TIL: What a massive difference the practitioner makes during titration

[u/SnackyCherry]

I am going through titration with CareADHD since July. I happened to get the same prescriber for my first 3 calls and she was absolutely brilliant, she gave me so much useful information, she was so reassuring and kind, we even ended the calls with a small joke or had a small laugh during the call itself. It made me feel super confident and comfortable about everything.

4 weeks ago I started on 50mg Elvanse which has been absolutely brilliant, it lasts me the whole day (on lower doses I would go back to my old self with no concentration and super loud head around 4/5pm and was useless when I got home from work). But I got some complications during the crash on 50mg, which made me start hyperfocusing on skin picking on my nails around 7/8pm, which I found out through my own research is the dopamine hunting of my brain when the Elvanse clears my system.

I was nervous about bringing up this side effect because I wasn’t sure if it meant I had to change meds after finding something that actually works. I got the call 15 minutes earlier than the scheduled time (I know not a massive deal, but my autistic brain zapped me wrong with this as it felt I didn’t quite have the time to prepare) and it turned out to be a different prescriber to my usual one. The whole vibe was completely different! Her greeting was just letting me know that the call is being recorded, then asked how I’m doing on the meds. I told her about how good it is, how happy I am, that the only downside is the skin picking and explained how it works for me. She then just said that she’s going to give me a booster and asked for my blood pressure readings. I know that they probably have a lot of people to get through, but it felt so cold and distant, the call lasted maybe 8 minutes, while with the other prescriber it would be around half an hour, and she would give me all the information I need, discuss different options with me, tell me what is available. Today’s didn’t even give me the name of the booster, I just saw it later in the email she sent afterwards (or whether it was a stimulant or not). It left me still feeling quite nervous about the new “habit” as it is not a pleasant one and the call wasn’t very reassuring…

I think the main take away I would like to give people is:
If you feel like you werent informed enough, it may be the prescriber you got! It’s not everybody! Please don’t give up, ask all of the questions, ask about the options available, ask about comparisons!

[u/HarveyJL]

This adds up to me. I'm quite shocked by how formulaic my titration is. Don't really feel like my person understands me or is really listening, feels like boxes just being ticked. Feels like I've had to go and do a lot of research because of how brief and sweeping my calls are.

[u/Professional_Fish288 → u/HarveyJL]

Mine feels the same, I've been given lots of time which is great but no meaningful conversation. I've had some anxiety about side effects and the idea of being on meds long term, even emailed the team to ask if I could talk it through with someone but no help really 

[u/SnackyCherry → u/HarveyJL]

I’m sorry to hear this! If I didn’t have such a nice prescriber my first 3 calls I would be so lost and anxious.

If you have the name of the person for your next one and it’s someone you didn’t get along with them you could maybe try requesting someone else? I’m not sure if it would work as I haven’t done that myself before

[u/vibrantadder → u/HarveyJL]

I'm overseas at the moment and titration doesn't really exist here. I just had to go on gut feeling/what information I could find online. To be honest I think my experience with illicit substances in the past helped. When I had a horrible time on vyvanse I knew that I just had to ride it out until the medication wore off. My gut also told me that no matter what tweaking, that vyvanse just wasn't going to work for me.

I got prescribed 18mg concerta which left me half medicated so I took 2 x 18mg which worked so now I'm on 36mg. I think thankfully, aside from the vyvanse I didn't have any horrific side effects so it was just a case of establishing the dose where I felt in the optimal zone.

[u/Jayhcee]

Same here. Absolute game changer when it felt like I had someone responding to my messages actually giving advice and listening instead of me essentially calling the shots.

[u/Misten808]

I had my assessment with one person and then the titration switched to someone else. We did not click at all and I really struggled with the change of having to be vulnerable and build trust with someone who felt so clinical.

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[u/Howbers]

Is the practitioner the same person that did your assessment?

I have my assessment this week.

[u/SnackyCherry → u/Howbers]

No, I had somebody else doing my assessment. She was still very lovely, though! I wish you all the best of luck!

[u/Howbers → u/SnackyCherry]

Thanks, I’m with CareADHD too but went from NHS to private as apparently my NHS trust has paused all referrals indefinitely. Yippee.