Expert Info

Posted by chrisfairhead
on 6 Sep 2019

** Main questions/concerns

I'm planning to move to the UK in December. I was diagnosed I think it was last year for ADD and recently started medication. I'm taking adderall, which I'm told isn't something the NHS will even prescribe, but to have something working for me for months and suddenly have that taken away would really suck, especially when I'm in the midst of this huge life change and lots to get done, not to mention potentially dealing with a lot of emotions. (Medication can also help with emotional regulation.)

I'm also concerned about being diagnosed in the first place, wondering if they'll feel the need to decide for themselves whether I have ADD or not. I'm aware that many in the UK and around the world have the idea that US doctors are a bunch of crackpots handing out diagnoses left and right, and I'm not sure what to say about that, all I know for sure is that they got it right with me. If they didn't the medication would affect me in an entirely different way from what I hear and I *probably* wouldn't have cried literal tears of joy after being productive like a normal person for hours without feeling overwhelmed and getting distracted constantly. I was SO grateful and am now so hopeful for what the future holds for me if I can continue to get treatment. I was pretty depressed when I first went to the psychiatrist, and I feel like I'll end up right back in that place if I go to the UK and they treat me like some kind of idiot or a drug addict or something and I can't continue medication.

If anyone is a medical professional or has any experience at all with this type of situation, please send me any and all information that might help me, I can't tell you how greatly I would appreciate some guidance. Thank you.

 

** A bit of back story for ADD diagnoses in case it helps answer questions

I was diagnosed with ADD as an adult. It was missed in childhood presumably because I have the inattentive type which often goes overlooked, especially in girls. Another big thing is that my brother had the combo of hyper/inattentive type - huge emphasis on hyper - and completely took up my parents' focus and energy, and they had three other kids besides us too. Not to mention the general lack of awareness surrounding ADD at the time I was growing up, and having gone mostly to crappy schools where most teachers didn't care and weren't paying attention anyway.

My husband suspected I had ADD early on in our marriage, but I just shrugged it off. He tricked me once into taking a quiz online for it and the result said it was extremely likely that I had it, but of course to get a proper diagnoses from a professional. Naturally I laughed it off and said it's just a silly online test. About six years later my husband was diagnosed with high functioning autism. While I was researching trying to learn about that, things about ADD kept popping up because a lot of the time people with ASD also have ADD. The more I read about it, the more I realized it described me to a T, minus the hyper part. I realized that despite having a brother with the disorder there was a ton that I didn't know about it growing up.  As I read the stories of other adults with ADD, it hit very close to home and I started to think my husband was probably right all those years ago. And all those years ago, having gone straight from my parents home to being married, "real life" hadn't yet fully revealed to me how glaringly obvious it was that I struggled more than most with a lot of seemingly straight forward things.

Fast forward to now, about two years after I started really wondering, I finally went to a psychologist and she said I think you have ADD. We talked for a while about what it is and what I can do to manage my symptoms. She recommended a book about it which I later purchased online and read, and she referred me to a psychiatrist. At the time, I wasn't sure if I wanted to try medication. My family is very all-natural and I kind of had it in my head that medication=bad, avoid if you can. Also the psychiatrist she referred me too was WAY too expensive. So I just kind of left it for a few months, relieved enough for the moment just to have an answer for why I am this way and can't seem to "get better" no matter how hard I try.

After some time had passed I found myself once again feeling intensely frustrated with myself and the state of my life and I got back into researching, trying to find ways of dealing with ADD. I tried to hear mostly from recognized professionals who specialize in ADD, especially for adults, cause a lot of people think it's just a kid thing. Over and over they would say medication has been proven to be the most effective first step in treating ADD, after diagnoses of course. At this point I was willing to try because none of the other stuff I was trying was working well enough to make a significant difference.

So, I found a more affordable but reputable psychiatrist in my area and went for an appointment. I had told him on the phone that I was already diagnosed, but he seemed to need to do the whole thing again. Lots of forms, lots of questions. Same forms repeated out loud in our session that I had answered on a form I filled out myself, etc. At the end he said he believes I have ADD, and also generalized anxiety and depression (been diagnosed with depression in the past). I said that I feel that my ADD is having the most significant negative impact on my life and could be the underlying cause for the other things, or at least a large part, which I have read is often the case. And I didn't want to start taking several medications at once when it's possible getting my ADD better managed could significantly improve my struggles with anxiety and depression. So he wrote me a prescription for adderall.

Now we're planning this move to the UK and I'm afraid things are going to unravel for me and I'll be right back where I started if my diagnoses may not be recognized or may take a very long time to be recognized, and/or they will refuse me the medication I've been taking that I already know works. I've read about adults there with ADD who ultimately had to wait years for a diagnoses that had initially been laughed out of their GP's office cause even doctors there don't know that ADD is not only a kid thing and that scares the hell out of me. 

 

 

Smith on 9 Sep 2019

The situation with psychiatry in the UK can vary a great deal with location. It may be more difficult to get access or diagnoses depending on which NHS trust you fall under. While it may have been somewhat true that adult and childhood ADD was underdiagnosed and undertreated in the past, it is not true that all doctors in the UK will refuse to consider it. In many areas of the UK psychiatric services are oversubscribed, which can lead to some higher barriers to entry or longer waiting times if you are entitled to go via an NHS route.

It is true that Adderall is not generally available via the NHS. Methylphenidate (Ritalin and other brand-names) is preferentially used in the NHS for a number of reasons, so it may be the case that access to your current medication may be difficult. Adderall is a compound of four different drugs which is not specifically licensed in the UK or available on the NHS, but the component drugs are in use separately, though not generally as a first-line treatment. This means that you may have access to medications very similar to Adderall, but not Adderall itself through the NHS. However, since it has already proven to be effective for you and if you do not want to consider switching to a more commonly used treatment in the UK, Adderall may still be available on a private prescription.

Expense may or may not be a concern for you, but private psychiatry is an option that will likely expedite the process. https://www.psychiatry-uk.com/adhd/ or https://www.clinical-partners.co.uk/for-adults/adult-adhd-add may be good places to start looking for access to private treatment, but I cannot testify to the quality of these. Most private psychiatrists will accept patients without a GP referral, but this will depend on your individual doctor. It may be a good idea to contact a private practice doctor or centre prior to your move, and establish what you will need for an appointment, just to make sure you don’t hit any road-blocks during such a stressful time. Additionally, many doctors operate both on private practice and via the NHS, so if you are entitled to NHS treatment then it may be possible to transition back into the NHS after initial private consultations. This will depend on your doctor and location, of course.

Getting as much documentation as possible from your current American doctor is a good start, but it’s likely that you will have to complete some or all diagnostic testing again, even with a prior diagnosis. Guidelines and criteria will differ between countries, but this does depend on your individual doctor. In addition, it may take some time to get access, particularly if you are entitled to NHS treatment, so stocking up before your move is probably a good idea if you don’t want your medication to be interrupted. You would have to investigate particular rules and quantity limits for importation of your medicines to be sure, but a valid prescription from your American doctor should allow for a certain supply to be brought with you. Prescriptions from your American psychiatrist will not be valid to be fulfilled by a UK pharmacy, though.

In short, it can be difficult to get adult ADD/ADHD diagnosis and treatment through the NHS but not impossible. You’ll be very unlikely to be prescribed your particular medication on the NHS, but it is still available on a private prescription in the UK if your doctor agrees it’s appropriate.  

(Please note that this does not constitute qualified medical advice. Always consult your own doctor(s) before taking any action.)

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