First time adult ADHD assessment

[ObsequiousAplomb]

Which side effects are most common and bothersome for your patients?

for Effexor, it's jitteriness, increased anxiety, insomnia, headaches, dry mouth, dry eyes, and inter-dose withdrawal symptoms.

Patients switching to imipramine from Effexor, in my limited experience, mention mostly dry mouth, dry eyes, but they specify that these are less dry than they were with Effexor. Again, in my limited experience, the Effexor was usually augmented with Abilify, which caused 20 lb+ weight gain and only minimal improvement in primary mood symptoms. Obviously, I'm only seeing the patients that were so upset by this that they switched psychiatrists.

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[Candidate2017]

Again, in my limited experience, the Effexor was usually augmented with Abilify, which caused 20 lb+ weight gain and only minimal improvement in primary mood symptoms. Obviously, I'm only seeing the patients that were so upset by this that they switched psychiatrists.

Nothing says personality disorder (and refusal to meaningfully participate in therapy) like antidepressant + antipsychotic augmentation, then switching to a new doctor instead of working with one's doctor regarding side effects.

 

[ObsequiousAplomb]

Nothing says personality disorder (and refusal to meaningfully participate in therapy) like antidepressant + antipsychotic augmentation, then switching to a new doctor instead of working with one's doctor regarding side effects.

I am much less selective than I ought to be.

 

[Merovinge]

I admit that most of my patients at least convincingly pretend to be wary of stimulants when I'm discussing risks, benefits, and alternatives. I think that's why most at least play the game of asking for something other than a schedule II at the first visit. I also admit y'all've convinced me and I'll be ordering screening UDSs for everyone over the next few months and see how it goes. Hopefully I won't be too surprised.

I saw that 30% of Americans may be iron deficient recently. Think we should be screening that more seriously?

It's great that you are trying something new and seeing how it goes.

I actually don't do iron studies unless there is anemia, but absolutely would if there was pica or RLS concerns. I get a lot of lab testing compared to the average psychiatrist due to a sicker patient population who has high eating disorder or SUD comorbidity. I see a variable testing pattern with Fe in non-anemic patients, with a lot of PCPs ordering this in menstruating females. Due to where in the country I live I get a lot of Vit D tests and catch levels <20 a handle of times/year where repletion seems to make a real difference.

 

[Stagg737]

Nothing says personality disorder (and refusal to meaningfully participate in therapy) like antidepressant + antipsychotic augmentation, then switching to a new doctor instead of working with one's doctor regarding side effects.

Idk. I think a patient telling you that you're the best doctor they've ever had and that you're the only one who has actually cared about them as a person then finding out from an inpatient/consult team 3 months later that the patient was sobbing, telling them how horrible of a doctor you were and that "they wouldn't even give me the meds I needed!" says it a little better, lol.

 

[Ceke2002]

I admit that most of my patients at least convincingly pretend to be wary of stimulants when I'm discussing risks, benefits, and alternatives. I think that's why most at least play the game of asking for something other than a schedule II at the first visit. I also admit y'all've convinced me and I'll be ordering screening UDSs for everyone over the next few months and see how it goes. Hopefully I won't be too surprised.

I saw that 30% of Americans may be iron deficient recently. Think we should be screening that more seriously?

Personal anecdotal experience only here, but as someone who used to doctor shop (not ADHD meds, we already had top quality stuff on the streets, why waste time bothering a Doctor) for pills the bolded section sets off red flags galore for me. That's exactly the sort of stuff I would've tried to pull.

 

[ObsequiousAplomb]

I am much less selective than I ought to be.

Also, to be clear, these patients have discussed side effects with the original doctor, who generally told them that the side effect they're having is impossible despite the specific side effect being abundantly common (weight gain with Abilify augmentation in TRD, etc)