4 ms·

Primary care doctors have been treating ADHD for a long time. Making an appointment with a primary care doctor and showing up to it isn’t that much harder than

Primary care doctors have been treating ADHD for a long time. Making an appointment with a primary care doctor and showing up to it isn’t that much harder than making an appointment with a telehealth doctor and showing up to it. > Stimulant medication is, in the overwhelming majority of cases, the single most effective part of treatment. Let’s not downplay the effectiveness of non-stimulant ADHD medications. They’re actually quite powerful at improving cognition and can have even better outcomes in many people, especially those prone to anxiety, rumination, or insomnia (all of which can be substantially worsened by stimulant medications). The downside is that the non-stimulant medications can take some time to become fully effective, which has created a false belief that they’re worse than stimulants. Telehealth pill mills like Cerebral only make the situation worse, as the doctors have no interest in long term patient outcomes other than writing as many Schedule II prescriptions per hour as they can. This isn’t healthy.

opportune 4y ago
Where do you live that a primary care doctor handles adhd treatment, beyond continuation of care for long-time stable patients? IME primary care doctors will refer you to a psychiatrist who themselves may or may not specialize in ADHD - I’ve never heard of a PCP (outside of maybe concierge medicine) handling adhd diagnosis or working on finding the right choice/amount of medication.
thomastjeffery 4y ago
> Making an appointment with a primary care doctor and showing up to it isn’t that much harder than making an appointment with a telehealth doctor and showing up to it. It sure as hell is when you have ADHD. I know because I've done it. The difference is night and day, and I'm really good at appointments. > Let’s not downplay the effectiveness of non-stimulant ADHD medications In other words: let's please downplay the effectiveness of stimulant medication. No. That's my answer. No. > The downside is that the non-stimulant medications can take some time to become fully effective That's incredibly significant if you are dealing with ADHD symptoms. It means you must not a habit before treatment. And if they don't work, you have to taper off. If stimulants work they work immediately. But that's not the whole story: non-stimulant medication is helpful for a lot of patients! And stimulant medication is helpful for a lot of patients! Choosing which one to start with is important, and the decision is in the hands of the prescribing doctor. Let them do their job. The idea that we should be avoiding stimulant medication is not backed by any science. Stimulants are reliable and effective. When prescribed to patients in a responsible way (not just because they asked please, but because they are pursuing treatment) stimulant medication is proven to be very safe. > Telehealth pill mills like Cerebral only make the situation worse, as the doctors have no interest in long term patient outcomes Yes indeed, that is a real problem, and I totally agree we should get rid of them for that very reason. But what do we replace them with? A system that is fundamentally broken for the people it is meant to serve? That isn't good enough. Despite having every wrong and damaging perverse incentive, "telehealth pill mills" like Cerebral - alongside the real damage they caused - managed some real good. They made an impossible system possible. They did so by breaking that system. I want to see us move forward, not by simply dropping the old broken system back into place, but by actually fixing it. Let's make real responsible treatment actually available to the millions of adults who simply can't get over the bullshit hurdles we have in their way. Until then, dangerous practices like Cerebral will be implicitly validated as the best we've got.

opportune 4y ago

Where do you live that a primary care doctor handles adhd treatment, beyond continuation of care for long-time stable patients? IME primary care doctors will refer you to a psychiatrist who themselves may or may not specialize in ADHD - I’ve never heard of a PCP (outside of maybe concierge medicine) handling adhd diagnosis or working on finding the right choice/amount of medication.

thomastjeffery 4y ago

> Making an appointment with a primary care doctor and showing up to it isn’t that much harder than making an appointment with a telehealth doctor and showing up to it. It sure as hell is when you have ADHD. I know because I've done it. The difference is night and day, and I'm really good at appointments. > Let’s not downplay the effectiveness of non-stimulant ADHD medications In other words: let's please downplay the effectiveness of stimulant medication. No. That's my answer. No. > The downside is that the non-stimulant medications can take some time to become fully effective That's incredibly significant if you are dealing with ADHD symptoms. It means you must not a habit before treatment. And if they don't work, you have to taper off. If stimulants work they work immediately. But that's not the whole story: non-stimulant medication is helpful for a lot of patients! And stimulant medication is helpful for a lot of patients! Choosing which one to start with is important, and the decision is in the hands of the prescribing doctor. Let them do their job. The idea that we should be avoiding stimulant medication is not backed by any science. Stimulants are reliable and effective. When prescribed to patients in a responsible way (not just because they asked please, but because they are pursuing treatment) stimulant medication is proven to be very safe. > Telehealth pill mills like Cerebral only make the situation worse, as the doctors have no interest in long term patient outcomes Yes indeed, that is a real problem, and I totally agree we should get rid of them for that very reason. But what do we replace them with? A system that is fundamentally broken for the people it is meant to serve? That isn't good enough. Despite having every wrong and damaging perverse incentive, "telehealth pill mills" like Cerebral - alongside the real damage they caused - managed some real good. They made an impossible system possible. They did so by breaking that system. I want to see us move forward, not by simply dropping the old broken system back into place, but by actually fixing it. Let's make real responsible treatment actually available to the millions of adults who simply can't get over the bullshit hurdles we have in their way. Until then, dangerous practices like Cerebral will be implicitly validated as the best we've got.