newly diagnosed as ADHD in civ deferred residency

[AFdoc8792]

Hi all, I am a civilian deferred resident s/p 4 years of HPSP. I have been seeing a psychiatrist for the last few months for anxiety and low mood. She thinks that I have been struggling with undiagnosed ADHD (inattentive type) for a long time, and just have made it this far with good non-medical supports. I have struggled since early elementary school with day dreaming, low test scores, late assignments, constantly missing items, etc to the point of almost failing classes and getting a reprimand at work...so I do believe the ADHD is a real diagnosis. In medical school I routinely got low shelf scores, notes took longer but were doable, and I just balanced it out with excellent clinical skills and strong patient/team rapport. However, now with the overwhelming burden of residency and constant distractions in the hospital, it has become incredibly difficult to manage and has become an emotional drain.

My doc recommends starting ADHD medication--Strattera (ideally to also help with mood). I don't really want to separate from the AF or have to pay back all of med school. I do think getting help now is the right thing to do, and my health is more important. But I do have options such as: start medications and whatever happens happens, taking ADHD medication temporarily while I learn the skills and hope that I don't need the medical support once I become an attending, or no medications, and work on non-medical supports solely. What are your thoughts?

Thanks so much for the ideas and feedback!

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[DrMetal]

Hi all, I am a civilian deferred resident s/p 4 years of HPSP. I have been seeing a psychiatrist for the last few months for anxiety and low mood. She thinks that I have been struggling with undiagnosed ADHD (inattentive type) for a long time, and just have made it this far with good non-medical supports. I have struggled since early elementary school with day dreaming, low test scores, late assignments, constantly missing items, etc to the point of almost failing classes and getting a reprimand at work...so I do believe the ADHD is a real diagnosis. In medical school I routinely got low shelf scores, notes took longer but were doable, and I just balanced it out with excellent clinical skills and strong patient/team rapport. However, now with the overwhelming burden of residency and constant distractions in the hospital, it has become incredibly difficult to manage and has become an emotional drain.

My doc recommends starting ADHD medication--Strattera (ideally to also help with mood). I don't really want to separate from the AF or have to pay back all of med school. I do think getting help now is the right thing to do, and my health is more important. But I do have options such as: start medications and whatever happens happens, taking ADHD medication temporarily while I learn the skills and hope that I don't need the medical support once I become an attending, or no medications, and work on non-medical supports solely. What are your thoughts?

Thanks so much for the ideas and feedback!

Well you can't be that ADHD, you are a doctor after all?! I don't care if you scraped by with straight D-, you still passed. You've demonstrated some good level of attention! (ADHD is very over diagnosed, in my arm-chair psychiatric opinion).

--Strattera (ideally to also help with mood).

Now depression or a depressed mood is a much more likely diagnosis, hell we all have it at some point or another. Why Strattera, vs some other generic SSRI (sertraline) or NDRI (bupropion)?

I don't think either a dx of ADHD or Depression would necessarily get you out of the military. Plenty active duty folks carry these diagnoses, are treated and allowed to continue service if stable. The latter (depression) is far more common (and probably more accurate). If you're really concerned about the 'ADHD' label, ask her to dx you with just a 'depressed mood' for now, and start a generic SSRI/NDRI (the more generic, the more common in the mil, the more likely for someone to just gloss over it . . . everyone is on zoloft! We don't use Straterra very often). Plus the generic SSRI/NDRI are cheap and help with ADHD (if its there).

 

[Gastrapathy]

I’m not sure I’d be so sanguine about the impact on coming on AD. It’s been a while for me but I believe that accession standards rather than retention standards might apply.
Regardless, do what you think is right for your mental health. You won’t be a doctor, military or otherwise, if you wait until you fail to get treated. Best of luck

 

[jdubs1984]

only slightly related, but seems like a good thread to ask this...Should I be concerned about trying to rejoin the military with ADHD? I did 6 years earlier in my life and my current goal is HPSP or USU and reenter as physician. Could an ADHD diagnosis prevent that?

 

[John1513]

only slightly related, but seems like a good thread to ask this...Should I be concerned about trying to rejoin the military with ADHD? I did 6 years earlier in my life and my current goal is HPSP or USU and reenter as physician. Could an ADHD diagnosis prevent that?

It is likely to cause barriers in your application. Might need a medical waiver, which is often a drawn out process.

 

[ValeRx]

You have to be off of ADHD medications for at least one year or you are disqualified from accession. Retention is different. My ex wife started on Strattera when she was already in and had no problems with it.

 

[jdubs1984]

You have to be off of ADHD medications for at least one year or you are disqualified from accession. Retention is different. My ex wife started on Strattera when she was already in and had no problems with it.

That really sucks...I'd like to stay on medication to help with school/work/study etc... Does anyone know how difficult a waiver is to obtain? Also, does anyone know if cluster headaches will disqualify me and if it's waivable?

 

[j4pac]

First things first...get treated. The path you are on is a marathon. Even well adjusted people in medicine without ADHD and depression burn out at an alarming rate. You need everything working in your favor. If you need the meds...you need the meds. Avoiding the meds would be incredibly shortsighted. But yes, the meds are a problem for milmed. Good luck!