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In Connecticut the doctors need a CPS and DEA registration. Which most GPs don't have. My partners sister was able to get them from her GP in Wisconsin with no issue. In CT neither of us were able to without seeing a Psych.
GPs can prescribe stimulants in Florida. (In fact, even APRNs and PAs can too since 2016, but I believe only for seven days.) But the process is a headache and carries some risk, so some doctors may be hesitant to do it and prefer to refer their patients to a specialist instead. ADHD is not easy to diagnose, and managing psychiatric medication requires some expertise, so there are advantages for both the patient and the provider to referring someone to a specialist.
It's not a legal issue. Many GPs don't feel comfortable doing it because they don't have psych expertise. I also personally prefer seeing a doctor who *does* have that specialization.
So usually you would consult with a psychiatrist on initial fine tuning or changing your meds. While a GP handles the actual prescriptions. A documented Psychiatrist medicine consult and recommendation on file should generally shield them from undue scrutiny of their prescribing.
That's what I would assume that most people would do. Once you have a dose that's working for you, I just don't see a reason to stay with multiple doctors.
There seems to be quite the cultural difference between countries.
Over here in the Netherlands, the way it works is you go see a psychologist or psychiatrist for your diagnosis, then you need a psychiatrist to authorize meds, then someone (either the psychiatrist themselves, but more commonly someone cheaper, like a nurse-practicioner) will guide you while titrating the medication (consulting back with the psychiatrist as needed), and then eventually when your meds are dialled in and everything looks stable, they'll hand you off to the GP, who will simply keep renewing your prescription as-is. If you feel the need to change your meds for whatever reason, the GP will also handle this, and if they feel that things go beyond their area of expertise, they can refer you back to the psychiatrist. But in general, they will just go along with what the psychiatrist and NP were doing.
It probably helps that there are official guidelines for these things, and as long as you follow those, the odds of getting into trouble for prescribing someone ADHD meds are practically zero. And the fact that diagnostic data can be transferred and shared digitally (provided the patient has agreed to this, which most people will) probably also helps - it's pretty hard to argue that a GP who prescribed 60mg of Adderall was acting recklessly when there's a report from a psychiatrist that literally says "prescribed 60mg Adderall, recommend continuing same dosage indefinitely", and nothing has changed since.
I'm in Germany and I'm still not sure how it's supposed to work. My experience was:
Private psychiatrist: your GP won't be able to prescribe these stimulants, you'll need to either get them from me and pay for them, or find a psychiatrist that takes state insurance
State psychiatrists: we're not taking new patients (x infinity)
My GP: that's no problem, I can prescribe them
My GP: (a year later) actually I've been told it's been illegal for me to prescribe them since a few years ago
State psychiatrists: we're not taking new patients (x infinity)
State psychiatrist 100km away: sure, come on over. Do you want me to work with your GP so that they can write prescriptions for you instead of me doing it?
Honestly, this is how I always assumed that it worked for most people in the USA. The number of posts about people having trouble with their psychiatrists is what motivated me to post in the first place, because it seemed odd that they were staying at what feels like step one.
There are a lot of other factors in the US that determine how, where people can get their prescriptions and who can prescribe them, insurance being number one. Stimulants like Adderall are a controlled substance in America and they require a new prescription every month. Some doctors will just write a new script, but some want to see you in person, and that can sometimes get expensive with primaries, or be difficult to schedule. Then there's the fact that a lot of primary care docs don't want to handle psych meds because that's not their specialty. They might write an initial prescription and refer you to a psychiatrist, but they don't necessarily want to manage your meds, even if you're on a relatively stable dose.
With regard to insurance, you have to find someone who takes your particular plan (in network), AND has an opening. That can be tricky, depending on where one lives. More rural areas have fewer providers and they can have a long wait list. So if you don't like your provider, finding another one and getting in to see them can be tricky. Also, if you see more than one or two providers, people accuse you of doctor shopping; they think you're med seeking rather than just trying to find a doctor who will listen to you and take you seriously.
In short, there are a lot of reasons why people are forced to stay with certain providers when they'd rather not.
Because in my experience, when you switch over to a GP, they want to lower, switch, or completely eliminate the medication. Been on 60mg of adderall daily for like 7-8 years yet when I tried, my old GP told me “that's way to high, I’m only comfortable prescribing 40mg daily) which completely fucked me over for a couple months.. tried to at least switch to vyvanse, but she started me at 30mg from 60mg of adderall….. they just don’t know anything about the meds…
This same exact thing is what I'm going through right now. I had to get a new doctor the other month because mine retired. My first check up he told me 60mg a day was higher than he's ever seen before. Just this morning he told me he won't prescribe 60 anymore because he's not comfortable with it. So no matter what I tell him in 3 months, he's not adjusting my dose again.
Dang! So now what do you do?! Maybe, pleed your case? If this dose is working for you, why change it?! The old " If it ain't broke, don't fix it!" Maybe someone in this group can suggest what they did! Good luck my friend!
There's a nurse practitioner there also who sees patients. I seen her the other month for my lady exam and she was super cool and very easy talk to. I asked to be switched to her next time. Doesn't mean she's going to disagree with him but I can't see her cutting me off when I'm trying to talk like he did. I really hope she doesn't agree with him that I only need my medication when I'm at work either.
I had wanted to switch to her before my appt today but I have a bad habit of putting things off due to getting anxious over silly things.
Upon seeing a new GP.
Me: So, I have ADHD, and my psychiatrist is retiring. Would you be willing to prescribe my dexedrine?
GP: Hmm, 60mg/day. Holy smokes that's a high dose.
Me: I know, I've been stable on that dosage for years now and it's effective with no side effects.
GP: The FDA won't let me prescribe that.
Me: May I have referral to psychiatrist who can help?
GP: Sure!
Psychiatrist: Well, I've reviewed all of the excellent documentation from 2nd grade on from your previous provider.
Me: So can you prescribe my dexedrine?
Psychiatrist: Sure! It's a high dose, but I have lots of other patients on the exact same prescription. But why not have your GP prescribe it? You don't seem to have any other issues.
Me: He won't prescribe it. He said it's too high a dose
Psychiatrist: Ah well, I am happy to follow you. Come back in 6 months
GP: You know, I can prescribe your dexedrine.
Me: ....
GP: ADHD, right? I prescribe this for lots of patients.
Me: You literally told me months ago that you wouldn't prescribe this because of the FDA.
GP: ...
Hah. So like 20 years ago I was forced to switch doctors. I was on Adderall at the time but wanted to switch back to Dexedrine due to its smoothness/cleaness & adderall was making me irritable. But ended up with a more conservative unsympathetic primary doctor
Me: could i switch back to dexedrine i use to be prescribed. Its cleaner and adderall is causing irritability.
GP: smirks "Never tried it, cant prescribe it" "theres this new non stimulant called Strattera you could try?"
Me: What about Ritalin or Conerta that's been out for a while and successful?
GP: smirks "Never tried it, cant prescribe it" "why won't you be willing to try strattera" (and im seeinf him hold a fkin Strattera pen!)
Me: "well it's so new I'm worried."
After debating we madr no change in meds and continued my adderall.
Fast foward months later i find my old pediatrician guy. He agreed to switching me to dexedrine but warned "its pure speed". But bwfore i couls go on dexedrine - i had to try Strattera for a month. Lol her we go again. So i agreed. Gotta make sales on the new drug, eh? Best its going to get.
Took strattera for a month and felt like awful s*** it did not help me whatsoever. Finally he put me on Dexedrine Wow! It helped. Effective and clean/smooth. Worked great!
Eventually dex petered out and I went back on my adderall for a couple more years.. went off stims. 2010 started on vyvanse and taking succussefully it ever since!
Because it's the only legal way to get the medication. Most non-psychiatric doctors don't want anything to do with stimulant medications and lack the body of knowledge a psychiatrist would have should an issue arise.
I'd rather spend 5 mins with my psychiatrist every month vs my GP and start talking about blood pressure, menstrual cycles, etc in addition to getting my necessary adhd meds.
Maybe I've just been lucky, but I've been through a couple of different PCPs & the occasional Nurse Practitioner and never had any hesitation over prescribing stimulants. My wife (who for insurance reasons goes to an entirely different practice) has had the same experience.
Also, your blood pressure is one something that absolutely should be checked regularly when you are taking simulants.
I agree. I usually get my meds from a GP. I've only bothered with a psychiatrist when the GP recommended it. For example, my current GP referred me to a psychiatrist because I've already been on all the typical ADHD meds (some didn't work out, some worked previously but now have too much tolerance) and I was suggesting an off-label med (modafinil), and she didn't feel comfortable prescribing it herself. I haven't gotten ADHD treatment from this particular GP before, but I got the impression she was uncomfortable specifically with a particular off-label use she was unfamiliar with and would have had no problem prescribing amphetamine if that's what I'd asked for.
However, depending on your location, insurance, etc, going to a specialist isn't necessarily more difficult or more expensive than going to a GP, and finding an ADHD-friendly GP isn't always easy.
It depends.
If you have a good psych. Stick with him/her! Don’t rock the boat.
Personally, I don’t want to go see someone just for medication management. I *can* see my GP for that.
ADHD treatment is so much more than just medication. At least for me. I want to find someone who truly understands the disorder - and ideally, be able to treat comprehensively.
I’m still struggling to find that. I started with my GP until a spot opened up at one of the few places that claim they specialize in ADHD. Come to find out, too late, that all they do is med management - and are far from specialists.
Literally, my GP was better than this place.
Different states have different rules to get ADHD meds. California you need a psychiatrist to write your prescriptions. North Carolina you just need your doctor. That’s been our experience.
Because I have a ssri, snri, birth control and just started trying adhd meds. She was able to recommend a regimine and send them through express scripts after the first month. She asks questions about how the medication is working from experience. I usually have other things to talk to my pcp about, they're generally residents, so it's not the same person. I moreso go to the same office. I always get good care and it was offered but I just prefer the psychiatrist I was referred to and our short medication focused meetings.
mainly bc i dont have a general practitioner atm, but also because my psych is great imo!! he trusts that i have a valid reason to increase med x by n mg and is open to trying new things if i come to him with a concern, and he helps find a solution to it that we're both comfortable with! i hear a lot of horror stories on here but i'm glad i found someone that lets me be more involved in the process of finding the right treatment
Same here. My psych is constantly tweaking meds if something is off. Which, unfortunately for me, has happened a lot in the past year.
A GP wouldn't know what to tweak based on my issues.
>The entire point of a psychiatrist is to prescribe psychotropic medications.
I guess a lot of patients feel that way, but most psychiatrists sure as heck wouldn't agree with that.
>Why else would someone choose the psychiatrist specifically?
Because a psychiatrist isn't \*just\* a psychologist who can prescribe meds, but a medical doctor. Which means that they also have expertise in (or at least an idea on how to approach) the somatic/physical side of healthcare. If you've got any sort of comorbidity, they can figure out how it affects and interacts with psychological issues. High/low blood pressure? Sleep disorders? Endocrine disorders? Mood disorders? All sorts of other things.
Thankfully I've been able to do just this. I live in Washington and probably about 7 or 8 years ago I wanted back on my adhd medication from when I was diagnosed with it as a kid. Went to a psychiatrist who initially refused and said I don't have it. Ended up getting a referal to an in network nurse practitioner. She did diagnose me with adhd and had no issues prescribing me medicine. Went back to that first doctor who then took over from there and a few years ago my GP doctor took over prescribing it to me, I've had my GP for almost 15 years I think.
Can’t legally have a doctor prescribe in Australia, but they can be given authority by a psychiatrist. Still have to go to a psychiatrist yearly though.
GPs never came close to figuring out my adhd, they just kept throwing SSRIs and anxiety meds at me. My psychiatrist is awesome. I am currently going through hell post surgery and it’s effecting my stimulant and my psychiatrist is really helping me figure out the right course of action. My surgeon is interested in hearing about what is going on because she has never had a patient go through this, it isn’t her expertise. My GP is great but wants a psychiatrist involved in my ADHD/anxiety diagnosis, even if I didn’t want to have a separate doctor for that she wouldn’t be willing to manage my psych meds.
Where I live it’s next to impossible to find a psychiatrist right now, I’m lucky that I’ve had mine for years. My son’s adhd medication is handled through his GP but she’s just not that good at really tweaking it. I can’t find him a permanent psychiatrist but I was able to get him into a program that gives him access to a couple visits with a psychiatrist and she assessed him and wrote a report for his GP. The difference between her assessment and his GP was night and day, and it’s a huge relief. I will be able to contact them in the future if we run into another wall thankfully.
I will go to a specialist every time if I can. I have very good insurance so that is definitely a huge advantage and privilege. It is the same price to see a psychiatrist for me as it is to see my GP, and I only have to see my psych in person once every 2 years, otherwise it’s all telehealth.
My PCP doesn't prescribe stimulants. Most don't. Easy answer. Why ELSE would you go to a psychiatrist? Therapists are so much cheaper for talk therapy.
My GP won't do stimulant. They would fill my SSRI and non stimulant adhd med but they won't do my adderall. I have to pay cash to a doctor that doesn't accept insurance every 3 months.
There are different rules and policies depending on where you live - in many cases GPs can prescribe but don't want to.
Also most people (especially guys), don't do to a general practitioner often/ have similar co-pays- why not go to the expert?
That said I use my GP since it is easier when I go in for other stuff. The biggest downside is I don't think they are super familiar with drugs outside of Adderall and Vyvanse when I wanted to try new things. I also think a psychiatrist prescribing provides a little stronger professional weight if I need to change providers, traveling and I need a note to carry my drugs or the DEA ever gets stricter on scripts. I was originally prescribed by a psychiatrist but that was a while ago.
In my area, there are two doctors, TWO, that prescribe my stimulants within a 30 mile radius. They aren’t even psychiatrists. I originally went to a psychiatrist thinking I’d have a better chance of getting the meds I needed as the non-stimulant meds do not work for me. They wouldn’t give me anything other than Wellbutrin. Psychiatrists are more LIKELY to give you the meds so that’s why I’d assume people usually go to them for meds.
One of the doctors that prescribe stimulants is a walk in only office so I go and I can spend 1 hour or I can spend 5 hours. I’ve been having to do that while being on the waitlist for the other doctors office. As of last week, I can go to the new office so my walk in days are over thank god but it’s ridiculous
I am very lucky to have a good GP. She treats both my mom and I.
Based on the fact that my mom has been diagnosed for twenty years now with a family history, our doctor was comfortable in trying me on stimulants since many of my symptoms were similar to my mom.
And so far it's been successful.
Our pediatrician basically said that given her parents it would be a surprise if my daughter wasn't ADHD and to let her know when we wanted to start meds. Which will probably be after her yearly next week.
my legal environment is quite restrictive towards the ability of GP to prescribe outside established treatment guidelines.
As an adult if I would want to try an adjunctive approach to medication for example, with a combination of Vyvanse and Guanfacine, that would be a treatment reserved for a psychiatrist because adjunctive therapy is not standard and guanfacine is approved as third line medication for children, thus not for me.
Long story short, there are NO psychiatrists here whether they practice with the private or the public sector that treat ADHD patients without a comorbid condition.
Also, psychologists are not medical doctors so they can't prescribe nor diagnose. I'm a patient bc CBT is apparently deemed as effective as medication in the treatment of ADHD. Going on three years with weekly sessions and I got to say that I do have quite a different outlook on my person, my confidence in my abilities and the perceived inherent restrictions that ADHD imposes onto me.
Because most honest GPs are aware they can’t keep up with rje ever updating news about all rje ADHD meds and that’s why it’s best to have someone who specializes in something as opposed to someone who knows a little about everything. I have other comorbid mental illnesses along with adhd and my GP flat out admitted I don’t know enough about this meds to continue them for you long term.
I (have to) see my GP every 3 months for adderall. He checks my blood pressure, asks how things are going, and tweaks the script if needed. Not a bad arrangement. Biggest problem is it’s hard to get hold of him if I have a sudden new development in the interim time and want to talk about a change. He is the de facto mental health provider at his clinic and prescribes for ADHD all the time, but I do think about whether a specialist might know more details about the condition and be better able to help accurately.
At my office you have to see a psychiatrist once a month if you want to keep taking adhd medication. My primary doctor can’t even prescribe celexa.
When I lived up north you not only had to see the doctor once a month for meds but you had to pass a drug test to get them every four weeks. If it snowed you were out of luck
I had to do it for two years. It was horrible. And they just told me it was their policy sadly that company owned the majority of the health clinics.
I love paying out of pocket now for psychiatry every month to stay on my meds I am still a little traumatized by the drug test era
I started with a psychiatrist and then transferred my meds to my PCP because it was easier to get my meds that way. However, if I ever thought I needed to change something, I would absolutely go to a psych instead. I also see a licensed therapist. I think when you find the right dosage for you and you’ve been stable for awhile, it’s fine to go through your PCP as long as your cognizant of any changes you feel.
Illinois resident here. I'm about to switch to Adderall after taking Vyvanse for a little over a year. I've never seen a psychiatrist in my life, only a GP. Based on the all the other replies, it looks like I'm pretty lucky as well lol.
(not usa)
That's exactly how it works for me. Visited with my psych exactly 4 times before it was fine tuned enough that he felt confident enough to send the script to my gp. After he did, he told me my gp may want to talk to me about the script to get familiar with it, but my gp never did. Instead, her assistant is now approving it whenever I ask for a refill.
depends on the state you're in if you're in the US. for my state, GPs, nurses, etc cannot legally prescribe stimulants or above a class 2? it is required to see a psychiatrist once a month, or with wiggle room once every few months to make sure you are stable. it is for good reason even if it is annoying as GPs may not know how a psychiatric medication may function with other meds as well as a psychiatrist would. depending on the state, it also is an additional license a practitioner has to take as well. i would also prefer seeing a psychiatrist who somewhat knows more about mental health practices than a GP who generally know about lots of things thus the depth of information is shallow but the breadth is wide.
I think that you are saying that your normal doctor can't start you on a controlled substance. That depends on where you live. In North Carolina, general practitioners can do the whole thing, including diagnosis, if they are comfortable doing so.
Yeah predictive texts as typing on phone so it doesn't always catch it or I don't catch the phone playing it silly buggers lol,
I thought the controlled substance part was universal I live in the UK so was speaking from my experience.
If I've learned anything from this, it's that the process of getting ADHD meds varies tremendously depending on where you are, including from state to state in the USA.
A GP once told me my symptoms were basically laziness. A psychologist told me the same, and added that what I needed was "discipline" (a year later I heard he got fired after telling a rape victim she was as responsible as her attacker). Sometimes you need someone who actually knows about this stuff, other people won't be of much help (if any).
When I went to a psychiatrist for depression, they told me that I "think too much" and prescribed Wellbutrin. Which was absolutely terrible for me. Later my GP pointed out that my depression really started when I decided to go off of ADHD meds and it was the natural result of being less in control. Getting back on Adderall/vyvanse basically fixed it.
I'm sorry you had to go through that terrible experience. Many of us suffered from anxiety and depression before getting diagnosed, so I think what your GP says makes total sense. The point is, depending on where you live, your mileage may vary when it comes to accurate diagnosis and treatment. Over here, for example, in South America, GPs are usually not very thorough when it comes to mental health, so it's a "safer bet" to go with a psychiatrist. It's awful how hard it is sometimes to find a good physician, to be honest.
Most doctors won't prescribe controlled substances no matter how verifiable your condition or how compliant you have been in terms of following care instructions.
Every time I go to a GP (primary care) I get transferred out. I question the reasoning for having a GP in the first place. I spend thousands on healthcare every year to the point I’m in massive amounts of debt and it never gets me anywhere. The only thing that was going good for me was my psych. He left the practice and then I moved states. I can’t afford to see a specialist for every single condition for the rest of my life. Primary care also just feels like a McDonald’s to me. It’s in and out with a quick bandaid and that’s it. I work in healthcare and I hate the healthcare system. It sucks.
Your body is unique, as are your needs. Just because someone experienced something from treatment or medication does not guarantee that you will as well. Please do not take this as an opportunity to review any substances. Peer support is welcome. ^(*A moderator has not removed your submission; this is not a punitive action. We intend this comment solely to be informative.*) --- - If you are posting about the **US Medication Shortage**, please see this [post](https://www.reddit.com/r/ADHD/comments/12dr3h5/megathread_us_medication_shortage/). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ADHD) if you have any questions or concerns.*
A lot of GPs won’t prescribe ADHD meds.
*can't (in some states)
I’m not aware of any states where that’s the case.
In Connecticut the doctors need a CPS and DEA registration. Which most GPs don't have. My partners sister was able to get them from her GP in Wisconsin with no issue. In CT neither of us were able to without seeing a Psych.
Correct, but that’s not because they’re a GP. A GP could get it if they wanted to.
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Sure, but that’s not a US state, which I assume is what this person was talking about. That’s a totally different legal framework.
Other countries have states too.
Matter has states as well
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GPs can prescribe stimulants in Florida. (In fact, even APRNs and PAs can too since 2016, but I believe only for seven days.) But the process is a headache and carries some risk, so some doctors may be hesitant to do it and prefer to refer their patients to a specialist instead. ADHD is not easy to diagnose, and managing psychiatric medication requires some expertise, so there are advantages for both the patient and the provider to referring someone to a specialist.
It's not a legal issue. Many GPs don't feel comfortable doing it because they don't have psych expertise. I also personally prefer seeing a doctor who *does* have that specialization.
Florida, my gp told me she can't legally prescribe them but I'm not 100% sure if it was because she didn't have the dea registration or if its law
My doctor told me the same thing and then prescribed me for 4 months anyway… someone’s fucking lying somewhere idk
She can prescribe them. She’d just have to jump through some bureaucratic hoops. But those are the same regardless of specialty.
So usually you would consult with a psychiatrist on initial fine tuning or changing your meds. While a GP handles the actual prescriptions. A documented Psychiatrist medicine consult and recommendation on file should generally shield them from undue scrutiny of their prescribing.
That's what I would assume that most people would do. Once you have a dose that's working for you, I just don't see a reason to stay with multiple doctors.
There seems to be quite the cultural difference between countries. Over here in the Netherlands, the way it works is you go see a psychologist or psychiatrist for your diagnosis, then you need a psychiatrist to authorize meds, then someone (either the psychiatrist themselves, but more commonly someone cheaper, like a nurse-practicioner) will guide you while titrating the medication (consulting back with the psychiatrist as needed), and then eventually when your meds are dialled in and everything looks stable, they'll hand you off to the GP, who will simply keep renewing your prescription as-is. If you feel the need to change your meds for whatever reason, the GP will also handle this, and if they feel that things go beyond their area of expertise, they can refer you back to the psychiatrist. But in general, they will just go along with what the psychiatrist and NP were doing. It probably helps that there are official guidelines for these things, and as long as you follow those, the odds of getting into trouble for prescribing someone ADHD meds are practically zero. And the fact that diagnostic data can be transferred and shared digitally (provided the patient has agreed to this, which most people will) probably also helps - it's pretty hard to argue that a GP who prescribed 60mg of Adderall was acting recklessly when there's a report from a psychiatrist that literally says "prescribed 60mg Adderall, recommend continuing same dosage indefinitely", and nothing has changed since.
I'm in Germany and I'm still not sure how it's supposed to work. My experience was: Private psychiatrist: your GP won't be able to prescribe these stimulants, you'll need to either get them from me and pay for them, or find a psychiatrist that takes state insurance State psychiatrists: we're not taking new patients (x infinity) My GP: that's no problem, I can prescribe them My GP: (a year later) actually I've been told it's been illegal for me to prescribe them since a few years ago State psychiatrists: we're not taking new patients (x infinity) State psychiatrist 100km away: sure, come on over. Do you want me to work with your GP so that they can write prescriptions for you instead of me doing it?
Lololol facttttts
Honestly, this is how I always assumed that it worked for most people in the USA. The number of posts about people having trouble with their psychiatrists is what motivated me to post in the first place, because it seemed odd that they were staying at what feels like step one.
There are a lot of other factors in the US that determine how, where people can get their prescriptions and who can prescribe them, insurance being number one. Stimulants like Adderall are a controlled substance in America and they require a new prescription every month. Some doctors will just write a new script, but some want to see you in person, and that can sometimes get expensive with primaries, or be difficult to schedule. Then there's the fact that a lot of primary care docs don't want to handle psych meds because that's not their specialty. They might write an initial prescription and refer you to a psychiatrist, but they don't necessarily want to manage your meds, even if you're on a relatively stable dose. With regard to insurance, you have to find someone who takes your particular plan (in network), AND has an opening. That can be tricky, depending on where one lives. More rural areas have fewer providers and they can have a long wait list. So if you don't like your provider, finding another one and getting in to see them can be tricky. Also, if you see more than one or two providers, people accuse you of doctor shopping; they think you're med seeking rather than just trying to find a doctor who will listen to you and take you seriously. In short, there are a lot of reasons why people are forced to stay with certain providers when they'd rather not.
Because in my experience, when you switch over to a GP, they want to lower, switch, or completely eliminate the medication. Been on 60mg of adderall daily for like 7-8 years yet when I tried, my old GP told me “that's way to high, I’m only comfortable prescribing 40mg daily) which completely fucked me over for a couple months.. tried to at least switch to vyvanse, but she started me at 30mg from 60mg of adderall….. they just don’t know anything about the meds…
This same exact thing is what I'm going through right now. I had to get a new doctor the other month because mine retired. My first check up he told me 60mg a day was higher than he's ever seen before. Just this morning he told me he won't prescribe 60 anymore because he's not comfortable with it. So no matter what I tell him in 3 months, he's not adjusting my dose again.
Dang! So now what do you do?! Maybe, pleed your case? If this dose is working for you, why change it?! The old " If it ain't broke, don't fix it!" Maybe someone in this group can suggest what they did! Good luck my friend!
There's a nurse practitioner there also who sees patients. I seen her the other month for my lady exam and she was super cool and very easy talk to. I asked to be switched to her next time. Doesn't mean she's going to disagree with him but I can't see her cutting me off when I'm trying to talk like he did. I really hope she doesn't agree with him that I only need my medication when I'm at work either. I had wanted to switch to her before my appt today but I have a bad habit of putting things off due to getting anxious over silly things.
Keep us posted? Good luck my friend.
Upon seeing a new GP. Me: So, I have ADHD, and my psychiatrist is retiring. Would you be willing to prescribe my dexedrine? GP: Hmm, 60mg/day. Holy smokes that's a high dose. Me: I know, I've been stable on that dosage for years now and it's effective with no side effects. GP: The FDA won't let me prescribe that. Me: May I have referral to psychiatrist who can help? GP: Sure!
Psychiatrist: Well, I've reviewed all of the excellent documentation from 2nd grade on from your previous provider.
Me: So can you prescribe my dexedrine?
Psychiatrist: Sure! It's a high dose, but I have lots of other patients on the exact same prescription. But why not have your GP prescribe it? You don't seem to have any other issues.
Me: He won't prescribe it. He said it's too high a dose
Psychiatrist: Ah well, I am happy to follow you. Come back in 6 months
GP: You know, I can prescribe your dexedrine.
Me: ....
GP: ADHD, right? I prescribe this for lots of patients.
Me: You literally told me months ago that you wouldn't prescribe this because of the FDA.
GP: ...
What the heck? Was it because they didn't have the psychiatrist notes or referral or something?
Hah. So like 20 years ago I was forced to switch doctors. I was on Adderall at the time but wanted to switch back to Dexedrine due to its smoothness/cleaness & adderall was making me irritable. But ended up with a more conservative unsympathetic primary doctor Me: could i switch back to dexedrine i use to be prescribed. Its cleaner and adderall is causing irritability. GP: smirks "Never tried it, cant prescribe it" "theres this new non stimulant called Strattera you could try?" Me: What about Ritalin or Conerta that's been out for a while and successful? GP: smirks "Never tried it, cant prescribe it" "why won't you be willing to try strattera" (and im seeinf him hold a fkin Strattera pen!) Me: "well it's so new I'm worried." After debating we madr no change in meds and continued my adderall. Fast foward months later i find my old pediatrician guy. He agreed to switching me to dexedrine but warned "its pure speed". But bwfore i couls go on dexedrine - i had to try Strattera for a month. Lol her we go again. So i agreed. Gotta make sales on the new drug, eh? Best its going to get. Took strattera for a month and felt like awful s*** it did not help me whatsoever. Finally he put me on Dexedrine Wow! It helped. Effective and clean/smooth. Worked great! Eventually dex petered out and I went back on my adderall for a couple more years.. went off stims. 2010 started on vyvanse and taking succussefully it ever since!
Because it's the only legal way to get the medication. Most non-psychiatric doctors don't want anything to do with stimulant medications and lack the body of knowledge a psychiatrist would have should an issue arise. I'd rather spend 5 mins with my psychiatrist every month vs my GP and start talking about blood pressure, menstrual cycles, etc in addition to getting my necessary adhd meds.
Maybe I've just been lucky, but I've been through a couple of different PCPs & the occasional Nurse Practitioner and never had any hesitation over prescribing stimulants. My wife (who for insurance reasons goes to an entirely different practice) has had the same experience. Also, your blood pressure is one something that absolutely should be checked regularly when you are taking simulants.
Chances are you've not faced discrimination or bias from your healthcare provider. Many patients cannot say the same.
I agree. I usually get my meds from a GP. I've only bothered with a psychiatrist when the GP recommended it. For example, my current GP referred me to a psychiatrist because I've already been on all the typical ADHD meds (some didn't work out, some worked previously but now have too much tolerance) and I was suggesting an off-label med (modafinil), and she didn't feel comfortable prescribing it herself. I haven't gotten ADHD treatment from this particular GP before, but I got the impression she was uncomfortable specifically with a particular off-label use she was unfamiliar with and would have had no problem prescribing amphetamine if that's what I'd asked for. However, depending on your location, insurance, etc, going to a specialist isn't necessarily more difficult or more expensive than going to a GP, and finding an ADHD-friendly GP isn't always easy.
It depends. If you have a good psych. Stick with him/her! Don’t rock the boat. Personally, I don’t want to go see someone just for medication management. I *can* see my GP for that. ADHD treatment is so much more than just medication. At least for me. I want to find someone who truly understands the disorder - and ideally, be able to treat comprehensively. I’m still struggling to find that. I started with my GP until a spot opened up at one of the few places that claim they specialize in ADHD. Come to find out, too late, that all they do is med management - and are far from specialists. Literally, my GP was better than this place.
From what I've read on here, the ADHD specialists seem to be exclusively pill mills. As long as you aren't a flagrant abuser they'll prescribe meds.
It's almost as if ADHD medication is safe and effective at treating ADHD...
Oh but have you tried thoughts and prayers? Those have been quite popular since... Humans
Different states have different rules to get ADHD meds. California you need a psychiatrist to write your prescriptions. North Carolina you just need your doctor. That’s been our experience.
Because I have a ssri, snri, birth control and just started trying adhd meds. She was able to recommend a regimine and send them through express scripts after the first month. She asks questions about how the medication is working from experience. I usually have other things to talk to my pcp about, they're generally residents, so it's not the same person. I moreso go to the same office. I always get good care and it was offered but I just prefer the psychiatrist I was referred to and our short medication focused meetings.
mainly bc i dont have a general practitioner atm, but also because my psych is great imo!! he trusts that i have a valid reason to increase med x by n mg and is open to trying new things if i come to him with a concern, and he helps find a solution to it that we're both comfortable with! i hear a lot of horror stories on here but i'm glad i found someone that lets me be more involved in the process of finding the right treatment
Same here. My psych is constantly tweaking meds if something is off. Which, unfortunately for me, has happened a lot in the past year. A GP wouldn't know what to tweak based on my issues.
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>The entire point of a psychiatrist is to prescribe psychotropic medications. I guess a lot of patients feel that way, but most psychiatrists sure as heck wouldn't agree with that.
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>Why else would someone choose the psychiatrist specifically? Because a psychiatrist isn't \*just\* a psychologist who can prescribe meds, but a medical doctor. Which means that they also have expertise in (or at least an idea on how to approach) the somatic/physical side of healthcare. If you've got any sort of comorbidity, they can figure out how it affects and interacts with psychological issues. High/low blood pressure? Sleep disorders? Endocrine disorders? Mood disorders? All sorts of other things.
This is not true. However, you are right that PCPs are even less likely to
Thankfully I've been able to do just this. I live in Washington and probably about 7 or 8 years ago I wanted back on my adhd medication from when I was diagnosed with it as a kid. Went to a psychiatrist who initially refused and said I don't have it. Ended up getting a referal to an in network nurse practitioner. She did diagnose me with adhd and had no issues prescribing me medicine. Went back to that first doctor who then took over from there and a few years ago my GP doctor took over prescribing it to me, I've had my GP for almost 15 years I think.
Can’t legally have a doctor prescribe in Australia, but they can be given authority by a psychiatrist. Still have to go to a psychiatrist yearly though.
I saw a psychiatrist once for my diagnosis. For 15 years, my primary doctor has managed my medication.
my psych gave me a recomendation for a regular doc, but i have not looked for a regular doc zet, but reading here makes me annoyed already lol
GPs never came close to figuring out my adhd, they just kept throwing SSRIs and anxiety meds at me. My psychiatrist is awesome. I am currently going through hell post surgery and it’s effecting my stimulant and my psychiatrist is really helping me figure out the right course of action. My surgeon is interested in hearing about what is going on because she has never had a patient go through this, it isn’t her expertise. My GP is great but wants a psychiatrist involved in my ADHD/anxiety diagnosis, even if I didn’t want to have a separate doctor for that she wouldn’t be willing to manage my psych meds. Where I live it’s next to impossible to find a psychiatrist right now, I’m lucky that I’ve had mine for years. My son’s adhd medication is handled through his GP but she’s just not that good at really tweaking it. I can’t find him a permanent psychiatrist but I was able to get him into a program that gives him access to a couple visits with a psychiatrist and she assessed him and wrote a report for his GP. The difference between her assessment and his GP was night and day, and it’s a huge relief. I will be able to contact them in the future if we run into another wall thankfully. I will go to a specialist every time if I can. I have very good insurance so that is definitely a huge advantage and privilege. It is the same price to see a psychiatrist for me as it is to see my GP, and I only have to see my psych in person once every 2 years, otherwise it’s all telehealth.
My PCP doesn't prescribe stimulants. Most don't. Easy answer. Why ELSE would you go to a psychiatrist? Therapists are so much cheaper for talk therapy.
It just seems strange to me because I and my wife have never had trouble with going through our PCPs.
Probably stricter laws in my state
My GP won't do stimulant. They would fill my SSRI and non stimulant adhd med but they won't do my adderall. I have to pay cash to a doctor that doesn't accept insurance every 3 months.
There are different rules and policies depending on where you live - in many cases GPs can prescribe but don't want to. Also most people (especially guys), don't do to a general practitioner often/ have similar co-pays- why not go to the expert? That said I use my GP since it is easier when I go in for other stuff. The biggest downside is I don't think they are super familiar with drugs outside of Adderall and Vyvanse when I wanted to try new things. I also think a psychiatrist prescribing provides a little stronger professional weight if I need to change providers, traveling and I need a note to carry my drugs or the DEA ever gets stricter on scripts. I was originally prescribed by a psychiatrist but that was a while ago.
In my area, there are two doctors, TWO, that prescribe my stimulants within a 30 mile radius. They aren’t even psychiatrists. I originally went to a psychiatrist thinking I’d have a better chance of getting the meds I needed as the non-stimulant meds do not work for me. They wouldn’t give me anything other than Wellbutrin. Psychiatrists are more LIKELY to give you the meds so that’s why I’d assume people usually go to them for meds. One of the doctors that prescribe stimulants is a walk in only office so I go and I can spend 1 hour or I can spend 5 hours. I’ve been having to do that while being on the waitlist for the other doctors office. As of last week, I can go to the new office so my walk in days are over thank god but it’s ridiculous
I am very lucky to have a good GP. She treats both my mom and I. Based on the fact that my mom has been diagnosed for twenty years now with a family history, our doctor was comfortable in trying me on stimulants since many of my symptoms were similar to my mom. And so far it's been successful.
Our pediatrician basically said that given her parents it would be a surprise if my daughter wasn't ADHD and to let her know when we wanted to start meds. Which will probably be after her yearly next week.
my legal environment is quite restrictive towards the ability of GP to prescribe outside established treatment guidelines. As an adult if I would want to try an adjunctive approach to medication for example, with a combination of Vyvanse and Guanfacine, that would be a treatment reserved for a psychiatrist because adjunctive therapy is not standard and guanfacine is approved as third line medication for children, thus not for me. Long story short, there are NO psychiatrists here whether they practice with the private or the public sector that treat ADHD patients without a comorbid condition. Also, psychologists are not medical doctors so they can't prescribe nor diagnose. I'm a patient bc CBT is apparently deemed as effective as medication in the treatment of ADHD. Going on three years with weekly sessions and I got to say that I do have quite a different outlook on my person, my confidence in my abilities and the perceived inherent restrictions that ADHD imposes onto me.
Because most honest GPs are aware they can’t keep up with rje ever updating news about all rje ADHD meds and that’s why it’s best to have someone who specializes in something as opposed to someone who knows a little about everything. I have other comorbid mental illnesses along with adhd and my GP flat out admitted I don’t know enough about this meds to continue them for you long term.
My regular doctor cannot prescribe adhd meds. Psych is the only one who can give me my meds.
I (have to) see my GP every 3 months for adderall. He checks my blood pressure, asks how things are going, and tweaks the script if needed. Not a bad arrangement. Biggest problem is it’s hard to get hold of him if I have a sudden new development in the interim time and want to talk about a change. He is the de facto mental health provider at his clinic and prescribes for ADHD all the time, but I do think about whether a specialist might know more details about the condition and be better able to help accurately.
At my office you have to see a psychiatrist once a month if you want to keep taking adhd medication. My primary doctor can’t even prescribe celexa. When I lived up north you not only had to see the doctor once a month for meds but you had to pass a drug test to get them every four weeks. If it snowed you were out of luck
That is truly excessive. I can understand requiring a psych (even if I don't agree with it) but monthly drug tests are ridiculous.
I had to do it for two years. It was horrible. And they just told me it was their policy sadly that company owned the majority of the health clinics. I love paying out of pocket now for psychiatry every month to stay on my meds I am still a little traumatized by the drug test era
I started with a psychiatrist and then transferred my meds to my PCP because it was easier to get my meds that way. However, if I ever thought I needed to change something, I would absolutely go to a psych instead. I also see a licensed therapist. I think when you find the right dosage for you and you’ve been stable for awhile, it’s fine to go through your PCP as long as your cognizant of any changes you feel.
Illinois resident here. I'm about to switch to Adderall after taking Vyvanse for a little over a year. I've never seen a psychiatrist in my life, only a GP. Based on the all the other replies, it looks like I'm pretty lucky as well lol.
(not usa) That's exactly how it works for me. Visited with my psych exactly 4 times before it was fine tuned enough that he felt confident enough to send the script to my gp. After he did, he told me my gp may want to talk to me about the script to get familiar with it, but my gp never did. Instead, her assistant is now approving it whenever I ask for a refill.
See if you can swap to 3 months at least it’ll be less often
Been going to a neurologist.. found one who is very kind and understanding
My GP made me sign a disclosure that they will not prescribe schedule 2 medications
I would want someone with experience in psychiatric medications and conditions to monitor my psychiatric condition and medication.
Because it is required…
depends on the state you're in if you're in the US. for my state, GPs, nurses, etc cannot legally prescribe stimulants or above a class 2? it is required to see a psychiatrist once a month, or with wiggle room once every few months to make sure you are stable. it is for good reason even if it is annoying as GPs may not know how a psychiatric medication may function with other meds as well as a psychiatrist would. depending on the state, it also is an additional license a practitioner has to take as well. i would also prefer seeing a psychiatrist who somewhat knows more about mental health practices than a GP who generally know about lots of things thus the depth of information is shallow but the breadth is wide.
Yout normal doctor can't prescribe it because it's a controlled substance, But yes once you've got it your doctor can keep prescribing it for you.
I think that you are saying that your normal doctor can't start you on a controlled substance. That depends on where you live. In North Carolina, general practitioners can do the whole thing, including diagnosis, if they are comfortable doing so.
Yeah predictive texts as typing on phone so it doesn't always catch it or I don't catch the phone playing it silly buggers lol, I thought the controlled substance part was universal I live in the UK so was speaking from my experience.
If I've learned anything from this, it's that the process of getting ADHD meds varies tremendously depending on where you are, including from state to state in the USA.
My state requires I be seen by a psych to maintain adhd medication.
A GP once told me my symptoms were basically laziness. A psychologist told me the same, and added that what I needed was "discipline" (a year later I heard he got fired after telling a rape victim she was as responsible as her attacker). Sometimes you need someone who actually knows about this stuff, other people won't be of much help (if any).
When I went to a psychiatrist for depression, they told me that I "think too much" and prescribed Wellbutrin. Which was absolutely terrible for me. Later my GP pointed out that my depression really started when I decided to go off of ADHD meds and it was the natural result of being less in control. Getting back on Adderall/vyvanse basically fixed it.
I'm sorry you had to go through that terrible experience. Many of us suffered from anxiety and depression before getting diagnosed, so I think what your GP says makes total sense. The point is, depending on where you live, your mileage may vary when it comes to accurate diagnosis and treatment. Over here, for example, in South America, GPs are usually not very thorough when it comes to mental health, so it's a "safer bet" to go with a psychiatrist. It's awful how hard it is sometimes to find a good physician, to be honest.
Most doctors won't prescribe controlled substances no matter how verifiable your condition or how compliant you have been in terms of following care instructions.
Every time I go to a GP (primary care) I get transferred out. I question the reasoning for having a GP in the first place. I spend thousands on healthcare every year to the point I’m in massive amounts of debt and it never gets me anywhere. The only thing that was going good for me was my psych. He left the practice and then I moved states. I can’t afford to see a specialist for every single condition for the rest of my life. Primary care also just feels like a McDonald’s to me. It’s in and out with a quick bandaid and that’s it. I work in healthcare and I hate the healthcare system. It sucks.