Is it bad to ask for a stimulant?

[Michael909]

I just started the medication Bupropion, and this is my first time trying meds. I just got diagnosed and I'm 29. After doing some reading, it seems that stimulants are the most effective drug. I was diagnosis by a nuropsychologist, who said I had AD/HD combined, with a Moderate severity. The low dose of bupropion is giving me a bit of enegy which has helped my exhuastion in the latter hours of the day. But as for my over-active mind and my impulses to stay on the go, they are still a problem. I'll tell my doctor that the medicine's effects aren't helping much, and I think he'll prescribe a higher dose becuase it takes time or because the last dose was small so there's no way in telling. Should I be patient as they say, or should I petition for a stimulant? I seem fit for a stimulant overall - history, heart condition, etc. He's using Bupropion becuase it's best practice and becuase stimulants are addictive, I can sell them, and they cuase heart problems long term. But all these are not strong reasons for me after studying Dr. Barkely's Adult ADHD book. I also told him I have general anxiety, but that was becuase I had a girlfriend and was super stressed. I'll clear that up with him. But should I petition for a stimulant in our next review?

[STEM_Dad]

You should be able to ask about other treatment options, including stimulants.The doctor is focusing on much more rare possibilities, instead of what is the best course of treatment. As I understand it, as a patient, it's actually your right (at least in the US) to discuss treatment options with your doctor.

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You mention that you were diagnosed by a neuropsychologist, but since psychologists cannot prescribe medication, my guess is that the prescribing doctor is a personal care physician (PCP).

Doctors are human, and so they can have their own biases and misconceptions, just like any other human can. Sometimes doctors will have patients who seem to be just medication-seeking, rather than care-seeking, and so sometimes doctors will react to how other patients have been with them, not how you have been acting.

You can ask. The doctor might still resist the idea of prescribing stimulants. They are using what they believe is their best judgement for your treatment.

Since stimulants work fast, you could know within a few days in they are working well for you. So you could try asking your doctor for a one week trial on a stimulant.

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Stimulants act by triggering the release of dopamine.

Bupropion acts as a dopamine and norepinephrine reuptake inhibitor, which means that it delays the reabsorption of the existing dopamine and norepinephrine that are released in your brain. (When nerve endings release a neurotransmitter to signal the next nerve, they will then reabsorb any unused amounts. Delaying the reabsorption helps to ensure that the signals are fully transmitted.)

Some people might be better treated on bupropion, but according to the research I've heard about from Dr. Russell Barkley and others, stimulant medications are still the most effective treatment for most people who have ADHD.

(I am actually treated better on a non-stimulant than the stimulant that I tried first.)

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You can try to look for a provider who is more familiar with ADHD, perhaps a psychiatrist, neuropsychiatrist, or neurologist. You could ask your doctor for a referral. Check with your health insurance plan to know what to expect for your copay or other out-of-pocket visits, since many plans have more limited coverage for seeing a specialist.

[Mamamichl]

you can definitely ask, but they don’t have to. Just be careful how you ask since those are title one, and quite restricted. Some docs are totally fine with it, while others are more cautious. I’ve had both. It’s easier for a psychiatrist to do so rather than a pcp.

Also, are you taking any other mental health meds? I am on anxiety meds, and my pst psychiatrist didn’t want to mess with adhd meds until my anxiety was under control… even though my anxiety was because of my adhd.

[MaudQ]

You should definitely ask and be really straightforward about your symptoms. Sometimes we try to be “nice” with doctors, but they can’t take action if we don’t tell them what’s going on. If they say no, you should get a second opinion. You want to have a good relationship with your provider because there’s so much back and forth with these medications. Who is prescribing your medication? If you’re not seeing a psychiatrist or a psychiatric nurse, I’d try to make an appointment with one. They will have a better understanding than your PCP. If you are seeing a psychiatrist, I’d go ahead and make an appointment with a new one. I’m on Bupropion and a stimulant - my prescriber says they work well in combination. I had to do an EKG to check for heart health before I started and continuing to monitor is a good idea. There’s stigma around stimulants but all drugs have side effects: the question is how does your individual body respond and are the side effects worth it for whatever benefit you receive. Your prescriber will start you on a low dose to see how you tolerate the drug - ie they are trying to find out what the side effects will be for you - and then they will titrate up the dose. A good provider will listen to you and be straightforward about risks and benefits.

[swfljsmith]

My experience is the best way to communicate with doctors is to tell them your signs. For instance, you can simply say "my over-active mind and my impulses to stay on the go, they are still a problem" and add other issues you may be having, such as inability to complete projects, or whatever else you experience.

The way the system is set up, it's our job as patients to be clear about what exactly is troubling us (where the pain is, what kind of pain it is, etc etc). So tell your doctor your signs (we think of these as symptoms but technically they are signs) and then leave it to the doctor to discuss treatment options. Try everything they suggest and bring back a truthful report of what happened for you.

Then if things are not going the way you hoped they would, you can say that. And if the doctor continues to not bring up stimulant medication, then bring it up yourself. But give them a chance to listen and prescribe as they see best, and if it doesn't work, tell them so. I'm assuming it is your primary care provider who is prescribing for you?

Having said all that, if you have a doctor who may be cautious or even biased against stimulants, you may need to find another doctor, or get to a specialist. Seek out a psychiatric nurse practitioner if you can't get in to a psychiatrist. Google is your friend: look for clinics that treat adults with ADHD.

My experience with bupropion was that it did provide the emotional lift and some energy, but it pushed up my blood pressure to borderline high, and it really didn't address things like focus, follow-through, tracking tasks and projects, completing things, etc. I went off bupropion when I moved to another state and had a hard time getting in to see another doctor. I finally got to see a psychiatric nurse practitioner who was experienced with treating adult ADHD and now I'm on Prozac, Adderall, and a tiny dose of Abilify to counteract the anhedonia that Prozac can cause. It's all working great - honestly, I didn't know I could feel this good and like my old self again.

Much good luck to you!

Edit to add: I'm 62 years old, diagnosed at 59. I also have an excellent psychologist who was also diagnosed ADHD as an adult. It's totally worth taking the time and energy to get the care you need: I haven't felt this good in decades.

[MrQuest in reply to swfljsmith]

I agree with this so much! Clear communication with your psychiatrist and finding one that works with you is so important. It isn't always easy if you have social stresses associated with AuDHD. It can make being clear really difficult. It took me a year to find my voice and figure out my psychiatrist wasn't really helping me and was just making safe or routine suggestions.

Sadly I had to go out of my healthcare network and pay out of pocket. Once I found a psychiatrist with real ADHD experience with other patients, the difference was life changing. I look forward to meeting with my psychiatrist now and discussing various options that might be beneficial for me.