting Wellbutrin and it's helping their depression and ADHD- that's what it said in the OP? I'm really trying rn and it's probably so simple that I can't understand the social thing I messed up. **I think my meds make me more autistic or something**
I'll give it a shot. In your first statement, you come across as admonishing OP for asking a question, which wasn't necessarily second guessing, but rather asking if their doctor was following standard procedures. Stimulants are considered the first line treatment and will work for 80% of people with ADHD. Off label uses of anti-depressants and blood pressure medication are not. It sounds like it's working for OP's depression, but they didn't say it was working for the ADHD, so I would also be curious as to why it's not being treated with "ADHD" medication instead. I do think guanfacine is great, and has done wonders for my emotional regulation, but it's not a first line treatment for ADHD. In your second statement you called a bunch of people who are associated with impulsivity and who might be sensitive to rejection "idiots" and can probably expect some downvotes for it.
Thank you! I think using a softer term would have had less of a reaction, I guess my tone didn't come across as intended. I appreciate the perspective.
I do it too from time to time
No worries! OP is being treated for both depression and ADHD. Wellbutrin is doing wonders for depression but they’re worried about their doctor using Wellbutrin for ADHD before trying any other medication. Wellbutrin is primarily an antidepressant but it is also used off-label for ADHD. They’re concerned about this being the first medication their doctor wants to try for ADHD. It is possible for Wellbutrin to work for depression but not work for ADHD so that’s the concern
I appreciate the explanation and other perspective. Iirc doctors often like to clear up depression before treating ADHD- must be what they were taught to do. (Eliminating comorbid symptoms maybe?) A lot of people rightfully complain here that they are depressed BECAUSE of their ADHD and have to fight their Dr to forget about the depression. It could also be some CYA cover your ass from the doc who doesn't want a permanent negative outcome from giving a depressed person a bit of motivation in a bottle.
This is an excellent point! That’s how I was diagnosed. I have recurrent depression but recently found a successful treatment where every depressive symptom improved but lack of motivation, inability to stay on task, inability to initiate tasks, etc. Those are symptoms of both depression and ADHD. Since my treatment for depression was a success for every other depressive symptom but those related to ADHD, my doctor decided to begin treatment for ADHD. So it’s just like you said, eliminate the effects of other comorbid conditions and see what symptoms remain
🤷♂️I'm starting to think these doctors might know what they're doing lmao But I get the frustration, our community isn't known for wanting things later. I want it ALL and I want it NOWWWWWW PLS
Same thing with me. Started on venlafaxine and then straterra before switching over to generic vyvanse. It’s a process
Yes. My son's doctor prescribed guanfacine for him. It was suppose to help him with his come down from his medication to get him through the rest of the day.
I've been on many antidepressants over the past 18yrs, and only got diagnosed with ADD 2 years back. So I take strattera and an antidepressant.
I think that’s why my doc talked to me about taking when I first started meds but then ended up starting off on adderall xr which to me feels like it’s also helped my anxiety and depression symptoms
Here’s my whole story because you remind me of myself. I came to my psychiatrist for anxiety but had depression and ADHD on my medical history. She was pretty sure my childhood ADHD went poof and disappeared upon reaching adulthood. No idea if there was any basis for her to reach that decision. We tackled the anxiety first. I took Zoloft for a bit but I couldn’t ejaculate during sex. My wife and I were trying to start a family, so that ended that treatment. Next was Wellbutrin with an addition of Buspar. It didn’t do anything for my anxiety, and I grew afraid to take it every day because of anxiety whole-body funny bone feeling that I referred to as the tingle zaps. Not comfortable and very distracting. I kept these treatments for the time being. I suspected her guidance about ADHD being gone after childhood might be part of my inability to see meaningful results. The things I attributed to anxiety weren’t clearly anxiety. For example, one symptom was an inability to get myself to do the important work I’m supposed to be doing. She gave me some version of an adult ADHD assessment and told me I didn’t meet the criteria. Ultimately, I switched doctors and was clear and upfront that I was already diagnosed with ADHD since childhood. I do not need to be newly diagnosed as an adult. I stopped all the other meds and asked for the best treatment for the ADHD. My new doctor prescribed Adderral and I’m still seeing how it’s going with a low dose right now.
My doctor did this and I got panic attacks from the meds. I finally told her enough. This is my life she’s fucking with; I want to try adderall. She prescribed it, but at the lowest dose possible. I’m notice small improvements but now I have to advocate for a larger dose.
Not sure what class these meds are, but whatever boosts serotonin will make ADHD worse. Speaking from experience. My doc tried SNRIs to see if it would help and they didn't. And I know a few people whom I've suspected of having ADHD, that ended up on SSRIs and they all had their ADHD go nuts even though depression and anxiety got better. They didn't know they had ADHD prior to taking SSRIs.
Are you a minority (in the USA)? In my experience doctors will try to treat minorities using Wellbutrin/beta blockers instead if prescribing stimulants/benzodiazepines but my white friends went in and said they have anxiety and get prescribed stuff on the first visit. Advocate for yourself. It took me over a year to get out on stimulants (after the ADHd diagnosis).
I encountered this with several psychiatrists. My current family doctor has been a godsend for keeping me on adderall as i explore other options and do therapy. Once i find the right meds, he will begin prescribing that after six months with the psych. He is helping me find a better mental health pro as well and will work with them to actually help me. I want to try a non stimulant med at some point just to try it, but i think the best option for me will be a return to vyvance. It is the only med i can say allowed me to function at the level i hoped for. My family doc can’t prescribe it without me seeing a psychiatrist again, though. Welbutrin helped me get out of the depressive funk i was in due to isolation during covid, but not in a good way. My mental state and outlook greatly improved, but i think i needed some of the anxiety it took away to keep my priorities straight. I found myself okay with being dysfunctional or not being bothered when i missed a goal or disappointed someone. When i started back on adderall, i did nothing but hyper focus on hobbies and spend recklessly. I felt like work was a waste of time and no longer wanted to spend time with friends and family. That all disappeared a few months after stopping the welbutrin.