Patients with multiple controlled substances.

[docksan]

I'd have paid off student loans already if someone gave me money every time someone with "bipolar" actually had ADHD.

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[littlefred]

I'd have paid off student loans already if someone gave me money every time someone with "bipolar" actually had ADHD.

Almost like a Scooby Doo episode, it had been ADHD the whole time

 

[mistafab]

I’d have Elon musk money if I was paid the amount of “bipolar disorder” and “adhd” that turned out to be borderline

 

[dozitgetchahi]

Yo over here in rheumatology, I routinely see these types of kooky regimens coming in in patients referred for “fibromyalgia”, usually +/- gabapentin/pregabalin, duloxetine, an atypical antipsychotic, maybe a tricyclic thrown in to boot, and also one or more muscle relaxers (cyclobenzaprine and tizanidine are favorites, thankfully Soma seems to have finally gone the way of the dodo bird).

Oh, and the patient still hurts. And is fatigued. And can’t concentrate. And is depressed. Fix me, doctor! Someone told me rheumatology holds the key to me feeling great again.

🤦‍♂️

 

[Attending1985]

What's really remarkable about the diversity of patients, medical conditions, and the medication tools at our disposal, is the sheer combinations that then might be indicated, even if under a very specific set of variables.

Why even have psychiatrists if one is just gonna have blanket rules like "only one controlled substance at time, ever." "There is no such thing as ADHD as a lifelong condition." May as well just hand the kingdom over to the NPs then.

This just saddens me. What sets us apart as psychiatrists is not our ability to use multiple controlled substances and promote polypharmacy that other docs would otherwise not use because it doesn't make any sense and/or is dangerous. It's our extensive medical training and our extensive psychological training. Good training allows for complex biopsychosocial formulations that we can either deliver on or make recommendations for. We should have restraint and know what not to medicate. This earns us respect. A lot of non psych docs that I know have very little respect for psychs that overprescribe with simplistic views of mental health. Unfortunately, all too common.

 

[Ceke2002]

Story of my life! Hah the age group is also on point. I don't mind prescribing ADHD meds to the younger population but once you are in adulthood it gets super sketch. Adult ADHD is kind of an oxymoron because it's supposed to be a neurodevelopmental delay in children/adolescents in comparison to their peers... How are you still delayed when you are 40 years and above?

Seems like everyone is getting stimulants up here and when they are held to any kind of scrutiny the diagnosis was made with some kind of self-administered questionnaire or prescribed by non-psychiatrists. Rough.

I was diagnosed with the old term for ADHD (Hyperkinetic Reaction of Childhood) back in 1975 when I was 3 years old; I was then 're-diagnosed' with adult ADHD when I was 27. I'll be 52 this year and my ADHD hasn't magically disappeared with age, I've just learnt to hide and/or manage the more obvious symptoms better over time. I took stimulant medication for a brief period in my late 20s and decided I didn't like the side effects, so I stopped taking it and just concentrated on figuring out how to manage symptoms in my own way. Just because there's a subset of patients who are gaming the system, and who may or may not legitimately have ADHD, doesn't mean there aren't legitimate cases out there.

Having said that I do agree that stimulant medication shouldn't just be thrown willy nilly at a problem like ADHD, or that it should always be the first option in all cases.

 

[docksan]

I’d have Elon musk money if I was paid the amount of “bipolar disorder” and “adhd” that turned out to be borderline

You forgot PTSD and Schizophrenia, commonly comorbid with Bipolar attention deficits.