Updating my review. The medical director at Neuro Wellness spa refused to accept Selegiline, a medication prescribed off label, as a 6th treatment option for ADHD, due to mixed evidence. I wrote up a report showing a fair amount of methodological flaws with the negative evidence (such as incorrect dosage, wherein Selegiline is not a Mao-B inhibitor), with controlled trials showing positive results. But after nearly a year of trying and having terrible experiences on different medications, I am told "to focus on medicines with evidence that they work." I find this rather patronizing and intrusive, especially since I provided a successful controlled trial and spent many hours trying to research this medication. To clarify, they suggested no safety issues with the medication; it is purely an exercise of not letting me decide the next viable treatment option. As stated before, this service is about as expensive as other services, but with only 15 minute appointments, often without access to a psychiatrist. Flexibility, the only reason I was graceful with my past review, is gone. I am infuriated and do not recommend this service to anyone who has had the misfortune of trying to self-advocate to stubborn doctors.
There is also the issue that they do not listen in cases of poor results. I was told a 27 mg dose of Methylphenidate is not "clinically significant," and was complaining about it making me sleepy. The director was surprised at this, despite reading notes, which makes me wonder how thorough the note taking process is, as this was my chief experience/symptom. I was also having radical mood swings, suicidal thoughts, and developed a stereotypy on a different medication, and they suggested raising the dose. The week another medication became clinically useful, I was so lethargic I could hardly get out of bed on another medication (as opposed to remission of depression for 1-2 years). And once again, "increase the dose." Expect months of excruciating pain from people who don't take no for an answer well.
On this point, something I could've done better is fully ramp on Amphetamines, but I noticed doubling the dose seemed to not have a useful effect. When I didn't really have a great answer as to why not move to a 40 mg dose, other than complaining that it made me shaky, nauseous, stressed, with none or negligible benefit to focus, when doubling the dose the first time, that was when I basically lost. The director already had their entire mind set on proving why I was wrong, which I didn't care about so long as I could take Selegiline as a 6th treatment option or so. As they thought the fault was entirely mine for not ramping up to full dosage on some/all of these drugs over the course of multiple months (which likely would've been difficult due to mental disruptions from medications), I felt I went from very little control to no control.
Just to clarify again, an inability to focus is having a severe effect on reaching school and work milestones, which is why I am surprised that the director suggested only using medications with FDA approval, when Wellbutrin and Pristiq don't have FDA approval for ADHD. It just feels like a double standard. Meanwhile, stimulant medications are in constant shortage, and are more expensive. Requesting me to take the highest dose of all these classes of stimulants first, when I complain about side effects, and pointed out a lack of long-term adherence (sources range from 35-70%, the only study I found which actually asked people, rather than reviewing medication pick-ups, 40% of initial responders on Adderall found it useful on 8 month follow up), is pushing back what I believe to be an understudied treatment option. In particular, I was hoping for Selegiline as a 6th treatment option, meaning I had no problem with taking other medications that I experience nasty side effects from, if I'm allowed a tiny bit of say. There is almost an assumption that ADHD has a specific cause, when it is a list of traits. There is also a conflict of interest in that I'd have to do monthly meetings due to risk of addiction or adverse effects on stimulants, while Selegiline is non-addictive and has a far better side effect profile (there are no dietary restrictions at a 5 mg dose). I wish there was any respect for potential financial stressors, supply chain issues, or an appreciation for attempts at innovation. That's my side of the story, minus dozens of academic sources, and endless bills (imagine how much higher they'd be with TMS), and good luck to anyone who chooses this provider. read more
