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Seeing a psychiatrist today...any tips?

This will be my first appointment. Is there anything I should be aware of?

Replies

Just be completely honest.  If you don’t feel comfortable or just don’t get a good vibe, go to another one.

Posted by pattyklaver on Sep 03, 2013 at 5:39pm

I agree with pattyklaver…be honest so your doctor can give you the best they can for your situation.  It’s okay to move on (to another doctor) if you feel you’re not going to be able to form a partnership with your doctor.

Good luck!

Posted by csiagent32 on Sep 03, 2013 at 8:55pm

The meeting went well, very understanding. She is very big on Ritalin over concerta and has been helping add people since the 70s. I got a very positive vibe. Here is hoping for a better future!

Posted by Newlife on Sep 03, 2013 at 9:01pm

Be aware that not everyone responds to the same drug the same way. What works for you may not work as well for someone else. I’m a bit wary that this doctor may not be aware of the efficacy and safety profile of other products that have come to market since Ritalin. Other patients may experience certain side effects but you may not.
Also be aware that you may have some initial side effects (increased irritability, nausea, dizziness) among others) that may/may not go away after your body acclimates.  Talk to your doctor about the more common side effects and what the expectation is for adverse events and their resolution, if any.
Always report any side effect, related to the drug or not, to your doctor, as soon as possible, as he/she has to report it to MedWatch, even if it is a known adverse event (AE).  Personally I don’t believe all doctors report these AEs to MedWatch, especially if they are “known” AEs. That is not the point. The point is to collect data on the prevalence/frequency of the AEs - especially the Serious Adverse Events (SAEs). 
MedWatch is a database to track drugs and their adverse events and possible incompatibility with other drugs that you may be taking.  You may also report an adverse event with MedWatch or the drug manufacturer directly who then has to report this data to the FDA. You are not only keeping yourself safe, you are helping others be safe as well.

Posted by AlGee on Sep 04, 2013 at 1:44pm

I completely agree with you AlGee, I too was started on Ritalin and did not like it, awful dizziness and there was no reward, no helping of my adhd… After two weeks he put me on Adderall which is a better choice but like you said there is newer better drugs available.. Maybe in a few months when Im ready to try medication again I’ll Vyvanse (spelling?) or the new patch one… Thank you for such a detailed reply

Posted by BexIssues on Sep 05, 2013 at 5:52am

Regarding the choice of psychiatrist, choosing one who has experience with AD/HD is a good idea, especially if you are new to it yourself.  Treat as radioactive any shrink that suggests it is a psychological problem, bad food or bad parenting or anything like that.  Those are getting rarer but there are still some witch-doctors out there.  You are dealing with a neuro-chemical problem that adversely affects what are called “executive functions”, mostly in the pre-frontal cortex and is mostly genetic in origin.  Beyond that there are all sorts of theories, but the above is now clearly established and generally agreed as the basis of AD/HD and I would be looking elsewhere if he or she doesn’t explain it in more or less those terms. 

In terms of what you want to get out of the sessions,
AD/HD usually poses two sets of problems.  You want help with the actual AD/HD, which does not respond to psychotherapy, and with coping with whatever collateral damage (they call it co-morbidities) it has caused/is causing in your life (anxiety, depression etc.), all of which do respond to psychotherapy.

The primary symptoms of AD/HD can only be effectively treated with medications.  There are several kinds, but they all affect the levels of 2 chemicals (serotonin and norepinephrine) in the brain.  You need to try various types and dosages to see what gives the best balance of benefits and low side-effects.  This can take some months and you have to be patient.  The brain reacts to the meds and often it can take a few weeks before the effect on symptoms is clear and the side effects fade away or settle down.  (Search my name in another thread for a more detailed discussion of differences between Ritalin and Concerta, which are the first meds most doctors usually prescribe).  I would look for a shrink who has a good knowledge of all of the options and is willing to experiment.  Be aware that most of the drugs have the potential for abuse and a “street value”, and that potential for illicit trafficking (including by you and family members)  is something they are required to consider, especially in the USA.  The more you can provide reassurance and build a relationship, the better.

The comorbid psychological problems can be improved by psychotherapy and this is where a good practitioner will probably focus discussions.  You need to be clear and honest about the kinds of effects AD/HD is having on your life and use him or her to look for ways to better understand and deal with it.  Bear in mind that AD/HD is just a part of who you are, and you need to look at the whole package.  Knowing that part of it is an inherited physical problem helps a lot, but it is only a starting point - figure out what are your own goals for the therapy and be clear with the shrink what they are, but in general this will focus on how to improve the whole “you” and how to cope with the AD/HD.  Meds can help, but there isn’t a cure (and anyone who says there is falls under “witch-doctor”, above).

A lot is being said about CBT (cognitive behavioural therapies) recently.  As above these cannot “cure” AD/HD, and thus far the evidence is that they do produce benefits, but that these tend not to last if you do a fixed programme and then stop.  Worth a shot, but assume that some kind of follow-up consults or coaching will be needed.

One other thing, especially if you are hyperactive, is not to hijack or dominate sessions (as I’ve done a few times).  It can be wonderfully therapeutic to have someone who really listens to and understands, but you have to sit back and listen and reflect on what is being said.

Good Luck!!

Posted by Cedar on Sep 08, 2013 at 2:34am

AIgee, great input. Thanks.

Cedar, great info. I have to disagree with the food/nutrition as I can guarrantee that food works for me. Try going from fast food to vegan diets…I mean a truly knowledgable vegan diet where you get proper and educated meals. Cut out animal products that are now laced with chemicals and growth hormones and crap. I just wish I could still have that food (it was my ex that cooked, my cooking is horrible) night and day differences.

I am seeing the shrink weekly and am there for guidance so I can hopefully adapt to my uniqueness, note cure.

Posted by Newlife on Sep 08, 2013 at 3:01pm

Same here Newlife, I completely changed my diet and since I don’t believe in man made synthetic medications I needed to do my research about nutrition, and I found all kinds of awesome advice.  Found out Im a celiac and went gluten free, then because of all the medications being injected into our animal food source I decided to be a vegetarian (mostly, I like cheese)  even though I did feel a difference right away, it took about a full year for my body to heal from the gluten poisoning in my body.  Which probably explains why when I did try medication it didn’t work, wasn’t able to be absorbed into my blood stream.  But anyway, I’m doing great just from changing my diet and some exercise.  If I get really crazy from too many thoughts or anxiety I take a few teaspoons of Kava Kwik and mix it with coconut water and drink up, Kava takes away the craziness within seconds and allows me to focus 100% on what I’m doing (reading, writing, watching a movie) it’s awesome, everyone should google it, if your medication free, not sure how it goes with medicine, but you can ask your doctor about it.
For my extreme laziness I’ll have a cup of Kratom Tea and within minutes my old lazy but is up doing all kinds of things,,, I believe in all natural.  Will take any advice anyone wants to share about natural healing. sorry about the off topic

Posted by BexIssues on Sep 08, 2013 at 10:37pm

Also, the witch doctor comment, is there witch doctors out there somewhere still? I know China has some intelligent Herbal doctors that I’ve looked into.  Just that you stressed it in your statement above/below lol

Posted by BexIssues on Sep 08, 2013 at 10:39pm

On the food stuff, I’ve seen studies that discuss effects on some of the related genetic issues like coeliac disorder, but as far as I know the only real links with AD/HD are with foods that can scratch the addictive itch, like sugars (and of course alcohol) and ones that are themselves stimulants.  I got through university on industrial quantities of coffee.  Most of the real food issues I’ve seen are about weight-management.  Exercise does help - I do some of my best thinking on a bike miles from anywhere. 

Yes, there are still some witch-doctors out there.  I’ve lived in a number of other countries (in Canada at present) and witnessed a British professor of psychiatry on the BBC argue that AD/HD is nurture not nature and that recent molecular biology studies were too new to be credible evidence AD/HD is genetic (ignoring about 30 years of consistent population study results). He basically said it should be beaten out of children.  That was around 2011 and as far as I know this froot loop not only sees patients, he teaches medicine.  Anyone who can understand the basics of AD/HD should take as much of a hand as possible in their own treatment, and caveat emptor when it comes to therapists.  Any one who doesn’t know the basics, I’d head for the exits.

Posted by Cedar on Sep 09, 2013 at 8:47am

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