The Trials & Tribulations of Titration

On Friday I went to my family physician for a scheduled appointment - 4 weeks after he titrated me from 20 mg to 30 mg daily of Strattera.

I have been noticing that my impulsivity - both verbal and 'action' stuff - has improved drastically with the medication. I am more calm, taking conversations in and digesting them before speaking. My weight continues to remain down, and I had a thought yesterday that this too was likely due to improved impulse control with my diet - I wait out the temptations and have a glass of water instead of a chocolate bar and have a light meal instead of something heavy.

Side effects are minimal - some dry mouth, but that's about it.

When my doctor entered the exam room he asked me 'How are you doing?' I reviewed my experience with him for a minute or two. He then began to tell me how it is important it is to balance the side effects with the clinical effects of the drug. I sort of watched him speaking, wondering what he was getting at. Then he explained how I will need to take 'drug holidays', and that I 'can't be on this forever'. So then I began to wonder if he thought Strattera was a stimulant medication. I have close to zero faith in my family doctor's knowledge about ADHD.

I told him that I had read 'drug holidays' are no longer recommended to patients who take stimulant medications. And I said either way, it didn't apply to me as Strattera is a non-stimulant medication. I didn't even bring up his 'forever' comment - I was thinking instead about what my new doctor will be like, the one I intend to switch to from this idiot.

He then abruptly told me that I should come back in a month and continue to monitor my progress. Given that he hadn't actually asked me any specific questions about my progress, other than 'How are you doing?', I doubted his judgment, and immediately responded to him.

I brought up that I understood from the Canadian ADHD Practice Guidelines that the dose of Strattera can be brought up to 60 to 80 and generally not more than 100 mg, and that my understanding generally from reading a great deal about Adult ADHD, that it is not at all unreasonable to increase the rate of titration given the relatively low side effects that I am experiencing. He began to talk about how the medication can keep me awake, and I quickly reminded him that Strattera is not classified amongst the psychostimulants, and therefore would generally not have an effect on my sleep. And that indeed Strattera has been demonstrated to be an effective anxiolytic in the case of co-morbid anxiety disorder, as I am led to believe my diagnosis contained. I told him that it was my expectation, and that "respectfully, I have to disagree with your opinion on this", that I was going to get an increase in medication.

He paused, and then casually suggested that we go up to 40 mg of Strattera, and that we meet again in a month. I politely agreed. He wrote the prescription and I said 'thanks' without wishing him a good day.

So my intention is to change doctors - to one who has experience with Adult ADHD, and one who is in Toronto (where I live).

A quick question for readers - I asked my doctor a couple of visits ago if I could see the diagnostic notes that the clinic had delivered to him for my records, and he told me that 'these things are generally confidential'. I didn't pursue it, but it kinda seems that they are my patient records, and that I should be allowed to view them. Plus I would really like to read the diagnosis and notes, because I believe it will help me more fully understand my diagnosis, towards the goal of self-coaching and understanding my treatment more. Am I being unreasonable?

Cheers,

Mungo

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