#FUCK YOU JOE FUCK YOU ENTIRELY DROP DEAD YOU FUCKING FILTH MONGER

[vergess]

An adult human in my vicinity went for ADHD dx. She had a call that had a lot of standard ND screening questions and got a prescription for both Wellbutrin and Zoloft, and told that she needed acomputer test for a proper diagnosis and actual ADHD meds, plus blood work. Is that normal? Do you know anything about antidepressants and ADHD?

I mean, it's definitely normal, yes. Whether it's good is much more debateable.

But it's extremely normal, because we live in a fuckign hellscape and the government in this country likes to arbitrarily gatekeep life saving medications like pain relief and stimulants to prove they're "tough on drugs" even though it literally makes the problems of addiction, street drugs, and overdose related death much much much MUCH WORSE.

/ahem

Anyway, it's very normal for a medical practice to either say outright "we don't treat ADHD here at all sorry" or to put access to stimulants behind a bunch of weird obtrusive hoops. For example, I have to go to my doctor every three months for a physical, a mental health screening, and to sign a stupid fucking contract that says I'm Contributing To Society In The Legally Mandated Ways before I am allowed to get the medicine that literally allows me to feed myself or clean my own body.

The computer screening in particular sounds Very Legit to me, because a lot of the time they're going to end up using the same diagnostic exam you can fucking take online, but monitoring you while you do. Advise your friend to always describe their most extreme ADHD symptoms when taking the screener. If they've ever "forgotten an important work task" she needs to put that she constantly forgets them, like the maximum fucking amount. Stuff like that.

Okay the actual question now.

Wellbutrin+Zoloft is a common enough treatment for ADHD when your doctor is averse to stimulants for whatever reason. In a normal society, this would be "because you have a history of heart problems or have tried stimulants and found them unhelpful," but we don't live in that world. It's what's called a second-line treatment, which basically means it's supposed to be tried second, after first-line (stimulants) have failed.

ADHD is generally believed at this point to be a fault in the way neurotransmitters bind to neurons in the brain. They take 'too long' to bind, and end up getting cleaned up instead of transmitting their message. Since the cleanup system is being constantly triggered, you also make less of these neurotransmitters since there's an apparent oversupply. (This is a WILD oversimplification)

Stimulants cause you to make more neurotransmitters, bringing production up high enough that the transmitters have a chance to bind before the overzealous cleanup systems eat them.

Wellbutrin slows down the cleanup process of one neurotransmitter (noradrenaline, I believe). Zoloft slows down the cleanup of a different one (serotonin). So, they're often prescribed in concert.

But, they literally cannot help you produce more neurotransmitters so they fundamentally have limited overall utility in ADHD. Not no utility. Plenty of people who cannot take stimulants find this combination adequate to live with.

But in almost all cases stimulants will work fucking better.

The fact that our goddamn War On Drugs bullshit has made it this difficult to get them is disgusting and is also specifically the fault of Joseph Robinet Biden, who takes great personal PRIDE in having created this medically destructive hellscape during his pre-presidential career and now seems to take great joy in doing nothing to clean up his own goddamn mess.

Okay so!

Yes, SSRIs, NDRIs, and other reuptake inhibitors (cleanup slowdowners) are definitely An Option for ADHD, but they're SUPPOSED TO BE A SECONDARY OPTION FOR A FUCKING REASON AUGH

ETA: You can also be prescribed secondline treatments in addition to firstline ones, if you for example need stronger management of symptoms, etc etc there's a lot of nuance this is a rage fuelled over simplification.

#Medical ableism #medical gatekeeping #war on drugs #Fucking god fucking damn it #My doctor is relocating to a larger town btw #And the nurse replacing him is 'willing' to fill my prescriptions for the 3 months on my latest checkup #BUT THEN WHO KNOWS ITS A REAL MYSTERY #FUCK YOU JOE FUCK YOU ENTIRELY DROP DEAD YOU FUCKING FILTH MONGER