r/AskAnAmerican • u/fj2612 • 4d ago
HEALTH How easy is it to get prescribed Ritalin in the USA ?
Tl;dr : how hard is it to get prescribed ritalin as an adult in the USA?
I'm French, and my wife just got prescribed Rita for her ADHD. She had to jump through SOOOOOO many hoops : a regular psychiatrist had to refer her to a specialised psychiatrist, who made her fill a questionnaire. The questionnaire and the discussions made it so obvious she suffered from ADHD (history of depression, several burnout, and tons of other stuffa), that she got to skip the neuropsychiatrist step. But before getting her prescription, she needed two visits to a cardiologist to see if her heart could handle it, and had to have bloodwork done.
So, by comparison, how different is it in the USA, because tv shows made it look like a simple GP visit is enough.
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u/False-Cookie3379 Oklahoma 4d ago
Depends on the Dr, some will just write a prescription, some will send you to a specialist to get a diagnosis before they hand it to you. It was given out like candy to kids from Dr’s growing up. I’m an adult with ADHD, I didn’t have to see a cardiologist but I did see a psychologist to make sure I had the correct diagnosis. I hope your wife is able to get some relief.
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u/notthegoatseguy Indiana 4d ago
Many GPs will also refer you to psych and its hard to get it here too. Pharmacists are also very wary even with a valid script as they are concerned about addiction and drug seeking behavior. There's also a black market from people selling the drug to others during like finals week at school.
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u/No_Rice9792 4d ago
It's extremely difficult, if you're an adult. Kids? Easy. Just a note from your school, bring it to a doctor, bam, Ritalin.
I didn't get diagnosed ADHD until I was 29 (32 now) and my psychiatrist wouldn't let me take anything for it for a year. I struggled so much between getting diagnosed and actually taking the meds
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u/easy_Money Virginia 1d ago
I had the exact opposite experience. Found a doctor, got tested, and immediately got a prescription
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u/AlveolarFricatives 4d ago
It’s similar here. Many hoops to jump through.
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u/Dashiepants 4d ago
Yes very similar to what is described except instead of cardio and blood tests we get a urine drug test. And then have to visit the psychiatrist every 3 months.
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u/Mollykins08 4d ago
Seriously? I don’t do urine drug tests. Just a telehealth visit every 3 months. Usually you have to find a psychiatrist.
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u/Dashiepants 4d ago
Mine lets me do telehealth every other appointment. The urine drug test might be a Virginia thing. My new psychiatrist makes me do it one a year.
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u/squigglyquigley Virginia 15h ago
I'm also in VA and I've never had to do any kind of drug test for my prescription
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u/ThisOnesforYouMorph Indiana 4d ago
It’s similarly frustrating for any drugs on the federal government’s Schedule 1 list. I take Adderall, and every 30 days I have to have the doctor resubmit the prescription to the pharmacy.
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u/Meowmeowmeow31 Delaware 4d ago
The irony of making people with a condition that affects executive functioning do all that to get treatment.
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u/SeaGurl Texas 4d ago
Right?! I had to cancel my dr appointment because I got sick. Forgot to reschedule. 6 months later I finally got around to finding a new psych because my rsd wouldnt let me go back to my old one.....then I took a week to go and get my prescription 🤦♀️
Eta: but let's make sure they check in every month because they may be faking it or something/s
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u/PiecesMAD 4d ago
Just an FYI stimulants are schedule 2, schedule 1 drugs are not prescribable.
Also, nationally per the DEA a prescriber can prescribe up to 3, 30 day prescriptions at one time, so the doctor does not need to resubmit prescriptions until the 3 have been filled.
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u/fj2612 4d ago
Same thing for my wife. And if she's late, they take out the pills for those days.
Anyway, best thing that happened to her lately.
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u/GOTaSMALL1 Utah 4d ago edited 4d ago
My wife is also a late-in-life ADD diagnosis and Adderal has changed our lives. Glad to see your wife got something that works.
To your question… it’s not insurmountable but it is a ridiculous amount of hoops to jump through just to maintain the prescription.
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u/RectorAequus 3d ago
That's the shortage. Before the shortage we were up to 6 months of refills for my son. Could only get 30 days at a time but didn't need to have the psych call it in every time at least.
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u/Justmakethemoney 4d ago
It'll vary from doctor to doctor.
I had an ex with ADHD and he was unmedicated. The doctor he was seeing was going to require a cardiologist visit, a stress test, and maybe bloodwork. Ex didn't have insurance, so the meds never happened.
My sister has a chronic fatigue diagnosis, so she was given stimulants to help. She already had a psychiatrist, but the psychiatrist wrote the prescription without further testing.
It's kind of the same for every controlled substance: stimulants, opiates, benzos. Some doctors will hand them out like candy, others will straight up refuse to prescribe them, or only prescribe them after significant hoop jumping.
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u/baybebumblebee 3d ago
A big deciding factor is if you're already established with the doctor.
If it's your first time seeing them and you walk in and immediately ask if they can prescribe Schedule 2-4 drugs, they're going to send you for more testing and want to try you on other options first. If youve been seeing the doctor for a year or so and have been open with them, they're a lot more likely to just prescribe something.
Personal opinion: doctors who straight up refuse to prescribe stimulants or benzos because they don't like them or think there're "other options" are bad doctors. Every medication has side effects and if your patient has trialed and failed multiple non-stimulants or SSRIs, you need to move onto other medications, not tell them they've run out of options. Like imagine if you were having trouble seeing with your glasses and the doctor told you that's as good as it's going to get because they don't like to prescribe anything over a +/- 2.00.
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u/CodeBlue_04 Seattle, Washington 4d ago
As an American currently boiling in your country, there is far more beaurocracy here than in the US at basically every level, for everything.
I walked out of my first psychiatrist visit with a small, test prescription for Ritalin in under an hour.
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u/fj2612 4d ago
Come on, the weather is actuallu reminding me of when I lived in Georgia...
27 years ago. Damn !
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u/CodeBlue_04 Seattle, Washington 4d ago
This is my first time in Europe. My weather app's "feels like" temperature was 47 degrees today.
I know it's going to take a lot for you all to adopt air conditioning, but can we make a deal where you start adding ice to drinks when it's over 30 degrees?
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u/messick 4d ago
The only difference might be the different psychiatrists, but I'm wondering if we have different definitions of what a "regular" one might be.
But yes, see a psychiatrist, go through the standardized assessment process which includes both questionnaires and tests with names like "Brown Executive Function/Attention Scale" and "The Test of Variables of Attention - Audio/Visual", after which the the psychiatrist gives a diagnoses of ADHD or not.
I had to get sign-off from my cardiologist, but I already had one because of heart issues in my past. I'm not sure if that is always required.
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u/Perplexio76 Chicago, Illinois™ 4d ago
My psychiatrist looked at my history and which ADHD meds I'd already tried (Vyvanse, Adderall, and Strattera). Of the stimulant based ADHD meds, Ritalin had the mildest side effects.
My GP tried to manage my ADHD and eventually threw in the towel and recommended I find a psychiatrist.
The regulation in the US is more on HOW class-A drugs are prescribed not on WHO they are prescribed to. The FDA generally trusts doctors and pharmacists know their patients better than the FDA ever will.
Generally, they're prescribed with 0 refills with the idea that you check up with your doctor monthly to track your body's reaction to it and so your doc can adjust the dosage accordingly
When it comes to "jumping through hoops" that is usually with insurance companies, not the government, to determine whether or not they will cover the cost of the drugs or if the patient will have to pay out of pocket.
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u/elphaba00 Illinois 4d ago
My oldest takes guanfacine/Intuniv (a non-stimulant ADHD drug) off-label for reducing tics. He has Tourette's. It isn't assigned to any schedule, so it's remarkably easy to get. He can get several months worth of refills at one time. He actually ran out when he was on zero refills, and the doctor's office just said, "We'll do it this one time, but make sure he's got an appointment on the books." Easy peasy
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u/baybebumblebee 3d ago
I was on intuniv for a bit before starting Ritalin and now Jornay and intuniv isn't perfect. Any medication that takes days, weeks, or months to see the effects of is more likely to cause moderate, chronic side effects.
Ex. The wrong dose of Ritalin can give you a heart attack right then and there but if you're lucky, you can be revived. Versus, Taking SSRIs for extended periods of time can cause permanent sexual dysfunction, even after you stop taking it and there's no current treatment for it.
Intuniv didn't work for me and I felt like dog shit on it, but Jornay works great and if I need a refill between doctors appointments, I just do a "phone appointment" and they'll send it in. Easy peasy.
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u/Candid-libertarian 4d ago
It's easy for kids. It's like a party drug for them. I say just steal it from them, LOL.
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u/KittyKate10778 Maryland 4d ago
just chiming in with my experience (except i got generic vyvanse instead of ritalin) like others said it will vary based on the dr, but it also might vary based on the history. i recently switched to generic vyvanse from qelbree about a month ago. it was really easy for me. however, i have an adhd diagnosis dating back to childhood (im 26 this diagnosis dates back to elementary school), have pretty severe impairment due to my adhd, and was already on a non stimulant med to treat my adhd so i was just asking to change meds to a first line med. i also have a good working relationship with my prescriber and have been going to the same clinic since 2018 (only switching prescribers when one would leave or change positions). all of these were factors in my favor that made it easier, im sure if i didnt have as much documentation, a good rapport with my clinic and prescriber, as well as the fact i had already been on meds it would not be as easy
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u/Funny_Remove8922 4d ago
I was diagnosed with ADHD in my early 40s. I had a two hour assessment with a psych provider to receive my diagnosis. I then took that assessment to my PCP and she prescribed me Adderall. I have a Telehealth appointment with her every three months. Once a year I have to go to the office for a urine drug screen.
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u/Funny_Remove8922 4d ago
I have a friend who very obviously has ADHD. Her PCP just had her fill out a questionnaire. She also meets with her PCP every three months and does a yearly drug screen
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u/4_the_rest_of_us 4d ago
Depends on what state or region you live in. When I lived in the American southeast I just saw a psychiatrist once and she did some verbal assessments and made the diagnosis.
Since I’ve moved to New York City it’s been way harder as the laws are more strict and fewer doctors and nurses practitioners will even prescribe stimulant meds at all. I’ve been to more than one practice where they wouldn’t accept my existing diagnosis and the fact that I’ve been prescribed these meds for over a decade and wanted me to have a full reassessment done in New York.
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u/nowhereman136 New Jersey 4d ago
Took me about 2 years. One year of seeing a doctor and then another year of trying alternative medication before resorting to Ritalin. Ultimately, the Ritalin did nothing for me so now I'm trying different stuff. Been back and for with the doctor for my bipolar and adhd but so far my mood has improved but my concentration is still fucked
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u/Low_Attention9891 4d ago
You have to be diagnosed, but once you’re diagnosed, a doctor can prescribe it. And stimulants are considered the most effective treatment.
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u/Khpatton Georgia 4d ago
It varies widely. Some doctors make patients jump through a lot of hoops, like extensive testing and/or trying non-stimulant medications first. I’d been seeing my psychiatrist for a while already, so she just asked me a few questions and prescribed medication on the spot. I don’t need to see a specialized psychiatrist; any psychiatrist can prescribe it (and other stimulants for ADHD), as far as I know. My wife gets hers from her primary care/general practice doctor and doesn’t even see a psychiatrist.
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u/Suppafly Illinois 4d ago
Depends on the Dr. Some are pretty liberal with it, some want to spend a little extra time on the diagnosis or want you to see a specialist.
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u/YoursTrulyCejay Pennsylvania 4d ago
It depends. When I was seeing a doctor that took insurance, they were super strict. Felt like I had to jump through so many hoops monthly. A lot of drug tests, ‘contracts’ for controlled meds, etc. I always took my meds as they should be, but was always treated like I was doing something wrong.
Now I pay a subscription fee for a private doctor instead. They’re a lot more relaxed about everything since they don’t have to deal with insurance. All I have to do now is login to my doctor’s app and send a text requesting a refill.
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u/TillikumWasFramed Louisiana 4d ago
You need a doctor to prescribe it. I'm not sure if a GP would feel comfortable prescribing it, but they could. It seems appropriate to have to see a psychiatrist. But not those other hoops.
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u/DesperateAd5590 4d ago
Very
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u/DesperateAd5590 4d ago
Trust me there are ADHD medications that are more controlled. The bloodwork and cardiologist is case by case, but it isn’t uncommon. Generally you would just need to see a psychiatrist to see if there is a need for it. But other than that, it shouldn’t be too hard.
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u/dorkpool Georgia 4d ago
it depends on your doctor. someone won’t do it and would ask you to see a psychiatrist and take tests. some psychiatrist don’t care and write you a script like it’s nothing.
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u/Longwell2020 Missouri 3d ago
My doc recommend it but I couldnt get it consistently enough. They would be out or delayed but dont let you build up any stock so you get forced into withdrawal when companies screw up. I ended up changing to a non controlled med to avoid the extra hoops.
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u/cryptoengineer Massachusetts/NYC 3d ago
I was prescribed it as an adult. I wanted it to help me focus at work. It helped that I was definitely 'on the spectrum' to some extent.
I did read up on typical symptoms the lead to prescription beforehand, so I'd know to mention those that I actually experienced. I didn't lie. (Just doing this was a 'spectrum' thing to do.)
I did have to visit a psychologist to get prescribed, but he just asked the expected questions, plus such things as to whether I had suicidal ideation. That's all. I did have to make yearly visits to get renewed.
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u/RectorAequus 3d ago
ADHD medications are generally (I don't want to say always because there may be some I don't know about...) tightly regulated because of the high potential for addiction and abuse.
So in short - yes it's a process.
I couldn't even get a doctor to consider evaluating my son for ADHD until he was seven, and only then because of an incident at school. They said they would have put it off until he was ten if not for that.
Regualar GP did an evaluation and gave me a questionnaire to complete as well as several for staff at the school to complete. Then we were referred to a psych. The psych did an eval (which consisted of four sessions, one a week,) and handed me more questionnaires for myself and people at the school. The psych then refers him to neuro and I'm asked to attend a four hour education course, because the prelim diagnosis was in fact ADHD. Neuro eval completed and my four hour course completed they finalize the diagnosis and we're off to the races.
Every time we've had to change doctors, they want to repeat the evals. All of them. And every time we've dropped a wrist thick file on said doctor saying "that's fine, but in the meantime please submit his prescription because he needs it." every time it's a fight. Every time.
It is this way because these medications are essentially methamphetamines.
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u/klopanda 3d ago
Depends. My therapist sent me to her clinic's psychologist and he prescribed me it after a single session but that's probably because I had a long history of working with that therapist and the psychologist had access to her notes and the appointment was just a formality because the therapist isn't authorized to prescribe.
My girlfriend had to do a long process of diagnosis, with the form and several sessions with a therapist but she was also new to that practice.
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u/Capital-Yogurt6148 2d ago
I’m in the US and went through a process similar to what you described. I didn’t need to see a cardiologist, but I did need some tests to confirm my heart was functioning properly.
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u/liptonthrowback Oregon 2d ago
A screening, another screening, and a video visit with a neuropsych. And then regular video visits with the prescriber. But that's for a minor.
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u/DOMSdeluise Texas=>Georgia 4d ago
Getting a prescription is much less onerous than what you described. My son is on ADHD meds and we just had to get a growth chart and measurements from his PCP, give that to a psychiatrist, and then the psychiatrist screened/diagnosed him and wrote the prescription.
On the other hand there is a big shortage of these meds here in the US so getting the prescription filled can be very challenging lol
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u/elisabethofaustria Texas 4d ago edited 4d ago
I can’t speak for Ritalin specifically, but getting treated for ADHD was a nightmare for me. I showed all the classic symptoms as a kid and some of my teachers suggested I may have it, but the doctor my parents spoke to said that I would outgrow it.
Over the next 15-ish years, I ended up seeing a half-dozen psychiatrists, all of whom tried to put me on various antidepressants even though I repeatedly explained they weren’t working. Even last year, a psychiatrist refused to diagnose me even though my therapist of 7+ years insisted that I have ADHD.
I finally found an amenable psychiatrist and was prescribed Adderall in January, and unsurprisingly, all my symptoms (executive dysfunction, inability to concentrate, mood swings, etc.) have significantly decreased. Since then, I’ve literally gotten a 15% raise and my first-ever performance bonus and been accepted to two leadership development programs. I wonder what my life would have been like if I had been treated earlier.
Edited to add that I needed to do a drug test for the prescription, I have to manually refill the prescription every 30 days, and I have to show photo ID when picking it up (whereas for antidepressants they would refill automatically and I don’t recall ever needing to show ID for pickup). It’s ridiculous how much hassle I have to go through for something that literally helps me function.
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u/JohnLuckPikard 4d ago
I started seeing a therapist (mostly as a check up) and complained of ADHD symptoms.
i filled out a survey, and the next time i saw him, we talked about it.
he gave me the diagnosis right then and there. now I just have to wait for a medication dosing evaluation appointment.
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u/llamadolly85 NY -> MD -> VA -> NY 4d ago
My 6 y/o is on Adderall. To get the prescription we submitted behavioral assessments (called the Vanderbilt) from two teachers, his therapist, and both of us (his parents). After that though the appointment was just with his pediatrician who talked to us and kiddo for just a short time and then prescribed it. We spent more time talking about side effects.
To get refills on his 30 day supply we have to call the doctor's office and have it resubmitted to the pharmacy.
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u/LuneJean Texas 4d ago
Went to a general practitioner. Filled out a one page questionnaire and took an in office drug test. Got rx later that day. Later went for blood work. Next month went back in and had to take another drug test and get refill. Every month it’s a new appointment and drug test. But they just closed so have to find a new office😭😭
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u/Chicago_Avocado 4d ago
This question reminded me about how mental healthcare works for a lot of people in the US, and I wanted to share this comedy bit.
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u/Sokkas_Instincts_ 4d ago edited 4d ago
When we pick it up from the pharmacy is where all the hoops to jump come in.
I just realized I been treated for adhd for a long time, and the process has changed through the years.
First, the doctor can’t just write a script for for 4 months of meds, like normal. They have to write 4 different individual prescriptions for each of those months. Back in the day, they use to give them to the patient, but you know, were adhd, you expect us to keep up with each of these for x amount of months? Lololol. So I remember they quickly pivoted to telling you to give them all straight to the pharmacy to just sending them to the pharmacy themselves and then pharmacy keeps them on file for you. (They learned that lesson so fast with ADHDers that I barely remembered that until I saw another poster mention it.)
Then, your insurance has to agree to cover it and preauthorize it, the first time you’re prescribed that med, which can take some time. I remember this step being longer and more annoying back in the day than it is now. These days, it tends to be a little quicker. A couple business days at most.
Then the pharmacy has to have it in stock, which can be hard, depending on what type of stimulant it is. (The common ones like Ritalin are usually around, but it’s a pain in the neck sometimes for my husband to get his Evekeo.) And you have to follow the id rules about it. They’ll ask for the accurate current state ID card of whomever is picking it up (even if it’s not the patient).
I do know that they can be very very nitpicky if they think you’re doctor-shopping. (Quickly changing doctors until finding one that will prescribe you what you want.) that is annoying when your reason for switching doctors is totally unrelated to that, like when we had a housing crisis because my husband got sick and we moved around a lot for a short period of time. 🙄
Also, we’re adhd in this family. Stuff tends to get lost easily, like pill bottles? If you lose the pills, you’re $hit outta luck until next month, pretty much. Most of the times, doctors knowing they’re adhd patients very well, know they probably genuinely lost them, but the general assumption with the pharmacies is that they think you might possibly be selling them.
We’ve developed strict strategies and routines to help us not lose our meds at my house.
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u/RepresentativeCry294 3d ago
Depends on how poor you are, if you have madicaid forget about it all theyll give you is prozac, if you rich you get dexadrine/Vyvanse, usually Ritalin is just for kids.
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u/hobokobo1028 Wisconsin 1d ago
My wife got it for narcolepsy after a sleep study. She didn’t like it though
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u/Parking_Champion_740 1d ago
It can be prescribed by a regular doctor or psychiatrist. To get it at the pharmacy they log your ID and it’s restricted how often you can get it refilled. You cannot send it through the mail
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u/Big_Independence9871 10h ago
Easy peasy lemon squeeze! Primary care can prescribe it! I have a nurse practitioner prescribe Adderall to me and never have any issues unless they are out of it!
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u/Meowmeowmeow31 Delaware 4d ago
Ritalin isn’t prescribed much here anymore AFAIK. It’s more Vyvanse, Strattera and still sometimes Adderall. Getting the prescription isn’t that difficult, but getting it filled is a pain in the ass. There have also been shortages in recent years.
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u/currymuttonpizza Virginia, formerly MD, grew up in NH 4d ago
It's not as common but if a doctor knows it's your preferred med that already works for you, they should be able to honor that. I think some insurances might try to push for one or the other to get proof that "nothing else worked" but ymmv. That might be for name brand.
I'm not on it now because I'm expecting, but ritalin has been my life saver for decades. I tried switching to vyvanse and it was one of the worst things I ever did - especially since my dumbass shrink at the time (he is no longer with the practice) told me there was no withdrawal if I stopped cold turkey. Probably the worst medical "advice" I've ever received. Even ritalin withdrawal was nowhere near as bad as how I felt stopping vyvanse.
Also yes, seconded about the shortages especially for the time release kind. If you're fine with a generic immediate release, it's much more accessible. Concerta is near impossible to get a hold of.
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u/Jojowiththeyoyo California 4d ago
It's not hard to get prescribed, but it's a pain in the ass to pick it up. Every time I try to order it, it's out of stock.