GP or specialist for prescription?

[CatMoose]

I'm currently trying to get connected to a therapist to help me build some coping skills besides meds, but I think I've accepted that medication needs to be a part of my coping strategies.

When I was younger, I went to a psychiatrist for years who wrote my prescriptions and to be honest, I don't remember much else about those appointments besides a general check in about how the meds are going, if symptoms are controlled. Until a couple years ago, the meds I was on had been working well for me and I hadn't had a change in about 10 years - so when I moved and the nurse practitioner who is my GP was comfortable writing the prescription, that seemed like an easy way to avoid a specialist co-pay. When the pandemic hit, the mild, totally manageable medication side effects I've had for years kicked into overdrive - I went from my meds keeping me up if I took them too late in the day to being up at 5am after taking it at 8am the day before, and I was having the hardest time making myself eat. I couldn't tell how much was stress and how much was my medication affecting me differently as I get older (I'm nearing 30 so it feels like my body tolerates everything just a little differently than a few years ago), but I knew that if eating and sleeping are the things I'm struggling with - stimulants aren't helping with either of those. My GP switched me to another med that I've tried and decided I do not like how I feel on it.

I totally get that the process of finding the right med can involve a decent amount of trial and error, but I'm questioning if I would be better off asking for a referral to a specialist. My GP is really great and seems to have decent understanding of ADHD and the medication options, she mentioned when she wrote this one that we could explore other non-stimulants or go the non-XR route on one of the stimulants that has worked well for me in the past, as the sleep is the primary concern. I'm just wondering if I'd be better off finding the right med with a specialist and then asking her to write it from then on, or if the process will be mostly the same regardless and I should save myself the time of getting connected to a new provider. And the awkwardness of asking my doctor to refer me to someone else for something she has said she can take of, which is probably much less of a concern than I am imagining.

[BlessedLady]

No doctor knows how a particular drug will affect a individual patient. If your NP listens and is willing to work with you to find another combination or medication. It seems like she is doing her job well.

Your NP knows you well. It takes time for a new provider to get to know you. Usually psychiatrists only spend a few minutes with patients to prescribe medications. You could see a psychologist and your NP. Your NP could prescribe your medication and the psychologist could teach you coping techniques

Were you less active after the pandemic hit ? Activity levels affects sleep. You may or may not need to add another medication(s) for depression and/or anxiety

[Gettingittogether in reply to BlessedLady]

Sounds like your GP is all in--as in she's mentioned future possibilities and changes, including moving away from XR medications. BTW: I used to take XR Ritalin (basically concerta) ... and switched to immediate release--and I LOVE immediate release.

I can control it better, it feels. I can really time taking it to minimize side effects (like sleeping which you mention) a lot better than I could the extended release medications.

Here's the thing about psychiatrists. If you are looking for one who accepts health insurance, then the meetings with be really fast, like 10 minutes, 15 minutes at absolute max. My psychiatrist was so rushed that he would only really consider a change every third appointment or so. These were quarterly appointments.

So if you go the psychiatrist route and you want some real time and consideration, you have to find a psychiatrist who doesn't take insurance and who charges a lot of money. If you can afford it, fine. And that is a good investment. I had a psychiatrist like this for a while and I LOVED him. No rush ... I knew I was getting top treatment. Then he moved and I couldn't afford to continue to pay non-insurance rates. Right now I go to a psychiatric nurse practitioner who is excellent.

But sounds like your GP is good. It's up to you. But your GP isn't blind and isn't narrowed minded and seems to have the right mindset. I'd follow her recommendation to consider some of the immediate release meds.

In the meantime, double-check your lifestyle, especially on sleep. I discovered--painfully slowly--that I could not have coffee past 12 noon when taking a stimulant and get good sleep. Like not a drip of coffee/caffeine in my system one second past 12 noon.

I was resistant to that simple fix, but it made a huge difference in my sleep. Also, I found that I had to get outside for at least some walking during winter days in order to get some decent sleep. Also I had to really focus on disconnecting from bright smart phones and laptops ... Starting at 9 p.m. or so, I started reducing the brightness ... and cut it down to the lowest ... I turn down the lights in my room ... I purchased blue-light-blocking glasses ... And I realize I had to stop any hardcore analytical thinking past say 9 p.m. in order to get to sleep at midnight.

BTW: these practices above are all recommended just for general sleep hygiene. I think they are doubly and triply important if you are taking a stimulant. Also people with ADHD tend to have night-owl body rhythms. Bright light boxes in the morning also help.

Bottom line: you really have to clean up your lifestyle to minimize stimulant side effects. And you might need to change meds.