Hi! Should I see a new psychiatrist?

#1

Hi!

I was diagnosed with ADHD (ADD at the time) in 2nd grade but spent my teens unmedicated, only getting back on meds in college. Tried a bunch of drugs with mixed results until I saw Jessica talk about Vyvanse, and asked my current psychiatrist if we could try it. Eureka! It was night and day- and now both my siblings take it too.

I’ve learned more about my ADHD from “How to ADHD” than from all of the medical professionals I’ve seen in the 30 years beforehand. I was pretty surprised when my psychiatrist said she’d never heard of emotional regulation being an issue for those with ADHD. (I was telling her about Jessica’s video on that topic)

I just read a post mentioning RSD (Rejection-Sensitive Dysphoria), looked it up, and again thought Eureka! This could explain soooo much but I’m nervous to bring it up with my psychiatrist, since she was apparently unaware of a huge part of ADHD, the emotional element. Should I see someone new? Anyone aware of a RSD-aware doc in the NE US?

Any advice or thoughts are appreciated. :slight_smile:

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#2

Welcome to the Tribe, Arikay!

In the end, you probably have a better idea if this psychiatrist is working out for you than we will. That being said, the DSM-5 doesn’t list the emotional component to ADHD among the symptoms, so if your psychiatrist is going strictly by the book, she wouldn’t be aware of the link. The other thing to consider is that RSD is not an officially recognized condition in the DSM-5. A lot of different studies have to be done and hoops have to be jumped through to add things to the DSM. It’s a good thing, because it keeps things fairly consistent and stable.

I personally don’t think you need a new psychiatrist. I think they are simply going by the manual and avoiding throwing out unconfirmed diagnosis. (Side note, how do you spell the plural of “diagnosis”? Diagnosis’s? Diagnosees? Diagonal?)

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#3

Well, emotional dysregulation is what RSD belongs to, and what it’s technically supposed to be called. Like a runny nose is part of having a cold, but asking the doctor they’d say you have a cold, not a runny nose.

But I would ask my doctor about it, and if (s)he reads up on it and tries to understand it a bit better, that would indicate the doctor really is trying to help you. And if they’re too busy to, that’s OK too. But I wouldn’t say not knowing about that should at all be a disqualifier. If you have other issues, shopping around is a good idea, but just based on RSD, which isn’t even recognised (yet?) as a symptom, no.

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#4

I think another thing to think about is the role of a psychiatrist. From what I have found is a psychiatrist will treat whatever conditions you have. Some will diagnose you but that is usually left to a psychologist. When it comes to working through the associated issues you have either a psychologist or an ADHD coach may be better.

A psychatrist is not really a therapist some do a reasonable job of it but it’s not really their training they are medical doctors they primarily will find the best course of treatment for you. And your particular symptoms. I think if you where to tell the doctor about a particular symptom and they didn’t show interest in it that would be a cause for concern but if they just are not aware of it it’s just a gap in training and they can read up a little and perhaps offer you a medical soloution.

Maybe what your looking for is supplemental support beyond the meds and your particular doc may or may not be able or willing to provide that. I don’t know your exact situation so it’s impossible to say.

I am picky about my doctors. Tend to trust my gut feeling a little it’s a long term relationship and good treatment is assisted by good medical history so changing is not a decision to take lightly but if you walk in the room and feel that your not getting the level of care you want maybe you should look around.

It’s hard to find a good doctor and expensive to try them out because each time you change they look at you and your concerns differently.

I started with a psychologist that was average who cost me quite a bit of money and when they got to the end of the diagnostic process the response was weak so I sought a second opinion from a psychiatrist. I took all my test results and the final report from the psychologist and then spent probably 3 hours talking through it all and he then decided to trail medication. The time and money in the end was worth it and I now have a diagnosis and treatment.

But I know that he is not a therapist as such he is not the guy to go and talk about specific problems in detail he wants to know all the details of any symptoms and side effects but we don’t talk so much about the impacts the symptoms have on life but how they change with different doses and medications and suggests changes right down to the time of day and sleep patterns and other management ideas. Essentially he is treating the condition and symptoms but not so much trying to help with how i feel about the condition as such.

I am not sure I have explained this well so take it with a grain of salt.

M

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#5

This was my thought; the psychiatrist is really there to manage your medication use and make sure your symptoms are managed without big side effects. The focus of ADHD treatment is with focus and attention, not the emotional dysregulation, and psychiatrist is also looking at the possible negative side effects and possible issues with dependency that stimulants can bring. So they’re balancing those things, and not necessarily some of the more emotional aspects of the disorder.

Would it be better if the psychiatrist was up to date on all the issues of all the conditions they treat? Yes, but they probably treat a number of different things in other patients, and emotional dysregulation is not that well known (sadly).

I agree that a therapist (psychologist, social worker, etc etc) who specializes in ADHD may be more helpful, @Arikay than expect the psychiatrist to be fully versed. But if you get a bad feeling about this psychiatrist, definitely consider another one.

I’m thinking the emotional dysregulation is not necessarily due directly to dopamine in the brain (the way attention/focus is), but more indirectly. It’s like a habit we’ve built over time because, as the video shows, a lot of things contribute to building it up. So medication alone isn’t going to fix it, even it helps the underlying causes.

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