One thing to keep in mind when stating that only a specialist should prescribe these medications – every state’s requirements on these meds is different. In Florida, up until July 1st, I have to see my GP in person to get my ADHD med prescription, and it has to be paper, and I have to carry it in to the pharmacy personally. After July 1, the doctor and the pharmacy are going to have research each person each time a med is prescribed.
There is no way I could get in to see a specialist as often as the State requires I see my GP. To my doctor’s credit, he would not make the diagnosis himself, and frankly, refuses to, as I understand it, in all cases. He sends his patients to a therapist who does a thorough evaluation (mine had my mother answer a multipage questionnaire and requested elementary school report cards) and then, based on the therapist’s report, he will or will not, prescribe the ADHD meds.
I have two family members that see Psychiatrists for medications. From what it appears, it is a case of show up, get script, walk out. What my GP does is far more involved. And then he sees me and asks a bunch of questions every three months. I just left today and with the new regulations for controlled substances that take effect July 1st, I am thinking my life is about to get a LOT more complicated. But, that’s ok. I can deal with it, as I need the meds to live my best version of my life.
I do agree that anyone with multiple concussions needs to be under the care of a neurologist, and all treatments carefully coordinated.
The idea that these meds are terribly overprescribed is a bit out of date. I think at one time, any unmanageable kid was referred for ADHD meds, but that isn’t the case in my friend’s elementary school anymore. What she does see is a parent pushing for any kind of diagnosis for their child because that may get them a “crazy check.” (Common vernacular, not my term) But, that isn’t the situation most of us will be familiar with.
In many cases (maybe not Jennie’s, since post and multi concussion syndrome is really dangerous) the GP is the right person to coordinate the meds used in these cases as the primary doctor managing care of each person.
I’m glad Jennie was willing to speak candidly and is seeking additional help in dealing with her conditions – head injuries are NO JOKE folks.
My position on this would be that once the diagnosis has been made by a specialist, continuing care could be performed by the Primary Care Provider as long as the condition hasn’t changed; when it does, the specialist needs to be consulted. Of course there are GPs who have more knowledge of mental health than others, but in my experience that is rare.
Thanks for replying and making me think a bit more critically about this, and limitations given different insurance plans, and provider availability in different locations.
I think my original post might not have been clear… I was not indicating that a psychiatrist provides counseling or psychotherapy… they typically only provide chemical medical care (prescriptions), or oversee therapies such as TMS and ECT, and they coordinate with neurology on certain medical conditions and symptoms as warranted . A Psychologist, LCSW, NP, or another type of licensed counselor typically provides psychotherapy or counseling. My experience though, is that depression in particular is best treated with a combination of psychotropic medication AND counseling.
I am blessed to have had insurance via the military and Medicare (not due to age… due to disability) that did not require referrals from a GP prior to seeing specialists.
I don’t believe people should forego treatment, but they should be aware that there are risks to going through a GP for specialized psychotropic meds, rather than to a specialist.
I will share that I personally had a very negative experience with GP’s misdiagnosing a psychiatric condition, and prescribing psychotropic meds inappropriately. I sought help from a GP 6 months after the birth of my second child. I was exhausted, had had sinus infections for three months straight that wouldn’t clear, had been told by an urgent care physician that they could see I had a visible lump on my thyroid gland, and I needed to get it checked out. I also seemed to have an ongoing clogged duct while nursing my daughter, that worried me. My GP did a full physical and regular blood work, which revealed slightly elevated white cell counts. They concluded I was an exhausted, run down young mom, struggling with kids and a deployed husband, prescribed an antidepressant, and told me to come back in a month to see if my blood counts fell back in the usual range. I mentioned the family history of breast cancer and thyroid disease… and was told I was too young, and that we should try the antidepressant and see if I felt better. I came back a month later… still ill and exhausted. White count was still high. They told me to keep taking that antidepressant, and follow up in another month. I did this for two more visits… the GP gave me a referral to a specialist for the chronic sinus infections. The specialist - who was an ear nose and throat surgeon - immediately identified the thyroid lump and diagnosed Hashimotos Thyroiditis, hypothyroidism, and significant thyroid cancer risk due to the size of the lump (over 5 cm). Biopsies and eventual surgery followed. Other symptoms continued though… GP kept on insisting I simply needed more rest and to give the antidepressant a chance. 7 months after my initial visit, I called the OBGYN who delivered my kids for help… I had lost confidence in the GP and felt like something was REALLY wrong, and they were dismissing me as an overly emotional depressed young mother. I trusted my OBGYN. My OBGYN directed me to come in immediately. Took one look at that “clogged duct” in my armpit, and sent me straight to a breast surgeon. Boom… late stage 3 breast cancer diagnosis a few days later, spread throughout my lymph nodes. The “clogged duct” was actually a lymph node… full of cancer. Too bad it wasn’t identified 7 months earlier… instead of having a GP misdiagnose me as overly emotional and depressed.
And guess what? That’s not even considered malpractice. Just a “mistake.” Im lucky to be alive, although I had to go through extra chemotherapy because of the extent of the spread in my lymph nodes. So beware going to GPs who are relaxed about playing the role of a psychiatrist, dismissing symptoms as the problems of “over emotional young women” and then writing prescriptions for specialized meds like antidepressants. The GP should have referred me a psychiatrist if that’s what they thought, and followed up on white counts, thyroid lumps, and armpit lumps. Or sent me to specialists for those issues too.
Sharing my experience, because I hope it spares someone else a similar one. Yeah… it’s a pain in the a$$ and expensive as hell to do lots of appointments with different doctors. Believe me… I know this. But you know what’s worse? Missing a cancer diagnosis at an early stage. My guess is coping with an improperly treated brain injury is not much of a picnic either. So follow up with the appropriate specialist when necessary for specialized medical issues.
I’m curious about what you shared. What changes in Florida after July 1? What do they mean that a pharmacy has to “do research” for each prescription?
I have had to deal with the whole paper prescription issue and going to the pharmacy in person here in Virginia. I was on oxycontin for several weeks after bad radiation burns, failed surgery, and a nerve damage issue… I was also on more chemo at the time, and prescribed low dose Ativan for nausea. If I wasn’t actually in the hospital though, the only way those prescriptions got filed or refilled was if I showed up at a pharmacy in person so they could look at me and my drivers license, in conjunction with the paper prescription. It’s the same for all schedule 2 meds here I think. It’s a shame… a lot of VERY ill, very frail and very old people with issues like cancer or other serious medical issues have to jump through hoops to get palliative care meds because of rampant overprescription and prescription fraud issues. I also was on low dose Ritalin for chemo brain issues for awhile… going to the pharmacy in person for that was not the same challenge though… I was well enough to drive myself then.
I’m curious about what you shared. What changes in Florida after July 1? What do they mean that a pharmacy has to “do research” for each prescription?
I am curious as well, and have been busy enough since I returned to the office that I haven’t pulled up the new regulations.
My Doc said they will have to run each patient through a database each time a script is written for anything controlled. The law did not limit it to narcotics – and he’s not happy about it. He then said the pharmacy will have to run the same sort of search on their end before they can fill a prescription, so essentially, each patient will be researched twice. Seems nuts to me.
And he said that he doesn’t know yet if he will be able to fill three months at a time, as we do now, or if I will have to pick up a paper prescription each month. He was pretty frustrated, because he said that he totally understands it for narcotics, and recognizes the problems people have with those, but for all controlled substances, he thought it was overkill.
I will do some research and find what the law contains myself in a bit.
@Bensmom - that sounds awful. And if you have to go once a month for prescriptions… The co-pays. Good Lord.
I think schedule 2 applies to narcotics, stimulants, and tranquilizers. It sounds like it targets schedule 2.
I wonder if the database issue works like the pseudoephedrine one that prevents people from going to multiple pharmacies buying multiple packs of pills in order to cook meth. I do believe there is a history of issues in Florida with people paying out of pocket and going to multiple “pill mill” doctors to get multiple prescriptions for narcotics. I seem to recollect Rush Limbaugh in particular publicly admitting to doing that in the past… He’s a recovering addict.
Prescription drug abuse stinks. It makes obtaining needed meds for people with real conditions challenging for sure.
Thank you for not taking the response personally!
I hear you regarding things being missed and not taken seriously because of between one to three of the three Fs (Fat, Female, Forty+) I’ve also had numerous issues missed because of the same bias including
4 yrs to diagnose a torn ACL (you just twisted it, again)
cellulitis/sepsis: sent home alone with oral antibiotic and orders not to go to work
poorly treated asthma: you’re just out of shape
Not to mention my mother dying of colon cancer because “There there dear, its just IBS” and no further investigation.
Navigating the medical system is a struggle at best, being female makes it much tougher and its worse still for riders because doctors rarely understand HOW severe issues have to be before we will seek help rather than patch it ourselves.
It looks as if most of the new restrictions are directly related to Opiods, and there is one good new part – it allows for electronic prescriptions! And the restrictions on amounts appears to be 3 days for Opiods, and 7 if documented serious condition. I’m not sure how that will play out. I know there are folks that really do need them, and visiting the doctor every 7 days?!
From what I understand the database check is for the same reason as the pseudoephedrine one, but I don’t know how it will be constructed.
I’m so glad I am severely negatively reactive to all of the opiods! I cannot imagine developing an issue with them, as sick as they make me!
Ugh Bensmom and VAHorse mom. I got misdiagnosed but not as bad. Went in complaining about fatigue (I was in my 20s and in law school). Without any tests, they prescribed an anti-depressant…came back a month later. I said I was perhaps not crying as much at sad movies but still super tired. They wanted to just up the dosage…that’s when I started to seek a second opinion (which was a battle with my insurance). Finally got to a different doctor who took one look at me, ordered blood tests. Turned out I was severely anemic (as in my blood count was in single digits). They were shocked I could walk let alone function (and go to law school, work and ride). They never have sorted out why I was so anemic…and the symptoms are very similar with depression…but geeze…one would think they want to rule out other things before prescribing mind altering drugs.
Misdiagnosis is unfortunately fairly common. We really have to be our own advocates…but with most of my rider pro friends not even having any health insurance. I could absolutely understand how they are facing limits in what they can do.
The Florida law changes are really interesting. I never did understand why they considered paper more secure than electronic. Seems like once an addict had a paper prescription in hand… It could be forged. My guess for many people with serious legitimate needs for pain meds beyond 7 days is that they are seeing doctors all the time anyway to manage their conditions.
I will respectfully disagree here. I have ongoing issues with my mental health due to my military service. It’s not officially diagnosed because of my ability to rationalize and compartmentalize. I am fantastic, stable and happy 95% of the time. 4% of the time that I am not, I can adjust. But if in that time period that i am not okay, the 5% of the time, something additional happens, then my coping mechanisms go out the window. My ability to rationalize, grieve and move on for 1% of my life is gone. I am not depressed to the point of suicide, but my ability to function in my day to day is severely compromised. I do not believe that I need to grow up, or be more mature. Do I suffer from full blown PTSD? For the past 5 years I would have told you no. But I suffer "transient " depression from whatever it is.
my mom does suffer from it. She doesn’t want to take drugs either. 75% of the time she is good and life is grand. But she needs to occasionally medicate for those times that life overwhelms.
The thing about mental illness, is that sometimes you are good for a really long time. Then all of a sudden you aren’t. Is it any less serious or a sign of immaturity? I have a bad back. I dont take anything for it. Except for when I over do it. Should i deny myself medication on those days?
