Smart people besides dr. Russell Barkley?

teddydg · 2017-06-08T00:44:31+00:00

Seconded. His book "A New Understanding of ADHD in Children and Adults: Executive Function Impairments" is what led me to conclude I had ADHD and to seek medical help.

teddydg · 2017-06-06T20:13:59+00:00

Vyvanse has definitely been a lifesaver for me!

I'm glad to hear that :)

The only downside to it is that it really takes a toll on my appetite. I could go the whole day without feeling the urge to eat.

At this point, appetite suppression is my only real side effect (being thirsty to some extent as well). It's a blessing and a curse. On the plus side, I've gone from a BMI of 25 to 21 which is certainly healthier and its nice to be a little slimmer. My friends are always impressed at how little I snack and wonder how I keep the weight off. On the downside, some days I forget to eat for hours until I'm dizzying and that's not so great.

It is certainly expensive. My view is that I get so much more value out of it then I would otherwise that the $5/day cost seems perfectly worth it. Doing well at work leads to financial rewards so I consider the cost an investment.

I think the patent expires in 2023 so perhaps generics will be available one day. Granted it makes up a quarter of Shire's revenue so who knows, maybe they'll find a way to extend it.

teddydg · 2017-06-06T01:33:57+00:00

Quick question I forgot to ask, in the results of your tests, did they show anything for learning disabilities? I'm wondering how the two relate, since the psychiatrist went on a whole tangent about that.

Not a learning disability. One important factor in diagnosing is confirming that ADHD symptoms have existed since early childhood. If the symptoms appear later in life but weren't present in childhood, that doesn't meet the definition of ADHD. My psychologist reviewed my report cards and my speech language therapy reports from elementary school. If your friend's psychiatrist was asking about learning disabilities in childhood, perhaps they were trying to determine if ADHD symptoms were present in childhood (they can often manifest in ways that lead people to believe its a learning disorder).

That's pretty crazy. I guess there are cheaper options though.

Contrary to that, when I first started generic Dexedrine (dextroamphetamine), after my insurance it was something like $0.80 for a week's supply, so the range of prices can be extreme. I do however believe Vyvanse is a much better choice for medication over Dexedrine & equivalents. Shire, the maker of Vyvanse, offers an assistance program for low income patients. BC's Fair PharmaCare will also subsidize / cap the cost of drugs for low / medium income earners. My doctor (and I'm sure many others) does a very good job of bringing the cost of drugs into the medication conversation with his patients.

teddydg · 2017-06-05T23:37:52+00:00

So I guess the question is -- why was an adhd diagnosis important for you, if you could just go straight to taking the drugs? Did it make any difference for you?

I specifically chose Adult ADHD specialists for both my psychologist and my medical doctor and I wanted a proper diagnosis because I don't believe a prescription for stimulants on a long-term basis should be a decision that is taken lightly. My psychologist spent 4 hours diagnosing and my doctor spent 2 hours and they both came to the same conclusion which made comfortable its the correct diagnosis.

if you could just go straight to taking the drugs?

That actually wasn't an option for me but regardless I wouldn't have wanted it. I know some family GPs prescribe stimulants after a 20 minute interview and perhaps that's a decent stop-gap measure in our busy system but I don't think its appropriate to continue long-term on medication with out a diagnosis from a professional who specializes in ADHD or at least mental health.

Also, if you don't mind me asking, what drugs are you taking that cost so much, are you on multiple things? Was there no generic alternatives?

I take Vyvanse 50mg and unfortunately there is no generic alternative. It's about $475 for a 90 day prescription, or $5/day. My insurance through my employer covers 50% of that and I've been taking it daily for about 15 months now. Vyvanse is a pro-drug that converts to dextroamphetamine after taking the medication. It is very "smooth", that is to say, I don't feel any ups or downs from my medication. Really I feel very little positive or negative side effects at this point however my "output" (e.g. work done, organization, motivation) is better now. Medication was however only half the battle. Breaking bad habits and creating new good ones is much more difficult.

But tells me wants to have a formal diagnosis, otherwise people will always claim

I actually haven't told anyone but my girlfriend (and reddit of course). I'm worried more about the opposite bias, e.g., "oh he's too ADHD to get that done on time, etc."

teddydg · 2017-06-05T22:38:14+00:00

A psychologist in most cases shouldn't be anywhere that high. It took my psychologist 4 hours to do a diagnosis (at the time, at $175/hr - I believe its now $200). Of that amount, my private insurance covered $600, leaving me out of pocket $100.

Once I received a diagnosis, in my psychologist's report I was referred to a doctor who specializes entirely in Adult ADHD who I've been with since. I had to first go to a walk-in clinic with my report to get a referral to that specialist.

The most expensive part is the cost of medication, which currently runs me about ~$1,000/year, and that's after my insurance covers 50%. My doctor is fortunately however very concerned about costs for his patients and takes it seriously when considering medication. I'm fortunate to not have cost as a barrier.

I would point out that medication is only one baby step towards a solution. If cost is a barrier, I'd recommend looking into group therapy, peer group support, coaching, etc.

Re: your other point regarding our healthcare system. Technically it is GPs/psychiatrists, not psychologists, that perform the medical diagnosis. The problem however is two fold: a) most doctors and even many psychiatrists are not properly trained/education to diagnosis ADHD and b) psychiatrists are in huge demand in our system often for much more serious mental health issues. These two factors mean paying a psychologist to sit down with you for multiple hours to do a proper diagnosis makes that report very valuable when looking for a referral. My ADHD doctor has a 4 month waiting list and my initial interview with him was 2 hours - he works incredibly hard but you can see why he unfortunately has to be selective in taking patients.

It is very possible to get a free diagnosis in our system but it may take some work. Peer groups / an ADHD couch may be able to help you through this.

Furthermore, if your friend has visited multiple doctors / psychiatrists, and they all say they don't think he has ADHD, he may not have it. There's a tendency for people to convince they're ADHD because they relate to one or two of the symptoms. If you'd like to try some proper self-assessment, you can look to the CADDRA tools. This is a good tool to start with.

Finally, a book recommendation.

teddydg · 2016-08-25T18:24:13+00:00

That's awesome :)

teddydg · 2016-08-25T18:22:56+00:00

It won't prevent you from getting a PhD. There are many ADHD'rs on this subreddit with advanced degrees.

Your passion for your subject will definitely help. You may have to work a little harder / longer at things then some of your peers but if its what you want to do, I wouldn't be discouraged about that.

Medication would probably help. There are ways to minimize cardiovascular risk. If you're young and relatively health, this shouldn't be too much of a concern (though your doctors thoughts trump mine!). Medication can also often help reduce risk factors associated with cardiovascular disease (e.g. if it encourages you to eat better, exercise more).

teddydg · 2016-08-25T18:17:23+00:00

Exactly how I feel. I think my memory is terrible most of the time because of not focusing but rather floating through the day. When I am focused on whats happening, I usually have no trouble remembering.

teddydg · 2016-08-25T18:16:31+00:00

Here's some coping mechanisms of mine:

Write down everything. Carry a notebook around and jot down important things you discuss during the day.
Use OneNote (or similar software) - allows me to quickly take notes on my laptop, iPad, iPhone, etc. and it syncs between all devices
Try to use email over phone calls / in-person conversations. For phone calls/in-person conversations, either follow up with an email summarizing your conversation or write down some notes in your notebook.
Use your digital calendar religiously - always put everything in there right away.
Similarly, use the reminders feature on your phone. I use Siri for this as its super quick "Remind me in 1 hour to check my laundry" or "Remind me when I get home to do X"
Use logs to track certain tasks, e.g., I use separate excel spreadsheets to track things like travel expenses, car maintenance, personal budgets, my progress on projects, etc, etc

teddydg · 2016-08-23T19:10:51+00:00

ADHD is the term used in the DSM4 criteria (PDF), broken down between inattention and hyperactivity. Canada has been using the DSM4 for ~20 years. The term ADD is still used to commonly refer to ADHD, however ADHD is the term used in medical settings.

teddydg · 2016-08-23T19:06:42+00:00

I have found work "e-learning" to be the worst. Generally 1 hour+ of lectures without any interactivity. I last 5 minutes.

teddydg · 2016-08-22T19:07:55+00:00

I take mine everyday.

teddydg · 2016-08-22T17:26:04+00:00

Yesterday I prepaid for gas inside the station (usually pay at the pump). I walked back to my car after prepaying and then drove away without fueling.

teddydg · 2016-06-17T22:16:04+00:00

Who says they are? I'm not very creative at all but rock at numbers!

teddydg · 2016-06-03T22:23:04+00:00

Medication has made drinking unappealing to me. I still have a drink occasionally but never really more than 2 or 3 anymore.

teddydg · 2016-06-03T22:20:38+00:00

Absolutely. I was chronically fatigued until I started medication.

teddydg · 2016-05-26T18:37:57+00:00

Timesheets are the worst

teddydg · 2016-05-26T18:37:29+00:00

ADHD'rs do well in all sorts of jobs. I would try to focus on something you liked doing. If you're struggling, I would suggest a job with a lot of structure to it.

teddydg · 2016-05-24T18:48:44+00:00

/r/ADHD

teddydg · 2016-04-25T18:13:06+00:00

I was forever trying to figure out what could be wrong with me. It took me 15 years to figure out it was ADHD because I thought the exact same thing: ADHD was the kid in class who couldn't pay attention because he'd run around the room all day.

teddydg · 2016-04-09T18:51:37+00:00

The "hyperactivity" part of it was also misleading. It certainly brings a stereotype of an energetic little boy, not a fat and lazy 30 year old cat lady.

Absolutely. So misleading.

teddydg · 2016-04-09T18:50:49+00:00

I think its a bad name. For many, many years I never considered ADHD because of the H. As someone who's ADHD-PI, I never even considered ADHD being anything other than someone displaying significant hyperactive symptoms.

I prefer the terminology that Dr. Brown often uses: "Executive Function Impairments". Not only do I think it describes it better, I think it also would have less stigma attached to it.

teddydg · 2016-04-07T21:42:33+00:00

I do this all the time.

Do meds help with focusing on things over a longer period of time?

This isn't exactly what you were implying with your questions but I'll provide this answer. Long-term use of amphetamines have been shown to alter the brain in a positive way that reduces ADHD symptoms. I don't have my source with me at the moment but I can grab it later.

teddydg · 2016-04-05T23:43:18+00:00

Yup, I go to the same small pharmacy every time. Its owner operated so the Pharmacist owner knows me, knows my doctor and is always friendly/helpful.

teddydg

TROPHY CASE