Help How open should I be with my new Psychiatrist about suicide before I can get medicated? (ADHD)

[antiqueantipodean]

I really need some advice from people who have experienced a similar situation to me cause I'm in honesty more than two minds…

I've been dealing with my strong ADHD symptoms for such a long time, multiple drs and psychologists have suggested a psych assessment to help and after a long time finally been able to get an appointment which is in two days.

But I'm also so anxious about it all. I've dealt with severe depression and anxiety for years as well and my life has hit the lowest it's ever been. I've always been suicidal and honestly haven't had a day where I've not thought about it at least once but now is the worst it's ever been. It's got a little better since the date of my appointment reaches but the anxiety hasn't.

For a little context I've tried multiple antidepressants and the side effects on each have made me worse and I have to go off them.

I'd really like to talk to the psych about if a new one would do as I have my mind on one or two MAOI's which may help and don't have as many recordings of the side effects I've suffered on the others SN/SSRI's but the problem is they are not advised to be used with Stimulants. If he suggests a stimulant then he probably won't give an antidepressant as it's suggested you stop an MAOI for a fortnight before stimulant use. You can use both but it's rarely implemented.

So I'm so anxious about it all, I know a lot will be helped when I finally have the appointment but you know anxiety! and don't know how to approach it at first in the appointment which is why I'm mostly asking advice…

What's a good way to approach it… I don't think with my depression and suicidal thoughts I can handle not being on an antidepressant especially if I get on a stimulant and have to wait the month or so it will take to get the right medication and let it work properly and even then the stimulant alone may not help the depression and anxiety or suicidal thoughts either. But if I mention the suicidal thoughts in too much detail I'm terrified they may not want offer stimulants for a period of time until they are in check but I really believe they are what will help me get my life back on track and don't want to risk that delay.

Has anyone been through something like this?

 

[antiqueantipodean]

Hi, please don´t take those pills, they are very dangerous and can serious effects on your brain. Try to cope with other techniques.

Sorry you won't change my mind… I'm very pro medication…. No other techniques have worked and my life is destroyed enough if they don't work it's CTB and at least I'll be more ready.

 

[Lookingtoflyfree]

Yeah, ignore people telling us ADHD aren't valid.

I would say keep your conversations to the doctors JUST on ADHD and not talk about the severity of SI. Anxiety is a symptom of ADHD and being on the right meds can help with it.

 

[NormallyNeurotic]

Some meds can worsen suicidal thoughts. If that's an issue/you're aiming for recovery, it might be beneficial to discuss it.

Something like "I've had issues with depressive symptoms and I'm worried any meds I take could progress it into suicidal thoughts, is that a worry with this prescription?"

Or "My family has a history of suicidal thoughts, should I be worried about that being a potential side affect that could arise for me?"

Something that's not EXACTLY the truth but also not completely a lie.

 

[Monolithian]

Personally I can't take any antidepressants because of my ADHD. Medication that targets serotonin specifically tends to dampen dopamine, which of course is already dysregulated by ADHD. It's important you be honest about your depression, but you don't have to disclose being suicidal. If he's a good psychiatrist he can work with you to find a combination that works. If you're worried about immediate suicidal thoughts I'd also ask for an emergency PRN just to save yourself during bad nights while you wait for the long term medication to do its thing.

 

[garcelle]

Sorry you won't change my mind… I'm very pro medication…. No other techniques have worked and my life is destroyed enough if they don't work it's CTB and at least I'll be more ready.

i thought that comment was a little odd, medication is awesome. My advice would be to say something along the lines of "i am susceptible to suicidal thoughts and want to take stimulants and something to manage my depression as well" or maybe a variation of this that isnt so brute force. They may just want you to start on stimulants, see if it allows u to cope with ur depression without antidepressants. If not definitely fight for the antidepressants. What type of side effects affected you? I had an issue finding the right antidepressant that didnt make me extremely nauseous and was prescribed mirtazapine which is not in the same group with the regular SSRIS/SNRIS so no stomach issues. Only side effect i had was 40lbs added but i was severely underweight so it was fine with me. Also it seems the weight gain side effect is only with the lower doses like 7.5mg 15mg(what im taking) when u go higher like 30mg which is what doctors prescribe for anti-depressive effects anyway, you dont see weight gain as an issue. I googled interactions with mirtazapine and some adhd meds and i didnt see any interactions, but im not a doctor tho lol. I got hope in you, YOU WILL BE OKAY!

 

[wheelsonthebus]

There is a real risk they won't even bother treating your ADHD if you tell them about depression, SI. The idea of "underlying depression" causing ADHD symptoms is so prevalent in psychiatry that they overlook the fact that the ADHD symptoms were lifelong/started before any depression, or that the patient has insight that the issues they face due to the ADHD symptoms is what leads to or contributes to the depression/SI.

 

[Redleaf1992]

It a tricky scenario.

Ultimatley you could lie to get the ADHD meds asap if you think that will help you most. It's not the worst idea, I got fucked over by being too honest in my adhd review and the private psych refused to medicate cos of me being too complicated. Now I'm waiting on NHS who will probably also refuse (after a 100yr wait time).

That said if this psych review is there to help you in all areas (not just adhd) perhaps honesty is best. Let them know exactly what you put here. That you think the ADHD is the stem of your problems and causing your severe depression. If they are looking after your whole MH they will be able to help plan treatment for all your needs, if you lie your other problems may get ignored, even if it means the adhd meds get delayed a little. If they don't know the full picture they can't help you properly.

 

[antiqueantipodean]

Some meds can worsen suicidal thoughts. If that's an issue/you're aiming for recovery, it might be beneficial to discuss it.

Something like "I've had issues with depressive symptoms and I'm worried any meds I take could progress it into suicidal thoughts, is that a worry with this prescription?"

Or "My family has a history of suicidal thoughts, should I be worried about that being a potential side affect that could arise for me?"

Something that's not EXACTLY the truth but also not completely a lie.

I'm not extremely worried on that as it can always be changed but yes good idea to mention it first, I'm gonna be open enough with my own suicidal thoughts without mentioning planning or Sasu obviously so know he will be wise enough to avoid that in meds.

i thought that comment was a little odd, medication is awesome. My advice would be to say something along the lines of "i am susceptible to suicidal thoughts and want to take stimulants and something to manage my depression as well" or maybe a variation of this that isnt so brute force. They may just want you to start on stimulants, see if it allows u to cope with ur depression without antidepressants. If not definitely fight for the antidepressants. What type of side effects affected you? I had an issue finding the right antidepressant that didnt make me extremely nauseous and was prescribed mirtazapine which is not in the same group with the regular SSRIS/SNRIS so no stomach issues. Only side effect i had was 40lbs added but i was severely underweight so it was fine with me. Also it seems the weight gain side effect is only with the lower doses like 7.5mg 15mg(what im taking) when u go higher like 30mg which is what doctors prescribe for anti-depressive effects anyway, you dont see weight gain as an issue. I googled interactions with mirtazapine and some adhd meds and i didnt see any interactions, but im not a doctor tho lol. I got hope in you, YOU WILL BE OKAY!

Side effects were only sexual but severe and cause mental spirals worse than when I'm just depressed. In my country the only non SN/SSRI's available that aren't an expensive private prescription are mirtazapine and meclobemide and as you said weight and that seems to be more than less common and I've obese so will refuse that meaning Meclo is my only option

 

[antiqueantipodean]

Bit of an update… had my appointment today
The main reason for going was always the ADHD so didn't go too far into much besides that just some basics of feelings over the last few months
Didn't get to ideation tho… he didn't go too much into depression either and was surprised he didn't even ask about self harm thoughts
He seems good but is the type that only offers 45min not 60/90 min sessions so bit quick tbh
But he basically said he's 99% certain of the ADHD but he has to fill out the paper questionnaire with me properly for the Gov to accept it but we didn't have time, he normally takes 2 sessions for a diagnosis anyway but that we'd also talk about meds next session so happy I'm getting them but also told me to stop antidepressants I already did this week anyway. Now I'm just gonna be more depressed for the next week so depressions gonna be very bad, a bit worried about my SI but will try to hold on for the week. Hopefully next week will quickly finish assessment talk about meds… then maybe I'll get more into it but may just bite the billet and go in for a third after a fortnight when I get properly on the meds to see how I feel first and if SI goes away

 

[Pale_Rider]

If your not already documented as a suicide risk deny, deny, deny

If you are admit to what they know, amd say you don't think about that stuff anymore.

That's just my opinion every psych is diffrent . most suck to be honest, but occasionally you sit across from one with xray vision. they will throw a monkey wrench in your shit. be warned.

 

[sevencolorfulmoths]

I am facing a similar situation at the moment. Most of my suicidal thoughts stem from me being "not enough", for things being not worth doing ever, as they require too much effort for too little reward. I do suspect I have ADHD as well, and I'm trying to get myself diagnosed and get the right medication for myself, but so far my appointments felt pointless. My psychiatrist is trying to treat depression first, disregarding my complaints about the ever-growing executive dysfunction. My experience with SSRIs was... okay, I suppose. They removed my anxiety and intense suicidal thoughts, but that's what also kept me studying, putting in effort, so now I'm kind of a mess anyway.
Wishing you the best of luck with getting the right medication sooner rather than later!

 

[Dot]

Bit of an update… had my appointment today
The main reason for going was always the ADHD so didn't go too far into much besides that just some basics of feelings over the last few months
Didn't get to ideation tho… he didn't go too much into depression either and was surprised he didn't even ask about self harm thoughts
He seems good but is the type that only offers 45min not 60/90 min sessions so bit quick tbh
But he basically said he's 99% certain of the ADHD but he has to fill out the paper questionnaire with me properly for the Gov to accept it but we didn't have time, he normally takes 2 sessions for a diagnosis anyway but that we'd also talk about meds next session so happy I'm getting them but also told me to stop antidepressants I already did this week anyway. Now I'm just gonna be more depressed for the next week so depressions gonna be very bad, a bit worried about my SI but will try to hold on for the week. Hopefully next week will quickly finish assessment talk about meds… then maybe I'll get more into it but may just bite the billet and go in for a third after a fortnight when I get properly on the meds to see how I feel first and if SI goes away

Imo if u r xpectng 2 b feelng mre suicdl whle w8tng fr nw medcatn thn fnd a wy t/ kp urslf sfe -- mke n.e suicde methds mre dffclt/impssble t/ accss & mke a crsis pln

Thre = crsis pln linkd in recvry rsourcs if nd

 

[Valky]

I am facing a similar situation at the moment. Most of my suicidal thoughts stem from me being "not enough", for things being not worth doing ever, as they require too much effort for too little reward. I do suspect I have ADHD as well, and I'm trying to get myself diagnosed and get the right medication for myself, but so far my appointments felt pointless. My psychiatrist is trying to treat depression first, disregarding my complaints about the ever-growing executive dysfunction. My experience with SSRIs was... okay, I suppose. They removed my anxiety and intense suicidal thoughts, but that's what also kept me studying, putting in effort, so now I'm kind of a mess anyway.
Wishing you the best of luck with getting the right medication sooner rather than later!

that is (sadly) quite normal. There is no point in getting things done if you don't have the mental capacity to even get out of bed. It does make sense that depression would be tackled first and then the executive dysfunction. Just keep pressuring that you have troubles with concentration and getting important stuff done, things will fall into place eventually :)

 

[Chili]

I really need some advice from people who have experienced a similar situation to me cause I'm in honesty more than two minds…

I've been dealing with my strong ADHD symptoms for such a long time, multiple drs and psychologists have suggested a psych assessment to help and after a long time finally been able to get an appointment which is in two days.

But I'm also so anxious about it all. I've dealt with severe depression and anxiety for years as well and my life has hit the lowest it's ever been. I've always been suicidal and honestly haven't had a day where I've not thought about it at least once but now is the worst it's ever been. It's got a little better since the date of my appointment reaches but the anxiety hasn't.

For a little context I've tried multiple antidepressants and the side effects on each have made me worse and I have to go off them.

I'd really like to talk to the psych about if a new one would do as I have my mind on one or two MAOI's which may help and don't have as many recordings of the side effects I've suffered on the others SN/SSRI's but the problem is they are not advised to be used with Stimulants. If he suggests a stimulant then he probably won't give an antidepressant as it's suggested you stop an MAOI for a fortnight before stimulant use. You can use both but it's rarely implemented.

So I'm so anxious about it all, I know a lot will be helped when I finally have the appointment but you know anxiety! and don't know how to approach it at first in the appointment which is why I'm mostly asking advice…

What's a good way to approach it… I don't think with my depression and suicidal thoughts I can handle not being on an antidepressant especially if I get on a stimulant and have to wait the month or so it will take to get the right medication and let it work properly and even then the stimulant alone may not help the depression and anxiety or suicidal thoughts either. But if I mention the suicidal thoughts in too much detail I'm terrified they may not want offer stimulants for a period of time until they are in check but I really believe they are what will help me get my life back on track and don't want to risk that delay.

Has anyone been through something like this?

I'm not going to lie, telling your therapist may delay medication because they'll want to see if something else is presenting as ADHD. Do with that what you will. It is your choice.

 

[compulsoryaliveness]

It sounds like your appointment went well! Also, from your user name, that seems in line with how the country is treated ADHD atm.

I think the 99% likelihood seems very good from a psychiatrist. As others have said, if severe depression gets raised as accounting for adhd symptoms, that would ruin your chances. So I would go in prepared (ideally with concrete evidence, eg school reports) of a history of ADHD symptoms, even if that is just being very confident in articulating problems at school or at home as kid that reflect ADHD.

Re: anti depressants. Well, a bunch of things can help depression. Personally, ritalin is hands down the reason I haven't CTBd yet. And I am not pro-medication generally, tbh, but I do think that daily stimulants have done a lot for my emotional regulation. For example, if I'm stuck in a hole of doom thoughts only (and I haven't taken the ritalin), I can stay there for days without coming out. Like full blown hyper focus. Where as on ritalin, my working memory is so much stronger than I can actually catch myself and be like - oh you're in the doom spiral, do you want to try something like a shower? This kind of shit is impossible for me without ritalin.

But that said, this is the positive views of the drug, I have many negatives too but that's not what you're asking for so I won't extrapolate on those.

I suppose what I'm saying is the stimulants might really help with depression, it's a common story I've heard. As long you don't have bipolar history, then they can be very tight about it, but it sounds like you have report childhood adhd symptoms, and probably mood symptoms are being thought of as being the result of untreated ADHD (fingers crossed for your sake!).

Other meds to consider for depression are the "pines," like low dose mirtazpine at night. All the best, but I reckon you're gonna be alright to get the stimulants from the first appointment.

There's a shortage of psychiatrists if your user name suggests what I think, so they're usually very quick appointments atm. Also be prepared for a health check before they put you on stimulants, many of them do this now, including blood test and urine drug test. This delays the process while you get them done and they wait for results.

Good luck!