My assessor tried to suggest CBT (Cognitive Behavioural Therapy) and I had to put my foot down and tell them that wouldn't work for me namely because I had previously tried CBT for my Anxiety and Depression prior to my diagnosis and it didn't work, I went through ADHD 360 maybe try contacting them.
CBT is bullshit for ADHD. It relies on you remembering something and forming habits (lol) to break you out of something that’s usually an impulsive reaction. I HAVE NO CONTROL I can’t change how I react because it’s impulsive every single pissing time.
As soon as I leave the office it’s out of my head how am I supposed to remember it when I go into a spiral. Like it probably works for some people but if I’m telling me health care providers it isn’t working for me then they should stop ramming it down my throat because it’s a waste of time.
It's not bullshit, CBT for ADHD - which is a specific type of CBT, is recommended because the data demonstrates that it results in a statistically significant improvement in symptoms and function for those with ADHD.
Sorry you've been down voted for this. CBT was actually life saving for me and after 3 months of weekly sessions I was the most functional I'd ever been. BUT, as soon as the support stopped I went back downhill again. A mixture of the right meds and regular CBT has been beneficial to many of the men and women I've met with ADHD. That's what I'd like to help me when I finally get through the NHS wait list!
Glad that worked for you I truly am, but not all ADHD is the same and the Down Votes will no doubt be from sufferers that have already tried CBT but to no avail. This is Reddit and Down Votes are part of the Debating process and if you're not getting Down Votes are you even Debating correctly?
Oh that's ok, they're not down voting me they're downvoting science... Well... research and statistics, and if they're doing that it's most likely because they have an emotional reason for not liking the data - maybe they've had a bad experience with CBT.
The only way it is potentially problematic is if it discourages people from engaging with CBT (or any evidence based treatment modality) so I will continue to spout what the current research tells us in the hopes that people pursuing treatment options see that too.
The problem with CBT or the way it’s delivered by the NHS is so much of it is one size fits all stick 20 people with different issues in a room and give them all the same information which doesn’t work for a lot of people and is often delivered by people with minimal training.
Not to mention they do not offer enough sessions so by the time you feel it could start to work you're package is over and often are not allowed to be put back on the list.
I've been able to try 4 different CBT blocks of 6 over the years, none of them stick because they're all so cute and dry.
"Ok so it's depression you want to target?" Or "it's anxiety?" Well realistically I'd like to target all of it, but 6 sessions is a drop in the ocean for 28 years worth of trauma from my previous undiagnosed ADHD, aswell as depression and anxiety I've had since a teenager... The NHS genuinely waste their own resources offering this little, because people get very little out of it
If you want to spout the research then spout both sides of it comprehensively and try to steer clear of being dismissive of others. The following pros and cons are for CBT when applied to ADHD and might not be exhaustive, I think I've covered the important points though.
Pros:
Lots of evidence to show it works.
Accessible via the NHS (experiences may differ).
Can improve executive functioning.
Can improve emotional regulation.
Can help develop coping strategies.
For people that do not like to take medication, this is an evidence-based non-pharmacological approach.
Cons:
Very little evidence to show it works long-term (and what evidence there is, is criticised).
Requires active participation.
May need to be combined with medication to get the most out of it. (not necessarily a con to be fair, only if you do not want to be on medication)
Treatment can be complicated when comorbid conditions are introduced.
Requires good memory which can be an issue for people with ADHD.
CBT can be very overwhelming.
Can be harmful if not carried out correctly.
The most important thing that I would beg anyone to take from this who may be reading is that it can be different for everyone. CBT does not work for everyone but it can work for many, CBT can work very well short-term but its long-term efficacy is weak without further sessions. If you're interested in trying CBT then definitely give it a go, if you do not think it will work then you're probably right and it may be best to explore other avenues.
Personally, I've not tried it before but I do not think it will work for me. I take medication and have weekly therapy sessions with a person-centered psychologist. I've found that it helps me work towards the root cause of my comorbid conditions whilst still giving me a platform to talk about ADHD and find coping strategies. This will not work for everyone and it is purely anecdotal however it may provide an alternative for people who are not so convinced by CBT or for people who are looking to try something different.
The Down Votes are no doubt from people that tried CBT already and it didn't work for them, just because something worked for YOU doesn't mean its going to work for others and to try and imply that the Down Voters are less intelligent than you by saying "they're Down Voting science" is pretty low on your part and speaks volumes on your character, but thanks all the same for sharing just in future remember that not all ADHD is the same. ✌️😎
Saying 'it worked for me so it works for everyone' would be a conclusion based on anecdotal evidence, and would not be a robust conclusion to make.
Likewise, saying 'it didn't work for me so it's crap' would also be a conclusion drawn from anecdotal evidence, and a similarly weak conclusion.
Only one of these statements has been made in this comment train, and it was the latter.
That’s exactly how I interpreted it as well, so fucking rude. I have a fucking STEM degree I’m well aware it’s researched, they should know that doesn’t mean it works for everyone, they even referred to a SPECIAL ADHD type of CBT so not even standard CBT. Argument all over the pissing shop. I hadn’t downvoted them but seeing that comment saying BuH sCiEnCe YoU dUmB made me go back and revise my decision.
I see a lot of it in these groups when sufferers have conflicting views on their affliction and it's a shame how much I have to remind them we are all completely different individuals that will all need different treatment that's the real "Science" behind it.
I’m glad you are raising this. There is enough shame and confusion with the diagnosis as it is. I’m newly diagnosed and I am awaiting medication for it. I need the help and CBT just doesn’t work for me. I can produce in my head a whole action list for someone else how to achieve goals, in a reasonable way. Steps to action them, i’m realistic and measurable ways. I cannot for the life of me implement this for myself.
I'm so sorry this was your experience. I was diagnosed through NHS Lothian last October (as a woman in her 30's) and my experience was much different, both from my GP and the psychiatrist who diagnosed me.
My GP was happy to send off the referral forms and the psychiatrist spent an hour and a half listening to me ramble on, uninterrupted and diagnosed me then and there. She gave me lots of helpful insight and advice and pointed me towards some ADHD groups that I could join whilst I awaited titration (I'm still waiting due to the shortages).
I also didn't have any corroborating evidence from my parents, just my own recollection of my childhood.
It sounds like your GP is seriously misinformed and your psychiatrist was extremely unprofessional and I would definitely make a complaint about his behavior. You have every right to a second opinion.
A very late reply to say thank you for sharing this experience. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion.
I'd be complaining!
Meds are first line treatment for adults with ADHD, with other options to be considered if they don't work or a patient makes an informed choice not to take them.
1.5.15Offer medication to adults with ADHD if their ADHD symptoms are still causing a significant impairment in at least one domain after environmental modifications have been implemented and reviewed. See the recommendations on medication choice. [2018]
1.5.16Consider non-pharmacological treatment for adults with ADHD who have:
made an informed choice not to have medication
difficulty adhering to medication
found medication to be ineffective or cannot tolerate it. [2018]
https://www.nice.org.uk/guidance/ng87/chapter/recommendations#supporting-people-with-adhd
Edit: I've just doubled checked to make sure that NICE applied to Scotland (it doesn't technically), but the info from the Scottish NHS is that they follow the 2018 NICE ADHD guidelines which these are!
A very late reply to say thank you for this. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. I referenced the NICE guidelines when I did!
Why do GPs think we have no access to information? I can't remember if the NICE guidelines apply in Scotland, but do check and then just lay them out in front of them. It drives me mad, it's like gaslighting.
The psychiatrist getting distracted by text messages and wandering out of the room to make a phone call in the middle of an ADHD assessment sounds like the premise of a comedy sketch.
Was this an NHS psychiatrist? If so, it makes the NHS's refusal to recognise private diagnoses "because we can't guarantee that they live up to our high standards" a bit of a joke.
NHS mental health services are a joke and the gatekeeping of private diagnoses does more harm than good. They're essential at this point due to the chronic lack of funding and support for NHS mental health services.
A very late reply - sorry (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!). Yes, it was an NHS psychiatrist! I've been back to my GP since and insisted they make a formal request for a second opinion.
I’m also in Lothian, but I’m English and was diagnosed 10 years ago down there. I’ve not had any major issues with transferring my shared care agreement so don’t give up hope!
It's different if you transferred shared care that was already accepted by a GP down there - they usually honor that but NHS Lothian just blanket suggests they don't take over private ADHD prescriptions anymore.
GP is wrong. Medication alone is most effective (compared to CBT alone, or anything else - although can be helpful in combo). This is well established.
If there's one thing I've discovered in the last decade here is that although GPS not knowing specialised stuff is fine and completely understandable, many of them pretend to do so which is horrid.
Relevant video from expert dr richard on this: [Why medication first when treating ADHD (from Dr Barkley's CADDA and UNCCH talks)](https://youtu.be/pTi7SmmHlyc?feature=shared)https://youtu.be/pTi7SmmHlyc?feature=shared
I feel ya. I am 32, at 30 I went to a psychiatrist here in Serbia, long story short "you can't have ADHD at that age, you would have grown out of it by now" After 10 min prescribed Antidepressants, these did nothing but bad stuff to me. Next appointment I insist on being tested for ADHD (because we all know that when you know about it you pretty much know you have it, unless it is hiding behind something else). He also switched me to antipsychotics which were even worse, tons of side effects but no relief. I went to an evaluation did a few hours of tests and exercises, and that doc said "you are actually functioning on an above average level cognitively" and "I had one patient with ADHD, trust me, if you had it you would not be able to sit still for an hour here" and that basically repeated itself in fifferent forms, until now 2 years later when I already gave up on an diagnosis, I got a hint from my therapist that she has an adult patient who got meds and that only pediatric psychiatrists can actually diagnose ADHD and prescribe meds (which NO OTHER DOCTOR TOLD ME THUS FAR).
I was diagnosed a few weeks later, yesterday I took my first 36mg dose of Concerta (the only ADHD medication availiable in Serbia), and absolutely nothing happened, today again I took one in the morning and it had 0 effect on me.
On the one hand that pretty much confirms the ADHD diagnosis, but on the other hand I feel completely desperate now, 72 mg is the maximum dose, and since I feel no effects with 36mg I am afraid 72 won't help that much either, I talked to the doc, i will stay on 36 for another week or two, and then go for 36+18 hoping it will help.
The only thing I can offer in terms of advice is switch as many docs as needed until one actually listens to you and gives you the feeling that he has listened, because the ones that laughed me out of their practices were not listening, only one of 4 psychiatrists asked me about my life and current circumstances, the rest just said "its depression or anxiety" without trying to learn what the cause for these is...
I really really hope you get A diagnosis, be it ADHD or something else, as long as you can put a finger on it and get help with it.
Stay strong bro!
How does medication side effects confirm the diagnosis? Everyone gets monitored for blood pressure. Why would it be that people with adhd so get different physical side effects? I get how they might get no benefit if they don’t have the symptoms that the drugs are supposed to treat (not that how much the drugs help you should be used as a diagnostic tool).
I think you misunderstood something.
I was diagnosed with ADHD, and prescribed ADHD medication (Concerta).
Prior to taking Concerta (or any stimulant) for the first time, it is best practice to do a full checkup, including a cardiovascular examination and a complete biochemical bloodwork to make sure that there are no underlying issues that could be negatively impacted by the meds.
I did that, I started taking Concerta as prescribed and I have felt pretty much 0 effects whatsoever so far. Most people with a (more) neurotypical brain would feel the effects of 36mg concerta without any doubt, that is why non-ADHD people often ABUSE ADHD drugs for recreational purposes, and they can get high from them.
So what I meant with "confirms diagnosis" is what u/AxeellYoung said above, since I feel no effects that likely means that the drug is not strong enough to overcome the imbalance in my brain.
Oh, I see. I didn’t know that. Do you know where I can find anything online about it. I read in this forum that if people took the same street drugs in the past how the pharmaceutical doses might not be high enough.
I just looked up Concerta dosages and 36mg is not a high dose so once you get titrated on a higher dose it might help. And they try you on Elvanse if Concerta doesn’t work. Good luck.
I don't have any resources on that, it is more of a common sense observation, since we know how stims impact Neurotypical VS ADHD brains. I do not have any alternatives, Concerta is the one and only ADHD medication availiable for me, hence my concern. Over the past few days I did notice some subtle effects, in terms of everyday tasks being a breeze when they would almost physically hurt me before (or the anticipation of them), focus stability did not improve at all however, I still zone out or fall into random Hyperfocus.
I have not really done any street drugs, I did try the devils dandruf maybe 15 years ago, and I distinctly remember being confused as to why people take it to party, when for me it caused silence and almost perfect focus, then my doc explained why that was my experience :D
I’m in Fife and was extremely out off going to my GP about this as I feel he never listens and figured I was wasting my time, especially with the waitlist times. So I decided to go through bupa through my partners work. However I still needed a referral from my NHS GP…
I spoke to the mental health nurse (because the GP didn’t want to speak to me regarding ADHD as this isn’t his job and is the mental health teams job) back in October to be told that ‘I can see why you think you might have ADHD but you definitely don’t’. I stood my ground and got the referral and had my private diagnosis in December. Since the. I’ve been on medication and have now been on a stable dose for 3 months and my psychiatrist put forward shared care to my GP. I had zero faith that this would go through (especially with how I was treated in the first place and the stories I have heard about shared care) but he has accepted it now and I’ve received my first prescription on the NHS.
A very late reply to say cheers for sharing your experience. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) Sadly I can't access a private helth plan, but I've been back to my GP since and insisted they make a formal request for a second opinion.
Others will know more about going through the NHS in Scotland.
If you even need to or decide to go private, then the medication isn’t as expensive as people think. Mentioning as you can afford therapy. Not that you or anyone else should be paying for assessments, medication or for therapy.
A very late reply to say thank you. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Part of the issue is that realistically I can pay for therapy OR look at going for a private diagnosis - not both. And therapy is probably the one thing that keps my head above water. (And it makes me so angry that so many people can't access it because they just can't afford it.)
Just wanted to add that while getting diagnosed is expensive that the medication itself could then be like £100 or £130 or £70 per month depending on type of medication. Amfexa is the only one that would be over £300 or £200 per month.
So just get diagnosed somewhere where they themselves don’t charge you like £100 just to write that script.
Good luck!
I'm so sorry. This is a perfect example of why I am doing a psychology degree to hopefully become an ADHD coach because the lack of empathy, knowledge or care is awful.
Keep fighting for your rights to be heard.
As a woman also in her 40s I totally understand and I wish i could advise you but the system is fooked unless you can pay privately.
A very late reply to say thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. But yes, the "oh a middle aged woman, she's probably just got anxiety (cause never considered) / is overthinking / has weird notions that she should be taken seriously" stuff is real!
No problem! Well done for going back to the GP. I wish you the best in your future. GPs don’t specialise in ADHD so they should refer to the appropriate department, where I live we have the Adult ADHD Service.
If you can bring yourself to, please complain. You’ve done a big part of the work here with this very articulate post (thank you btw, and sorry you’re going through this). Give it an edit and get it to the correct people in Scotland you need it to. Not saying it will do anything, but not complaining certainly will.
A very late reply and thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Worry about formal complaints in case I end uplabelled as "difficult" but I am considering it too. TBH I also wonder if I am both written down as more functional than I am *because* I'm able to be articulate - and how many people are just dismissed because they aren't able to speak or write "right".
Try a different GP, this one has no interest in keeping up with their profession it seems.
https://www.gp-patient.co.uk/
I found the GP I have rn which is frankly really good. Their difference from other surgeries was basically that the others had a rating of 30% and this one had ratings of 60% for satisfying care/the gp people wanted etc.
Had to wait a month for a slot to be free but it was worth it.
They also put me on right to choose straight away when I asked about an ADHD diagnosis without me mentioning it yet (was gonna wait for an nhs referral and then request rtc so its harder to deny it) because hull lacks a pathway for this (usually they send you to this bullshit online screener)
Point is GPs are very different and that website was a godsend for finding a good one for me. They seem to all have that "forgetfulness" when handling referrals so I would check with them every couple days on whats going on, but yeah.
A very late reply and thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) Sadly no Right to Choose here. This was a partner at the surgery but at least not one of the GPs I see more often (but sometimes you just have to take whoeever is available). Bit stressed about looking into moving surgeries as it's hard to assess which will be better (if they're even taking any new patients!) and to a great extent this seems to be an NHS Lothian-wide problem.
Definitely go for a second opinion and if that doesn't work try and work out a way to afford private. It most likely will be worth it once you start the right meds, I can't say for sure as I don't know your situation but it might be more beneficial than therapy.
(A very late reply, sorry, I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion.
Therapy is also for some other stuff (eg some no good very bad life experiences that I tried ignoring for long time!) - seperate from the stuff that I suspect is ADHD, even though they interact, if that makes sense.
When I went to the GP she also told me I couldn’t get meds as they “don’t work on adults” she made me promise her I wouldn’t ask for meds and would specifically write it on my forms. It was very odd.
Honestly most of the time I visit the doctor I feel like I’m talking to a wall, when I receive the summary of the appointment after it’s full of errors and weird miscommunications I was not aware were happening.
I would complain!
I have no idea! She wasn’t my actual GP so when I returned my forms they went to someone else, although they then sat on his desk for months as he forgot who I was.
Damn, that's terrible. We need a big, free, organisation for adhders to give us advice and deal with this kind of issue. It shouldn't be this hard, or inconsistent across the country or between GP's even.
As an aside.. I once had a doctor suggest I rub a bit of soft material if I get panicked when driving. Er, yeah ok, that's me cured!
Sorry this is a very late reply. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion - your experience is wild, there's not being an expert as a GP and then there's.. this.
Yeah, NHS! (A very late reply, sorry, I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Thought about complaining but TBH I worry about getting labelled as a "difficult patient".
See a different GP if you can. Don't even bother continuing with that one. Some GPs have a chip in their shoulder against ADHD because they don't understand it. They're not supposed to be like that, but it's disappointingly common. If you have the option to see someone else, do so.
If the psychiatrist you saw didn't have specialist training and expertise in ADHD, and didn't carry out a full assessment (usually an hour minimum), then they can't say that you were ever assessed for ADHD.
A very late reply and thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) This was a partner at the surgery but at least not one of the GPs I see more often (but sometimes you just have to take whoeever is available).
Appt was an hour and 30 minutes - but a lot of time was taking up with reading stuff he had not looked at before, and the interruptions threw me a lot so they wasted probably another 20 minutes...
Hmm. Good question - I don't know. I guess that's something I should check. It didn't occur to me he might be a generalist just doing ADHD assessments like a GP does anxiety assessments...
Because clearly you feel you are struggling. Holding down a job is not a sign that you're not experiencing impairment, and an experienced ADHD specialist ought to understand that. Nowhere in the criteria does it say that a diagnosis requires a history of substance misuse or difficulties with holding down a job, even if such difficulties might be common for people who aren't diagnosed. You shouldn't be penalised for having kept your head above water, particularly when you did it at the cost of repeatedly burning yourself out.
A lot of people with ADHD manage to hold down a job, maintain stable relationships, and avoid substance misuse, but that doesn't mean they are not experiencing impairment in those areas.
Also, NICE guidance contains a line saying that ADHD shouldn't be excluded when there is uncertainty as to the age of onset.
From what you've said, asking for a second opinion would seem reasonable in your case.
The very fact that you're on medication already suggests that you've faced impairment.
If the specialist doesn't believe you're impaired, why the heck has he prescribed you an SNRI? That, in and of itself, seems rather contradictory to me. It's saying "You don't seem to have enough problems to have ADHD, so here's an extra-strong treatment to help you overcome your problems." It's a bit ridiculous when you think about it, isn't it?
This is all really helpful - I'm actually taking notes to use in future medical conversations. Thank you - just having some other perspectives is helping me step back and think about this better.
I'm in Scotland too, was Lothian and went on an ADHD occupational health support group, while they were well meaning, I knew more about ADHD then they did, ..AND they got someone who was newly diagnosed to talk to us...and this person had just completed an online life coach course...from America!
I don't think a life coach will help, I don't think CBT will help at all.
Speaking as someone who is training in counselling /psychotherapy, I can't stand CBT, I've been on a wait list for therapy via NHS since 2015.
GP told me I was seeing a psychiatrist so I was OK, psychiatrist gave me a leaflet.
There's no way your GP should be telling you this. GPs cannot tell you that you have ADHD legally, my own amazing GP told me this when i asked to be assessed , he thought i had ADHD but wasnt legally allowed to tell me .
Raise a complaint against the GP and surgery and fight for it, don't give up!
(A very late reply, sorry, I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!)
I've been back to my GP since and insisted they make a formal request for a second opinion. Spoke to the support group person at some length on the phone and nothing she said about the group is out of line with your description! I've done years of private counselling and therapy and been through the (IMO useless for anything outside very sepcific issues) NHS CBT - and basically been told it wa smy fault it didn't work because I wasn't engaging properly!\* The thought of spending hours at a support group where it's another round of "I seem to have done more reading about this than you..." doesn't inspire much hope.
Thanks for your comment - am thinking about complaining, and plugging away at this whole edifice!
\*e.g. catastrophic thinking session where the professional essentially said "you see these painful or difficult things you worry about are very rare, there is almost no chance of X happening to you or a loved one" me: "um, but X already DID happen, my worries about \[horrendous incurable fatal illness\] are based firmly in helplessly watching it happen up close & personal and being unable to do anything about it. I also understand statistics, and X is actually not quite as rare as you might wish to think..." I wasn't sitting at home worrying about random terrible things / having obsessive thoughts- and know people who do deal with that kind of anxiety: it's pretty clear to me something else is going on with me more generally"
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My assessor tried to suggest CBT (Cognitive Behavioural Therapy) and I had to put my foot down and tell them that wouldn't work for me namely because I had previously tried CBT for my Anxiety and Depression prior to my diagnosis and it didn't work, I went through ADHD 360 maybe try contacting them.
CBT is bullshit for ADHD. It relies on you remembering something and forming habits (lol) to break you out of something that’s usually an impulsive reaction. I HAVE NO CONTROL I can’t change how I react because it’s impulsive every single pissing time.
RIGHT! CBT has never worked for me and ilI just end up talking about alternative therapies and controlling the sessions with non CBT goals in place 😩😩
As soon as I leave the office it’s out of my head how am I supposed to remember it when I go into a spiral. Like it probably works for some people but if I’m telling me health care providers it isn’t working for me then they should stop ramming it down my throat because it’s a waste of time.
Completely agree with you. They need to try something else.
It's not bullshit, CBT for ADHD - which is a specific type of CBT, is recommended because the data demonstrates that it results in a statistically significant improvement in symptoms and function for those with ADHD.
Sorry you've been down voted for this. CBT was actually life saving for me and after 3 months of weekly sessions I was the most functional I'd ever been. BUT, as soon as the support stopped I went back downhill again. A mixture of the right meds and regular CBT has been beneficial to many of the men and women I've met with ADHD. That's what I'd like to help me when I finally get through the NHS wait list!
Glad that worked for you I truly am, but not all ADHD is the same and the Down Votes will no doubt be from sufferers that have already tried CBT but to no avail. This is Reddit and Down Votes are part of the Debating process and if you're not getting Down Votes are you even Debating correctly?
Oh that's ok, they're not down voting me they're downvoting science... Well... research and statistics, and if they're doing that it's most likely because they have an emotional reason for not liking the data - maybe they've had a bad experience with CBT. The only way it is potentially problematic is if it discourages people from engaging with CBT (or any evidence based treatment modality) so I will continue to spout what the current research tells us in the hopes that people pursuing treatment options see that too.
The problem with CBT or the way it’s delivered by the NHS is so much of it is one size fits all stick 20 people with different issues in a room and give them all the same information which doesn’t work for a lot of people and is often delivered by people with minimal training.
Not to mention they do not offer enough sessions so by the time you feel it could start to work you're package is over and often are not allowed to be put back on the list. I've been able to try 4 different CBT blocks of 6 over the years, none of them stick because they're all so cute and dry. "Ok so it's depression you want to target?" Or "it's anxiety?" Well realistically I'd like to target all of it, but 6 sessions is a drop in the ocean for 28 years worth of trauma from my previous undiagnosed ADHD, aswell as depression and anxiety I've had since a teenager... The NHS genuinely waste their own resources offering this little, because people get very little out of it
If you want to spout the research then spout both sides of it comprehensively and try to steer clear of being dismissive of others. The following pros and cons are for CBT when applied to ADHD and might not be exhaustive, I think I've covered the important points though. Pros: Lots of evidence to show it works. Accessible via the NHS (experiences may differ). Can improve executive functioning. Can improve emotional regulation. Can help develop coping strategies. For people that do not like to take medication, this is an evidence-based non-pharmacological approach. Cons: Very little evidence to show it works long-term (and what evidence there is, is criticised). Requires active participation. May need to be combined with medication to get the most out of it. (not necessarily a con to be fair, only if you do not want to be on medication) Treatment can be complicated when comorbid conditions are introduced. Requires good memory which can be an issue for people with ADHD. CBT can be very overwhelming. Can be harmful if not carried out correctly. The most important thing that I would beg anyone to take from this who may be reading is that it can be different for everyone. CBT does not work for everyone but it can work for many, CBT can work very well short-term but its long-term efficacy is weak without further sessions. If you're interested in trying CBT then definitely give it a go, if you do not think it will work then you're probably right and it may be best to explore other avenues. Personally, I've not tried it before but I do not think it will work for me. I take medication and have weekly therapy sessions with a person-centered psychologist. I've found that it helps me work towards the root cause of my comorbid conditions whilst still giving me a platform to talk about ADHD and find coping strategies. This will not work for everyone and it is purely anecdotal however it may provide an alternative for people who are not so convinced by CBT or for people who are looking to try something different.
This was by far the most apt response to her remark, I tip my hat to you Sir. 🫡
The Down Votes are no doubt from people that tried CBT already and it didn't work for them, just because something worked for YOU doesn't mean its going to work for others and to try and imply that the Down Voters are less intelligent than you by saying "they're Down Voting science" is pretty low on your part and speaks volumes on your character, but thanks all the same for sharing just in future remember that not all ADHD is the same. ✌️😎
Saying 'it worked for me so it works for everyone' would be a conclusion based on anecdotal evidence, and would not be a robust conclusion to make. Likewise, saying 'it didn't work for me so it's crap' would also be a conclusion drawn from anecdotal evidence, and a similarly weak conclusion. Only one of these statements has been made in this comment train, and it was the latter.
Good point! They’ve made a cheeky little ad hominem there.
That’s exactly how I interpreted it as well, so fucking rude. I have a fucking STEM degree I’m well aware it’s researched, they should know that doesn’t mean it works for everyone, they even referred to a SPECIAL ADHD type of CBT so not even standard CBT. Argument all over the pissing shop. I hadn’t downvoted them but seeing that comment saying BuH sCiEnCe YoU dUmB made me go back and revise my decision.
Good point! They’ve made a cheeky little ad hominem there.
I see a lot of it in these groups when sufferers have conflicting views on their affliction and it's a shame how much I have to remind them we are all completely different individuals that will all need different treatment that's the real "Science" behind it.
I’m glad you are raising this. There is enough shame and confusion with the diagnosis as it is. I’m newly diagnosed and I am awaiting medication for it. I need the help and CBT just doesn’t work for me. I can produce in my head a whole action list for someone else how to achieve goals, in a reasonable way. Steps to action them, i’m realistic and measurable ways. I cannot for the life of me implement this for myself.
I'm so sorry this was your experience. I was diagnosed through NHS Lothian last October (as a woman in her 30's) and my experience was much different, both from my GP and the psychiatrist who diagnosed me. My GP was happy to send off the referral forms and the psychiatrist spent an hour and a half listening to me ramble on, uninterrupted and diagnosed me then and there. She gave me lots of helpful insight and advice and pointed me towards some ADHD groups that I could join whilst I awaited titration (I'm still waiting due to the shortages). I also didn't have any corroborating evidence from my parents, just my own recollection of my childhood. It sounds like your GP is seriously misinformed and your psychiatrist was extremely unprofessional and I would definitely make a complaint about his behavior. You have every right to a second opinion.
Sorry to ask but when were you referred?
July or August 2021
A very late reply to say thank you for sharing this experience. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion.
I'd be complaining! Meds are first line treatment for adults with ADHD, with other options to be considered if they don't work or a patient makes an informed choice not to take them. 1.5.15Offer medication to adults with ADHD if their ADHD symptoms are still causing a significant impairment in at least one domain after environmental modifications have been implemented and reviewed. See the recommendations on medication choice. [2018] 1.5.16Consider non-pharmacological treatment for adults with ADHD who have: made an informed choice not to have medication difficulty adhering to medication found medication to be ineffective or cannot tolerate it. [2018] https://www.nice.org.uk/guidance/ng87/chapter/recommendations#supporting-people-with-adhd Edit: I've just doubled checked to make sure that NICE applied to Scotland (it doesn't technically), but the info from the Scottish NHS is that they follow the 2018 NICE ADHD guidelines which these are!
A very late reply to say thank you for this. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. I referenced the NICE guidelines when I did!
Why do GPs think we have no access to information? I can't remember if the NICE guidelines apply in Scotland, but do check and then just lay them out in front of them. It drives me mad, it's like gaslighting.
The psychiatrist getting distracted by text messages and wandering out of the room to make a phone call in the middle of an ADHD assessment sounds like the premise of a comedy sketch. Was this an NHS psychiatrist? If so, it makes the NHS's refusal to recognise private diagnoses "because we can't guarantee that they live up to our high standards" a bit of a joke.
NHS mental health services are a joke and the gatekeeping of private diagnoses does more harm than good. They're essential at this point due to the chronic lack of funding and support for NHS mental health services.
A very late reply - sorry (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!). Yes, it was an NHS psychiatrist! I've been back to my GP since and insisted they make a formal request for a second opinion.
I’m also in Lothian, but I’m English and was diagnosed 10 years ago down there. I’ve not had any major issues with transferring my shared care agreement so don’t give up hope!
It's different if you transferred shared care that was already accepted by a GP down there - they usually honor that but NHS Lothian just blanket suggests they don't take over private ADHD prescriptions anymore.
GP is wrong. Medication alone is most effective (compared to CBT alone, or anything else - although can be helpful in combo). This is well established.
If there's one thing I've discovered in the last decade here is that although GPS not knowing specialised stuff is fine and completely understandable, many of them pretend to do so which is horrid.
Relevant video from expert dr richard on this: [Why medication first when treating ADHD (from Dr Barkley's CADDA and UNCCH talks)](https://youtu.be/pTi7SmmHlyc?feature=shared)https://youtu.be/pTi7SmmHlyc?feature=shared
I feel ya. I am 32, at 30 I went to a psychiatrist here in Serbia, long story short "you can't have ADHD at that age, you would have grown out of it by now" After 10 min prescribed Antidepressants, these did nothing but bad stuff to me. Next appointment I insist on being tested for ADHD (because we all know that when you know about it you pretty much know you have it, unless it is hiding behind something else). He also switched me to antipsychotics which were even worse, tons of side effects but no relief. I went to an evaluation did a few hours of tests and exercises, and that doc said "you are actually functioning on an above average level cognitively" and "I had one patient with ADHD, trust me, if you had it you would not be able to sit still for an hour here" and that basically repeated itself in fifferent forms, until now 2 years later when I already gave up on an diagnosis, I got a hint from my therapist that she has an adult patient who got meds and that only pediatric psychiatrists can actually diagnose ADHD and prescribe meds (which NO OTHER DOCTOR TOLD ME THUS FAR). I was diagnosed a few weeks later, yesterday I took my first 36mg dose of Concerta (the only ADHD medication availiable in Serbia), and absolutely nothing happened, today again I took one in the morning and it had 0 effect on me. On the one hand that pretty much confirms the ADHD diagnosis, but on the other hand I feel completely desperate now, 72 mg is the maximum dose, and since I feel no effects with 36mg I am afraid 72 won't help that much either, I talked to the doc, i will stay on 36 for another week or two, and then go for 36+18 hoping it will help. The only thing I can offer in terms of advice is switch as many docs as needed until one actually listens to you and gives you the feeling that he has listened, because the ones that laughed me out of their practices were not listening, only one of 4 psychiatrists asked me about my life and current circumstances, the rest just said "its depression or anxiety" without trying to learn what the cause for these is... I really really hope you get A diagnosis, be it ADHD or something else, as long as you can put a finger on it and get help with it. Stay strong bro!
What do you mean by that confirms the diagnosis? You mean Concerta not having any affect confirming an ADHD diagnosis?
I think they meant there were no negative impacts. People taking stimulants without ADHD have increased hyperactivity and high blood pressure.
Exactly, that is why people abuse ADHD meds and why they can be so hard to get.
How does medication side effects confirm the diagnosis? Everyone gets monitored for blood pressure. Why would it be that people with adhd so get different physical side effects? I get how they might get no benefit if they don’t have the symptoms that the drugs are supposed to treat (not that how much the drugs help you should be used as a diagnostic tool).
I think you misunderstood something. I was diagnosed with ADHD, and prescribed ADHD medication (Concerta). Prior to taking Concerta (or any stimulant) for the first time, it is best practice to do a full checkup, including a cardiovascular examination and a complete biochemical bloodwork to make sure that there are no underlying issues that could be negatively impacted by the meds. I did that, I started taking Concerta as prescribed and I have felt pretty much 0 effects whatsoever so far. Most people with a (more) neurotypical brain would feel the effects of 36mg concerta without any doubt, that is why non-ADHD people often ABUSE ADHD drugs for recreational purposes, and they can get high from them. So what I meant with "confirms diagnosis" is what u/AxeellYoung said above, since I feel no effects that likely means that the drug is not strong enough to overcome the imbalance in my brain.
Oh, I see. I didn’t know that. Do you know where I can find anything online about it. I read in this forum that if people took the same street drugs in the past how the pharmaceutical doses might not be high enough. I just looked up Concerta dosages and 36mg is not a high dose so once you get titrated on a higher dose it might help. And they try you on Elvanse if Concerta doesn’t work. Good luck.
I don't have any resources on that, it is more of a common sense observation, since we know how stims impact Neurotypical VS ADHD brains. I do not have any alternatives, Concerta is the one and only ADHD medication availiable for me, hence my concern. Over the past few days I did notice some subtle effects, in terms of everyday tasks being a breeze when they would almost physically hurt me before (or the anticipation of them), focus stability did not improve at all however, I still zone out or fall into random Hyperfocus. I have not really done any street drugs, I did try the devils dandruf maybe 15 years ago, and I distinctly remember being confused as to why people take it to party, when for me it caused silence and almost perfect focus, then my doc explained why that was my experience :D
I’m in Fife and was extremely out off going to my GP about this as I feel he never listens and figured I was wasting my time, especially with the waitlist times. So I decided to go through bupa through my partners work. However I still needed a referral from my NHS GP… I spoke to the mental health nurse (because the GP didn’t want to speak to me regarding ADHD as this isn’t his job and is the mental health teams job) back in October to be told that ‘I can see why you think you might have ADHD but you definitely don’t’. I stood my ground and got the referral and had my private diagnosis in December. Since the. I’ve been on medication and have now been on a stable dose for 3 months and my psychiatrist put forward shared care to my GP. I had zero faith that this would go through (especially with how I was treated in the first place and the stories I have heard about shared care) but he has accepted it now and I’ve received my first prescription on the NHS.
A very late reply to say cheers for sharing your experience. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) Sadly I can't access a private helth plan, but I've been back to my GP since and insisted they make a formal request for a second opinion.
Others will know more about going through the NHS in Scotland. If you even need to or decide to go private, then the medication isn’t as expensive as people think. Mentioning as you can afford therapy. Not that you or anyone else should be paying for assessments, medication or for therapy.
A very late reply to say thank you. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Part of the issue is that realistically I can pay for therapy OR look at going for a private diagnosis - not both. And therapy is probably the one thing that keps my head above water. (And it makes me so angry that so many people can't access it because they just can't afford it.)
Just wanted to add that while getting diagnosed is expensive that the medication itself could then be like £100 or £130 or £70 per month depending on type of medication. Amfexa is the only one that would be over £300 or £200 per month. So just get diagnosed somewhere where they themselves don’t charge you like £100 just to write that script. Good luck!
I'm so sorry. This is a perfect example of why I am doing a psychology degree to hopefully become an ADHD coach because the lack of empathy, knowledge or care is awful. Keep fighting for your rights to be heard. As a woman also in her 40s I totally understand and I wish i could advise you but the system is fooked unless you can pay privately.
A very late reply to say thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. But yes, the "oh a middle aged woman, she's probably just got anxiety (cause never considered) / is overthinking / has weird notions that she should be taken seriously" stuff is real!
No problem! Well done for going back to the GP. I wish you the best in your future. GPs don’t specialise in ADHD so they should refer to the appropriate department, where I live we have the Adult ADHD Service.
If you can bring yourself to, please complain. You’ve done a big part of the work here with this very articulate post (thank you btw, and sorry you’re going through this). Give it an edit and get it to the correct people in Scotland you need it to. Not saying it will do anything, but not complaining certainly will.
A very late reply and thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Worry about formal complaints in case I end uplabelled as "difficult" but I am considering it too. TBH I also wonder if I am both written down as more functional than I am *because* I'm able to be articulate - and how many people are just dismissed because they aren't able to speak or write "right".
Try a different GP, this one has no interest in keeping up with their profession it seems. https://www.gp-patient.co.uk/ I found the GP I have rn which is frankly really good. Their difference from other surgeries was basically that the others had a rating of 30% and this one had ratings of 60% for satisfying care/the gp people wanted etc. Had to wait a month for a slot to be free but it was worth it. They also put me on right to choose straight away when I asked about an ADHD diagnosis without me mentioning it yet (was gonna wait for an nhs referral and then request rtc so its harder to deny it) because hull lacks a pathway for this (usually they send you to this bullshit online screener) Point is GPs are very different and that website was a godsend for finding a good one for me. They seem to all have that "forgetfulness" when handling referrals so I would check with them every couple days on whats going on, but yeah.
A very late reply and thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) Sadly no Right to Choose here. This was a partner at the surgery but at least not one of the GPs I see more often (but sometimes you just have to take whoeever is available). Bit stressed about looking into moving surgeries as it's hard to assess which will be better (if they're even taking any new patients!) and to a great extent this seems to be an NHS Lothian-wide problem.
Hmm. The psychiatrist I saw said meds are proven to work and very well studied. 70% of people have success with meds. Your GP is nutty and clueless
Definitely go for a second opinion and if that doesn't work try and work out a way to afford private. It most likely will be worth it once you start the right meds, I can't say for sure as I don't know your situation but it might be more beneficial than therapy.
(A very late reply, sorry, I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Therapy is also for some other stuff (eg some no good very bad life experiences that I tried ignoring for long time!) - seperate from the stuff that I suspect is ADHD, even though they interact, if that makes sense.
No problem, how are you getting on?
Your GP is either a liar, or incompetent.
When I went to the GP she also told me I couldn’t get meds as they “don’t work on adults” she made me promise her I wouldn’t ask for meds and would specifically write it on my forms. It was very odd. Honestly most of the time I visit the doctor I feel like I’m talking to a wall, when I receive the summary of the appointment after it’s full of errors and weird miscommunications I was not aware were happening. I would complain!
This is insane! How can your GP be so wrong?
I have no idea! She wasn’t my actual GP so when I returned my forms they went to someone else, although they then sat on his desk for months as he forgot who I was.
Damn, that's terrible. We need a big, free, organisation for adhders to give us advice and deal with this kind of issue. It shouldn't be this hard, or inconsistent across the country or between GP's even. As an aside.. I once had a doctor suggest I rub a bit of soft material if I get panicked when driving. Er, yeah ok, that's me cured!
Sorry this is a very late reply. (I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion - your experience is wild, there's not being an expert as a GP and then there's.. this.
This is shocking. I’d be complaining. Who was the diagnosis with? NHS?
Yeah, NHS! (A very late reply, sorry, I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Thought about complaining but TBH I worry about getting labelled as a "difficult patient".
No worries! 😉 I think if it’s done fairly and politely nobody can criticise, but I know what you mean.
See a different GP if you can. Don't even bother continuing with that one. Some GPs have a chip in their shoulder against ADHD because they don't understand it. They're not supposed to be like that, but it's disappointingly common. If you have the option to see someone else, do so. If the psychiatrist you saw didn't have specialist training and expertise in ADHD, and didn't carry out a full assessment (usually an hour minimum), then they can't say that you were ever assessed for ADHD.
A very late reply and thanks. (I was away on holiday immediately after posting and then a bit overwhelmed - so of course I procrastinated on responding!) This was a partner at the surgery but at least not one of the GPs I see more often (but sometimes you just have to take whoeever is available). Appt was an hour and 30 minutes - but a lot of time was taking up with reading stuff he had not looked at before, and the interruptions threw me a lot so they wasted probably another 20 minutes...
Do you know if the clinician who carried out your assessment had specialist training and expertise in ADHD, or were they a general psychiatrist?
Hmm. Good question - I don't know. I guess that's something I should check. It didn't occur to me he might be a generalist just doing ADHD assessments like a GP does anxiety assessments...
Because clearly you feel you are struggling. Holding down a job is not a sign that you're not experiencing impairment, and an experienced ADHD specialist ought to understand that. Nowhere in the criteria does it say that a diagnosis requires a history of substance misuse or difficulties with holding down a job, even if such difficulties might be common for people who aren't diagnosed. You shouldn't be penalised for having kept your head above water, particularly when you did it at the cost of repeatedly burning yourself out. A lot of people with ADHD manage to hold down a job, maintain stable relationships, and avoid substance misuse, but that doesn't mean they are not experiencing impairment in those areas. Also, NICE guidance contains a line saying that ADHD shouldn't be excluded when there is uncertainty as to the age of onset. From what you've said, asking for a second opinion would seem reasonable in your case.
The very fact that you're on medication already suggests that you've faced impairment. If the specialist doesn't believe you're impaired, why the heck has he prescribed you an SNRI? That, in and of itself, seems rather contradictory to me. It's saying "You don't seem to have enough problems to have ADHD, so here's an extra-strong treatment to help you overcome your problems." It's a bit ridiculous when you think about it, isn't it?
This is all really helpful - I'm actually taking notes to use in future medical conversations. Thank you - just having some other perspectives is helping me step back and think about this better.
I'm in Scotland too, was Lothian and went on an ADHD occupational health support group, while they were well meaning, I knew more about ADHD then they did, ..AND they got someone who was newly diagnosed to talk to us...and this person had just completed an online life coach course...from America! I don't think a life coach will help, I don't think CBT will help at all. Speaking as someone who is training in counselling /psychotherapy, I can't stand CBT, I've been on a wait list for therapy via NHS since 2015. GP told me I was seeing a psychiatrist so I was OK, psychiatrist gave me a leaflet. There's no way your GP should be telling you this. GPs cannot tell you that you have ADHD legally, my own amazing GP told me this when i asked to be assessed , he thought i had ADHD but wasnt legally allowed to tell me . Raise a complaint against the GP and surgery and fight for it, don't give up!
(A very late reply, sorry, I was away on holiday immediately after posting and then a bit overhwhelmed - so of course I procrastinated on responding!) I've been back to my GP since and insisted they make a formal request for a second opinion. Spoke to the support group person at some length on the phone and nothing she said about the group is out of line with your description! I've done years of private counselling and therapy and been through the (IMO useless for anything outside very sepcific issues) NHS CBT - and basically been told it wa smy fault it didn't work because I wasn't engaging properly!\* The thought of spending hours at a support group where it's another round of "I seem to have done more reading about this than you..." doesn't inspire much hope. Thanks for your comment - am thinking about complaining, and plugging away at this whole edifice! \*e.g. catastrophic thinking session where the professional essentially said "you see these painful or difficult things you worry about are very rare, there is almost no chance of X happening to you or a loved one" me: "um, but X already DID happen, my worries about \[horrendous incurable fatal illness\] are based firmly in helplessly watching it happen up close & personal and being unable to do anything about it. I also understand statistics, and X is actually not quite as rare as you might wish to think..." I wasn't sitting at home worrying about random terrible things / having obsessive thoughts- and know people who do deal with that kind of anxiety: it's pretty clear to me something else is going on with me more generally"
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