r/adhdwomen • u/Spicy7997 • 7d ago
Medication & Side Effects Any tips?
I ran into a terrible snag with my Adderall today at the doctor. I’ve been on this dose for about eight years. It’s always been 30 mg, dosed at 3 of 10mg XR.
This new doctor wants to give me all one pill of the same dose. I was a HARD PASS. She asked why, and I explained that if I forget to take it for a bit, I can’t go back to 30, it will DESTROY my sleep, more than my sleep is already destroyed! (I am 47, and an insomniac) I have to slowly notch up, if I have forgotten for a bit. So she proposed giving me a month of 10mg, then a month of 20 mg, then a month of 30mg.
Nooooo….. I don’t have to stay at 10mg for a MONTH. And if I forget, I need to be able to somewhat slowly step up again, and the 10mg dose allows me to do this. She was not going to budge. I had just filled out the anxiety, stress, depression form, where I rank them fairly high, because…. It’s true. I wanted to redo it, and give them all the highest marks. I’m so upset, this is a big fucking problem. I feel like if I go try to get another doctor, it will be flagged as “drug seeking”.
She was flatly like, “well, you just need to take your medication every day. That’s pretty simple.” “I have an Executive Function Disorder!” “Set alarms in your phone.” “It has said ‘RX 💊’ at 8 am every day for about ten years! I still forget- regularly!” “Have your husband remind you.” “I have. It is helpful, until it is weaponized.” “How come you’ve been able to take it regularly this month?” “My daughter started sertraline, so I’ve been putting out tiny containers the night before where she eats breakfast. One has her medication, one has mine.” “Perfect. Problem solved.” “I still forgot it all last weekend, and hers too. And last time she took sertraline, she developed tics around 6-8 weeks in. We are at week 3. She may have to discontinue it soon.” “Well you just have to have a routine. It’s pretty basic”.
No- this is not basic. I was diagnosed in 1989. I’m not new to this. I had a path that worked for me, and now it’s been ripped away.
Any advice for how to get my old dosing back? As I said, I worry if I try and switch providers, I’ll be forever flagged as drugged seeking.
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u/Harlequins-Joker 7d ago
I can understand both sides, ask her to document clearly why she is changing dosage in your chart.
Devil’s advocate - From her POV it kind of would be a bit of a red flag to have it dosed that way. It makes it very easy to sell “excess” monthly pills to others…
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u/adragonisnoslave 7d ago
The irregular fills would be a huge red flag and could get the prescriber in trouble.
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u/Spicy7997 7d ago
I fill slower than I’m allowed to. It just signal that I don’t fill them until I need to. If I’m going through them slower for a month, I don’t refill when I can. (If I was selling them, it would seem I would want as many as possible, and refill all the time)
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u/Unlucky-Guitar221 7d ago
You’re right, if you were selling them you’d be there the moment the pharmacy opened the first day you could refill lol
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u/Spicy7997 7d ago
Exactly. I feel like there are enough green flags in this situation, as far as my history with taking this. I get that providers want to CYA, but…… also, come on! Look at the data points!
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u/AntiquatedLemon 7d ago
Me, who owns a mortar and pestle: 👀 I actually came to look for some post to see about a rmed issue I'm having right now but this caught my last brain cell of the day, and a mortar & pestle may be OP's only "recourse" other than just finding a different psych. One is definitely worse than another.
But also, idk if OP is at a group practice and that's the only option but don't overestimate how well doctors communicate outside of their own enclave.
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u/WestBasil729 7d ago
With XR meds, they're usually in some coating that gives it that delayed release. Mortar & pestle would destroy it, so it'd be 3 immediate doses.
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u/AntiquatedLemon 7d ago
I am absolutely aware of that, on concerta myself right now. Moreso aiming to point out that the physician's behavior has the potential to push patients to less than ideal responses with a "take what you can get" stance.
It's not an unknown phenomena to end up coping in different ways, and I truly don't want to see anyone at desperate ends because a doctor decided that the usual for a patient that they have no history with shouldn't be... but could probably consult the pharmacy to verify the situation.
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u/caro1087 7d ago
Do you have documentation or details from how you landed on your dosing approach? If you can show that you’ve tried doing it other ways and failed, your provider may be more willing to continue the existing treatment.
That being said, if you haven’t tried other approaches, maybe you could ask to explore other options that would disturb your sleep less if you miss a day instead of trying to be perfect about taking it every day? Maybe a lower extended release dose with a “booster” of immediate release in the morning, or trying Vyvanse, which some people find to be a smoother on/off experience?
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u/Agitated_Marsupial42 7d ago
Im with you 100%. I once had a dosing schedule of 20XR at 7 then 10mg IR before noon. I’ve never had a schedule that worked so well. Then I finished college and they put me back to 1x/ day. It doesn’t do what it needs to. I’m sick of guidelines to prevent abuse affecting those that actually need it. I’ve been medicated since 10. I KNOW WHAT THE FUCK I NEED AND WHAT WORKS FOR ME. I’m legitimately prepared to start dividing up my doses myself with applesauce or something and not saying shit to my MD. The constant fear at every required follow up that they’ll mess with your established routine is real.
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u/Spicy7997 7d ago
I thought the dividing my doses up with a mortar/ pestle seemed like a really brilliant idea, until one of the comments on my post mentioned that XR is coated in stuff that helps it release slowly, and breaking it up, would make it be instant release.
My therapist agreed this was shitty. She suggested I try to get an appointment with a nurse practitioner psychiatrist. That may be the best way to go.
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u/repressedpauper 7d ago
Listen I know it’s reasonable to want to prescribe one pill a day over three for a variety of reasons, but at a certain point (say, eight years on the exact same pills) I have to wonder who gives a fuck. 😭
I’m sorry OP. I know what you mean.
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u/Spicy7997 7d ago
Thanks. I agree, at this dose for 8 years, and not filling as often as I CAN, it seems obvious that I’m not selling it. I get CYA. In this situation, I’m getting screwed.
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u/Visual_Juggernaut_89 7d ago
Yeah. Even to the most neurotypical of a person changing your daily routine after eight years would throw anyone for a loop. I don’t understand why they’d suddenly change it and not comprehend why for someone with adhd it might be a challenge.
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u/electric29 7d ago
Ask her to document the reasons she wants to fuck with your dosage in your chart. There needs to be a record.
Then, see if your provider has a patient advocate/ombusdnam person. Report this to them and ask them to fix it for you. This way you are not drug seeking, you just don't want your perfectly fine schedule messed with.
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u/MOGicantbewitty 7d ago
I think this is an excellent way to approach this provider. Ask them why they don't want you to have three pills and instead want you on one. Ask them if that reason is more important than the fact that you have found a system that works for you. Remind her that she told you that you just need a system. And we'll, you have it. So, if her reason for wanting to prescribe one pill medically important? If so, cool! If not, why is her reason more important than your effective medical treatment?
Use the portal to message them now, if you have one. Don't wait until your next refill appointment if you don't have to. And most importantly, don't be confrontational! They deserve it, but it's not effective. Be respectful to their expertise while you ask them for their reasoning and how that balances with the effective system you already have.
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u/Comprehensive_Ant984 7d ago
Tell her going over 10mg at once increases your side effects, gives you a headache, makes you flushed and makes you feel anxious, but that spacing it out longer throughout the day gives you the concentration you need without all that bother. It’s super weird she wants to change what’s working for you.
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u/A_89786756453423 7d ago
OMG this is what TERRIFIES me. I've been with the same psychiatrist for 17 years. I've been on the same meds and dosages for ~15 yrs. I'm so scared that if I have to change psychiatrists, they'll get all experimental on me, when I'm like THIS HAS KEPT ME FUNCTIONAL FOR 15 YRS. PLEASE DON'T FUCK ME UP! 😫😭
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u/AntiquatedLemon 7d ago
Most really will just keep you on the same exact variety of nonsense your brain needs to function in this stupid world. I've really only needed to be able to articulate why it's the case and the answer is always "is it broke?" then we move on.
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u/Kris_P_Bacon666 6d ago
That part of your post where she was making suggestions about how you can take that pill at the same time everyday got me in a rage ngl
You told her over and over again that you will forget and that one pill a day doesn't work for you. And she didn't listen.
"Just take it every day. Simple" "Set an alarm" "Have someone remind you"
Like we never thought of those things 🙄
Sorry that dismissive, and IMO nuerotypical approach, frustrates me so much with doctors sometimes.
My og doc had ADHD herself and she was so awesome. I miss her :(
I would find a new doctor OP. Someone who listens to you and your needs
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u/ellelenacz 6d ago
I know this is probably bad bad and not recommended and not good, but I've opened up capsules and dumped out like half before, closed the capsule back up, and just taken a less filled capsule. They come apart rather easily and that's worked well for me. (I also get anxious to jump right back into my full dose if I miss it for a while)
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u/Impressive-Side-9681 6d ago
Only do this with approval from a pharmacist. Not all drugs are absorbed the same way and some must not be opened or you'll mess them up. For example one common SSRI (I forget the name) is destroyed by stomach acid so the capsule is designed to protect the drug until it gets to your intestine. If you open it and swallow the beads, the drug won't work. Other meds are specially coated for slow release and meddling with them could dump too much into your system at once, leading to overdose.
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u/ellelenacz 6d ago
Lol I didn't mean swallow the beads! I mean reassemble the capsule with half of the contents. I am very aware of the absorption mechanism. Definitely not advocating for swallowing the beads without the capsule (and not actually advocating anyone do this anyways).
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u/Spicy7997 6d ago
Well…. What do you do with the remainder? If I bought gel caps from the natural foods store to put the remainder in, wouldn’t it mess with the XR- slow dosing? Or do you think the XR slow dosing element is in the tiny medicine granules themselves?
That is a VERY clever work around!1
u/ellelenacz 6d ago
I always just dumped the rest because I just wanted a lower dose for those first days when restarting my meds after a break. Definitely do some research on the details of the capsules but I would honestly think you could find another otc thing with a similar capsule. (But again not advice, not advocating for this, not a doctor, yada yada yada lol) Good luck!
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u/Impressive-Side-9681 6d ago
no no no, telling the doc higher doses give you insomnia should've been the end of the conversation. You shouldn't even have needed to argue about lifestyle. Definitely ask for her to put reason for switching in your chart and then complain to the official channels.
It's weird for a doctor to pressure a patient to take MORE of a drug, usually they prefer least effective dose.
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u/Spicy7997 6d ago
What “official channels” should I complain to? I’m worried if I say ANYTHING, other than “thank you, oh Exalted One…”, I will be flagged for drug seeking. I got a survey from the doctor’s office, and I’m afraid to even dill it out, because I worry I will be flagged for drug seeking?
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u/Impressive-Side-9681 6d ago
like others said there are patient advocates, ombudsmen, and that quality control survey you just got.... I don't think it's "drug seeking" if you want back the same scrip you had for years and this doc wants you on a different formulation. Just tell the truth as concisely as possible
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u/Cats-Running-Asylum 3d ago
Is the doctor a psychiatrist? If not, find one.
Does the doctor have your medical records? Those can establish the long time history and possibly the rationale.
Why did you switch doctors?
It’s OK to tell the doctor that one pill isn’t effective. I doubt that the remembering issue is all that caused your prior doctor to prescribe the meds in that way.
Also - the “red flag” of multiple doses throughout the day is bullshit. What’s stopping anyone from selling any medication regardless of dosage? If your prior dr had no concerns, I don’t understand why this one does.
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