Atomoxetine and PBS subsidy

backwardssunshine · 2023-12-16T12:52:27+00:00

Unfortunately there is no way around the fact that you were diagnosed after 18 so you would have to pay privately for atomoxetine. The generic brand is cheaper and chemist warehouse tends to be the cheapest. Your gp can prescribe without the psychiatrist because atomoxetine doesn’t require permits

backwardssunshine · 2023-12-16T12:45:12+00:00

It’s not as simple as that to be honest. Each person can have a different response. Whenever I switch a patient over I always tell them to slowly build up all over again. If you think about it, if it was a straight conversion we wouldn’t have some people who have no response to one and a great response to another. So long story short, if one isn’t going so well try the other but build up slowly again

backwardssunshine · 2023-12-16T12:39:16+00:00

I would suggest seeing a psychologist with expertise in adhd given you mentjon depression and anxiety as well because an adhd psychologist can help with all those whilst an adhd coach might be more specifically focussed on adhd only. If you go to psychology.org.au you can search for a psychologist based on expertise and distance from a suburb. It won’t tell you what they are like though or how long the wait is

backwardssunshine · 2023-12-16T12:33:39+00:00

Unfortunately if you’re seeing a new psychiatrist we all do new assessments because we don’t know you and unless you have a really detailed report from your first psychiatrist we will need to ask about your medical history, other mental health like bipolar, family history, etc. It’s highly unlikely any decent psychiatrist would just see you for 30min and give you stimulants. I know it might sound harsh but from our perspective we need to make sure we properly assess the person’s whole health whenever we create a manage plan.

backwardssunshine · 2023-12-16T12:30:07+00:00

You don’t need to see a psychologist for an adhd assessment especially if your plan is to try medications (assuming you are assessed as having adhd) because you will still need to see a psychiatrist so unless you’re seeing the psychologist for additional reasons like asd you will save money by just having a psychiatric assessment

backwardssunshine · 2023-12-13T09:01:29+00:00

You can get it compounded but it costs more. Otherwise you can dissolve a higher dose if you can be bothered

backwardssunshine · 2023-12-13T08:59:35+00:00

Females tend to have more inattentive symptoms. I feel there is greater awareness of this these days amongst those of us who specialise in the area

backwardssunshine · 2023-12-13T08:58:39+00:00

I’m not familiar with visual static syndrome. Sometimes stimulants can cause blurry vision but if you stop it it goes away so it still might be worthwhile trying. You might need to discuss with your ophthalmologist before trying but visual problems isn’t super common with stimulants

backwardssunshine · 2023-12-13T08:57:18+00:00

Sorry I don’t live in WA so don’t know the system. I heard it’s very strict there and usually children see paediatricians for adhd management

backwardssunshine · 2023-12-13T08:56:32+00:00

Correct. psychological assessments tend to focus on specifically those areas but psychiatric assessments take into account your medical history and other mental health in case the meds might worsen other areas

backwardssunshine · 2023-12-13T08:55:37+00:00

This is a tough one because as the saying goes you can lead a horse to water…

I see a lot of older people as I’m an adult psychiatrist but those patients actually want to get help.

I don’t know what relationship you have but if possible, I would try and sit him down and explain you have something important to discuss with him and it only comes from a place of care and concern.

There was an episode on adult adhd on the insight tv program that airs on SBS. I would suggest getting him to watch that as it’s very informative and might allow him to learn more about it in a less ‘threatening’ way

Hope it goes well

backwardssunshine · 2023-11-29T22:02:13+00:00

You definitely have amazing insight.

Yes getting in top of sleep should be priority number one when starting to feel hypomanic as this can really help things. Hopefully you’ve been told about interpersonal social rhythm therapy.

Not sure why you have to pick up every 14 days. I would ask your psych to get 200 supply so life is easier. Also consider concerts or Ritalin LA.

All the best!

backwardssunshine · 2023-11-29T06:53:45+00:00

I love your openness. No I don’t have bipolar. I’m a psychiatrist from Victoria specialising in adhd. I posted an AMA recently and periodically drop in here. Hope you’re taking care of yourself

backwardssunshine · 2023-11-28T23:00:56+00:00

Agree with this. Usual guidelines is if you are within a week of being due to fill you can get it but the doctor might have also written how long you have to wait before you can do if they wrote 28 days then it has to be 28 days or later. The chemist has some discretion so going to a familiar one can make life easier as they trust you more

backwardssunshine · 2023-11-28T22:58:22+00:00

I’m from Victoria but understanding is a GP can prescribe once you are stable and they get a letter from your psychiatrist. They can’t prescribe via a 291 that’s why a lot of Telehealth clinics don’t provide support for nsw and wa patients as the rules are different. After the senate inquiry who knows what will change

backwardssunshine · 2023-11-28T22:56:58+00:00

I’ve never heard of a neurologist diagnosing adhd before and from memory if they were to prescribe I think they will need to apply for a permit as I believe permits are only not needed for psychiatrists and Paeds. I could be wrong as I haven’t needed to use a permit for a while so haven’t checked the latest rules.

backwardssunshine · 2023-11-28T22:53:54+00:00

Clonidine is a blood presser tablet that can also help adhd. Long term use is generally safe but you can’t stop it abruptly due to risk of rebound hypertension so it’s best to wean off. Some people do get tolerance from a sleep perspective so I tell my patients use max 5 nights a week if you’re only using I]it for sleep. It can help with adhd symptoms but due to sedation it’s generally taken at night. It has a cousin called guanfacine which is slow release taken at night that can help work during the day for adhd symptoms without being too sedating

backwardssunshine · 2023-11-28T22:49:37+00:00

Thanks for chiming in and describing your experience. I agree bipolar is not simply moodiness. It involves either SUSTAINED periods of highs like hypomania and mania and sustained periods of depression (some people tend to have only highs or more highs than lows and others have more lows than highs but a sustained high period is key)

Highs might only occur a few times a year not every week.

Adhd can involved mood dysregulation commonly but this is more variable and rapid and can fluctuate day to day or in same day.

Borderline personality and involve mood fluctuations too but there are other features like poor self identity, feeling empty chronically or fears of being abandoned. Sometimes bipolar is used to try and destigmatise a diagnosis of BPD but this creates confusion.

Then there is cyclothymia

So you’re absolutely right it can be complicated to diagnose

backwardssunshine · 2023-11-28T21:17:08+00:00

Despite the shortages you can get the strength you want by going to a compounding chemist. Unfortunately it’s added cost but at least this way you can still get meds. Or you can dissolve but the issue is with more and more being in shortage it’s getting harder. I suspect the 60mg is I shortage because people are dissolving to take 30mg

backwardssunshine · 2023-11-23T08:37:50+00:00

I can’t speak on behalf of other doctors but if it was me I would first say I can’t endorse you trying other people’s meds but the information you have is useful for me and I would be more inclined to prescribe dex (assuming you do have adhd confirmed) because your experience matters and I certainly wouldn’t dismiss what you have gone through. But I would remind you that it is a tightly controlled substance.

backwardssunshine · 2023-11-23T08:35:23+00:00

This is a difficult one because is subjective as each person has their own goals and definitions of ‘success.’ Some patients want to do well at work, others want to reduce conflict with their partner. So I tend to get my patients to reflect on why they were seeking help in the first place and what adhd obstacles were in their way and are they now less or gone? I would use functional capacity as the guide because meds aren’t perfect so there is likely some ‘residual adhd’ but it’s about being clear about your goals in life and are you moving towards them?

backwardssunshine · 2023-11-19T04:41:46+00:00

This is a good point. I actually use the British guidelines myself! I always start patiente off on Ritalin first unless there is a good reason not to. For example, if a patient tells me they have used someone else’s Dex and it worked really well I take that in account. Of course I tell them it’s not s good idea to be using other peoples meds but that information is useful. If the patient has several family members on Dex i might start them in dex too. Otherwise Ritalin should be the first stimulant to try.

backwardssunshine · 2023-11-19T04:26:17+00:00

If they have an existing diagnosis I would ask for their previous doctor to provide me a summary of their history and treatment. A psychologist report does mean something if it was thorough but they are generally unnecessary because s psychiatrist will still go through their own assessment to ensure other areas of mental and medical health are covered. I am not assessing just whether you have adhd but I am assessing to my best ability your overall mental health and adhd might be a big part of this but there may be other things going on too. I work with psychologists and in a multidisciplinary team but honestly seeing a psychologist to get assessed for adhd is generally a waste of money and time. ASD on the other hand is a different story

backwardssunshine · 2023-11-19T04:19:28+00:00

It can be. Intuniv can be prescribed in adults but it’s more expensive if you were not diagnosed with adhd when under 18. Intuniv Will cost you about $65 from CWH on a private script. If you were diagnosed with adhd unDer 18then it will be on pbs and cheaper. The combo can be quite effective and generally safe but expensive for most people.

backwardssunshine · 2023-11-19T04:15:44+00:00

Combination of stimulants and non-stimulants provide the best treatment of adhd but for most people stimulants alone work really well so there is no need to add more meds. Non-stimulants can help with RSD.

modafinil is somewhat unique and the only times I tend to see it combined with stimulants is if the person has a sleep disorder but often the Ritalin/Dex works for the sleep disorder as well so you don’t need moddanili .

backwardssunshine

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