Ep15: Dr Kate and Sarah discuss the ADHD 'movement' and medications

Hello and welcome to Unmasked Minds, the podcast, with me. I am Sarah the Psych on Instagram and a psychologist in real life where I work predominantly with millennial middle-aged women navigating all of the complexities with this stage of our life. And today I am joined by my sister, Dr. Kate, who is a psychiatrist, and she is joining me today to tackle some of the most asked questions we both get around ADHD, the diagnostic process, and medications.

Thanks, Sarah. Good to be here.

So welcome back. We did do an intro episode. If you haven't listened to that one yet, jump in and listen to that one where I introduce her properly in a lot of detail. And it's a beautiful episode to understand a lot more about Dr. Kate and what she's passionate about and why I guess we are doing this little series on, on the podcast. But let's jump straight into this one today, which is all around ADHD. One of the questions that I get all of the time is, what is the difference between going to a psychologist and a psychiatrist when it comes to ADHD?

What a great question.

Do you get it?

Uh, well, by the time they get to me, not so much.

I guess the first thing to acknowledge is getting an ADHD diagnosis is quite a complex process, isn't it?

It's huge. I mean, the whole health pathway thing is really, really complex to navigate, and I think that's why it's so important to do this podcast.

Yeah, beautiful. So I guess, you know, and what we will focus on today is just psychologist versus psychiatrist— what are the similarities and what are the differences—

and then touch on the GP thing as well.

Yeah, and then we can touch on that, but I think it's also really important to note that we are very aligned on our processes, and we already know that we both take a very holistic approach with our clients and with any sort of diagnosis and that kind of thing, the biopsychosocial sort of sphere. Um, so whilst we will talk in depth today about our processes and what we do, it may not be the same for all psychologists and psychiatrists, right?

Yeah, absolutely. I mean, obviously there's an area that we work in, but people have their nuances of how they approach it.

Yeah, exactly. So let me talk about my process if I'm diagnosing someone. So typically, if someone presents to me for an ADHD diagnosis, what I'm noticing with all of the information now available— we have more research, evolving research, particularly when it comes to women, and we have a lot more accessibility when it comes to social media and online and Googling stuff and ChatGPT. So people tend to arrive and they are feeling pretty informed about it. Let's talk about a question that came through, um, on my Instagram, which was one of my followers saying, I feel like I have FOMO at the moment because everybody is being diagnosed with ADHD.

Yes. And I guess that's something that comes up a lot really, doesn't it? Because, uh, We have a situation where it seems like we're getting lots of diagnoses of ADHD.

Yeah.

But what we also find is that people will come in and think that they might have ADHD because they've got this problem with inattention or lack of focus.

Yeah.

And it could have different sources.

Yeah.

It could be based on a different presentation. It could be they're depressed, or it could be that they've got trauma in their history, or they've got hormonal things that are going on. So there are quite a range of things that might present with that symptom but might not be that.

Yeah. So one thing, an analogy that I really like to use when people ask this question, like, why are there so many people being diagnosed, particularly women, at this middle-aged stage of their life? And the analogy I like to use is when, um, the telescope was invented, people started to realize that there were so many more stars. And so there's this whole sort of concept at the moment that it's not that we are creating more people with ADHD necessarily, it's that we're starting to see things and understand how ADHD presents differently in women more than we ever have before.

Yeah, and that really comes back to even the diagnostic criteria, which we know changed recently, 2013, with the DSM-5. Where, uh, originally people thought that you could only have ADHD when you're a child and that you grew out of it.

Yeah.

Uh, and that when you're an adult, you didn't need medications because you didn't have it anymore. And we now know that that's not necessarily the case. It can be for some, but because they manage it with strategies, they grow out of it. But for others, it can be that as they reach different life stages, um, different levels of cognitive load, that it can actually come up again. And the other thing is that you can have both ADHD and autism diagnosed at the same time, which in the previous DSM version you couldn't. And on top of that, we also know that girls present very differently. So, um, that wasn't something that happened in the past. It was always the boy bouncing off the walls. That was, you know, your classic ADHD.

And we now know that girls have a very different presentation and that girls were flying under the radar, so to speak, when they were younger, because girls do typically tend to have much more internalized symptoms of ADHD or presentations of ADHD. So I guess to summarize that, we're saying we are diagnosing more at the moment because we understand it more. There is also a lot more awareness out there, so people are doing their own research and things are resonating with them, and they are coming saying, hey, maybe this is what's happening for me. And all of that is very positive because our telescope now is discovering more stars.

Yeah, so I think that society really is kind of set up now for these kind of dopamine hits that we're seeking. And so it kind of, um, actually leads us to feel like we aren't able to concentrate because everything comes in 30-second grabs. You know, you're watching reels for 30 seconds, you can't read an article that's too long because you don't have the time. Everything's time pressured, it's all about productivity. So, um, the system is kind of set up to actually mean that we, we feel like we can't focus because attention is the new currency. That's what, um, everything is about on social media.

Yeah. And so what you're saying there is yes, a lot more people are being diagnosed because there is a, a bit of a negativity around that at the moment. Oh, everybody wants a diagnosis, right? But what we are saying is yes, there are more people di— being diagnosed and supported, and that's a wonderful thing. However, What we also are noticing is with the changes in the technological environment and with social media and reels and all of that, we are starting to see big struggles in people who are not neurodivergent and their ability to pay attention.

Yeah. And that can show up in things like burnout too.

Yeah. Yeah. So it is worth considering not everybody who shows up in front of us that says, I think I have ADHD gets diagnosed with ADHD, which we will talk to the process of that. But yes, we wanted to also acknowledge that the way our society and our lives are at the moment with so much time on our screens, we are noticing a lot more people presenting with attention problems that are not ADHD necessarily. So when someone presents to me and they say, I think I may have ADHD, I go through a bit of a process. First step is sort of an initial history taking and understanding what's happening for that person. Usually people are really familiar with the criteria now and are able to sort of say, you know, I'm either hyperactive, impulsive, or I'm really inattentive. You know, they're the two types of ADHD we're really looking for. Even though they're really aware that that's what's showing up for them now as an adult, that's not all we diagnose on, right? So we can acknowledge that those, those sort of presentations are there, but the initial intake really looks at that person as a whole with a big focus on their childhood, you know. So were these, um, presentations or symptoms present in childhood, or have you experienced trauma, neglect, any other things, you know, such as depression or anxiety, which could be showing up as these sort of inattentive symptoms or hyperactive symptoms? So firstly, we take this big intake to understand whether there might be other things going on, or whether this does look like it's ADHD for that person.

Yeah, I guess it's important to really, um, stress that it is a neurodevelopmental disorder. Yeah. And that's why we need to see the evidence from when you're a child.

Yeah.

So it's not just saying, well, I've got these symptoms now, and yes, you do, but maybe that's something that's developed more as you're an adult rather than having it there as a child.

And it might not have been so obvious back then, but we do need to see that there was evidence of it back then to make that diagnosis, which is something we talk a lot about, you know, how do we get that evidence if we don't have parents or we don't have parents who are able or willing to participate in the process. And so the second part of my process is we run a lot of assessments. You know, there are some that we can do online that we send out to the client, but then there's one that I do really in-depth. It's the, you know, diagnostic interview that I spend a couple of hours with the client really going into the criteria and whether those criteria are met in adulthood, but also as equally as important whether those criteria were met in childhood, which we're really looking for pre any sort of trauma or, you know, environmental impacts on that person. Yeah. Once I've gone through that and I do look for what we call collateral information, I am wherever possible looking for parental input. Sometimes I will use siblings, which we can talk about whether that's effective or not, but it is a useful piece of information as we're trying to understand an individual. And like I said, sometimes people can't get that information. When I am working with a client, I trust and believe them, you know, inherently. If they're telling me they remember this about childhood and this is what it felt like for them, that is really important. For me. Um, I'm looking at you because I know you've got something to, to add to this, but yeah, when I am diagnosing someone as a psychologist, I am not medicating them as a next step. So usually when someone comes to me, they are looking for a diagnosis as a way of understanding themselves, as a way of unpacking why they are the way they are, and as a way of using usually non-medication support.

I guess the other thing to really stress with the diagnostic criteria is it has to have a functional impact. You can have all of these symptoms, and that's part of your diagnostic interview as well, is having all of the review of all the different areas where it can impact your function as an adult, but also as a child, because we are dealing with adults.

Yeah. Yeah.

So that's the first one. Yeah. The collateral information is an interesting one. I tend to— I mean, the gold standard is really we want school reports. We want— we're not looking at grades, we're looking at comments. We want to see what the teacher teachers were saying, it could be that you were distracted, you were daydreaming, didn't perform as well as expected, you know, these kind of things that are kind of codes really for what might have been going on at the time.

Yeah.

Maybe you're a chatterbox in class. Yeah. That's the big one that comes up for girls. Yeah. It's also, it's just good to get their input and to see what their perspective is on it. And they might not be the ones that are supportive of the diagnosis. And I understand the, the the reasoning around getting sibling input because you don't have anything else. Yeah, I guess it, it becomes a difficult one because recollection's a really difficult one to quantify. Yeah. And it is a subjective thing. Of course, we're looking at that from parents too, but, but if you're getting a sibling that's a similar age, it has a little bit less objectivity, I guess, than a parent might have, just that age of maturity.

And I guess you're asking the adult sibling to recall things in childhood, right? Exactly. And so you're Really, you know, and a lot of that is shaped by the stories we tell of our childhood and that kind of thing, as opposed to actual objective, this is how she or he used to sort of behave and perform.

So, so the way we get around that, um, if we don't have that kind of collateral, you can go and do a psychometric test where you have, um, a test that you get to respond and see if it picks up on impulsivity or inattention, those sorts of things. And I have one of those that we do in session.

Yeah.

Again, I mean, it's difficult because it is picking up what you're experiencing now rather than when you're a child. But it is another way of getting objective information.

Yeah.

And the other way is, of course, you can get a second opinion.

Yeah.

So if you're getting somebody else to look at it and kind of say, yes, well, you know, I agree, we've gone through all of these different things and that just substantiates what you're saying, you know, so it's not just one person's lens of looking at it and then it can It's kind of the, the process that we go through that allows you to then go on to do the medications, particularly because stimulants are so restricted.

So this is a conversation that we have had. I, in some situations where I've worked with a client for a long period of time and I understand enough about their childhood, I will diagnose without a parent's input if I don't have it. And I guess for me, from a risk perspective, that, that's okay, and it's a valid diagnosis, right? Because I really understand that client and I'm diagnosing them with ADHD. However, in situations where I've then referred the client on to you to look at, you know, potentially medicating, you have to do a couple of extra steps. And I guess this is really interesting because you're not really saying I don't agree with your diagnosis, Sarah Wills, but you're saying the risk from your perspective changes. Absolutely. So let's talk about that.

Yeah, yeah, good point. So from my perspective, I think it's great that you do the DIVA, the diagnostic interview, because I don't get time in session to do it. I know I'm not going to make people spend, you know, all that money to go through that process in session. I would tend to get people to go and do it at home. So having done it with you, I think is invaluable. From my perspective, I tend to look at it from the kind of medical side of it where I need to do an organic workup. And what that means is we look at the physical health side of it. Is there anything else going on? Is there some hormonal thing happening? Is there thyroid problem? Is there vitamin D? Is there iron deficiencies? All these things that can actually impact your ability to function and your ability to focus.

And what medications you should or should not be taking.

Absolutely.

Yeah.

The other thing is substances. So if people are using alcohol, if they're using other types of substances that can really impact how you present, we need to have a period of abstinence in order to be able to assess what's going on. So it's really looking at that kind of what we call organic workup.

Yeah.

Physical health side of things to look at what's going on, because that will impact how we then treat it in terms of medication approach. Yeah. Because by the time they've seen you and they come to me, I'm assuming you're getting all of the psychological side of it.

Yeah.

So for me, it is about, well, how do I help support you to be able to do the psychological work?

Yeah. And so for people who are asking, do I see a psychologist or a psychiatrist, it's a difficult answer. And I guess it comes down to what are your goals. If someone comes to me and says, I really want to try stimulant medication, or medication, we'll get into that, but I really want to try medication, then I tend to say, well, look, it's probably important that you go straight to a psychiatrist because they will follow a similar diagnostic process. I mean, we have to meet the criteria to be able to diagnose. We're both doing that. However, a psychiatrist will from the beginning be starting to, to create and collect and understand that organic sort of more physical medical sort of stuff. Whereas from my perspective, if you're coming to me saying, look, I'd like to understand if I'm ADHD because I want to understand myself, I'm on this chapter of self-discovery and understanding, and I want to support myself in strategies and tools and non-medication ways, then absolutely it might be appropriate to have— to be diagnosed by a psychologist.

Yeah, so I, I mean, I think if you decide to go the direct route through the, the medical approach, you can have that as well, but, but it's a different approach. If you— if it's really important for you to have the medications, I do think it's worthwhile going that way because otherwise you're doing things almost twice, really.

Um, and, and usually if you, you know, diagnose someone and prescribe the medication, you're usually going to recommend they go and see a psychologist anyway after that, aren't you?

Yeah, or an ADHD coach, or, you know, looking at strategies to support you. So definitely it's holistic. The other thing I think it's really important to mention is the family history, and you touched on this a little bit too. That can play a huge part because we know it is neurodevelopmental. And so we want to see if there's any vulnerabilities. So if there's a family member, you know, first-degree relative who's had it, the likelihood of having this is higher. But also if there are other things, so other things that might complicate the picture in terms of medication. And this might be, you know, if you have a vulnerability to something like psychosis, then we need to really look at whether a stimulant is going to be right for you because there are risks.

So that probably leads into a lot of— when I asked on Instagram what questions do people have for you, there were a lot around stimulant medication. What are they? Should I be taking them? And I guess, what are the alternatives?

Yeah, big question. First-line treatment for ADHD, once you've clarified, you know, there's no organic process, that we've done all of the other ruling out of everything else, um, is a, is a stimulant. That's the first line treatment. There's not one, there are two different types. There's short acting, there's long acting.

And what are the commonly known names of those?

So methylphenidate is the Ritalin, and then we have the dexamphetamine, which is short acting, but the long acting version is Vyvanse. And again, it's— there's ways that you can start introducing it, but we tend to titrate. Titrate, meaning you start on a low dose and then you go up until you get to the right dose for you. And that can be really different for different people too. There's not just one size fits all. So we tend to do that and then we get you to a level before we put you onto the long-acting one. But there are different ways you can, you can approach it. So that is an individual thing in itself. Some people aren't suitable for stimulants, and that comes back to this sort of vulnerability that we were talking about. Or it may well be that anxiety is the big problem for you, or it may well be that, you know, you've got trauma that's comorbid, meaning existing at the same time with the ADHD. And then we have these other medications called alpha agonists, which help reduce that arousal state.

Yeah.

And so that can be quite helpful for sleep. It can be helpful.

So nervous system arousal. So sort of that fight or flight response.

Yeah. Yeah. And we often use these medications in trauma and they're also used for kids for behavioral issues. So we're starting to really see that that's valuable to use, um, in adults with ADHD. And sometimes we're actually using both. So a stimulant can increase your anxiety. And so if you're going to take this other medication, these agonists, alpha agonists, it can help reduce the anxiety but still give you the benefit of the stimulant.

So when you go through that, I often reflect and have this sort of aha moment of like, yes, when people come and say, I just want to try medication, it can be really hard to say to them, hang on, you're not getting it tomorrow. There's a process and you might start it with your psychologist, but then when they come to you, they've got to go through this process again. But it's not about creating hoops for them to jump through for the sake of it. It is really about sort of respecting the role that medication can play, but also understanding its limitations and interactions and that kind of thing. And if you do this right for a person, it can, you know, you can get that secret, you know, the right medications and really, really provide such wonderful support for them, right?

It can be life-changing.

Yeah.

But as you point out, there's a risk. That's why we have to be so careful that what we're doing is actually going to be beneficial rather than make it worse for you.

I feel like a lot of people, because it is so easy to go to a GP and get depression medication and anxiety medication, it's really sort of— it's the word— made it feel like there's not a lot of risk with these types of medications. And the fact that ADHD medication at this stage needs to prescribed by a psychiatrist, a lot of people just feel like it should be that easy to get.

Yeah, yeah. You make a really good point. I think that because it's so common, um, that people don't really understand the regulations around it. I mean, when I have people that come and see me to get a stimulant, I actually have an agreement that I want people to sign to say that they're aware that you're not supposed to get your friends to try it. You're not— yeah, you've got to store it in a certain place. It's got to be locked up. It's— you've got— you can't go and lose it on the train and expect to have it, you know, a script replaced, because they're dangerous medications. It really is important to understand the risks involved.

Yeah, part of me is laughing when you say that, because who is the most likely to lose a script? An ADHD person, right?

Which is why you make a big deal, right? Because if you don't, it's like, oh, what's the problem? Yeah, yeah.

And look, I, I'm sort of focusing on this because even as a psychologist, we've had a lot of chats about this, because my understanding of it was limited, you know, when I first started diagnosing people, um, and the one— the medications around the medication.

Yeah, that's not your scope.

Yeah. And, um, we, you know, I, I feel very privileged that we have this relationship where we have been able to spend a lot of time looking into both of our diagnostic processes and aligning our processes so that we can refer clients to each other, because the more I understand it, the more I realize that for clients, the answer is both. You actually, you know, for a lot of clients, particularly if you do, do want medication or would like to use medication or medication is most suitable for you, having a psychologist and a psychiatrist on your team is, you know, a much more holistic way of of doing it, and particularly when we have consent to, you know, work together to support that client, right?

Yeah, absolutely invaluable.

So one other question that I get a lot is around, you know, there's still a bit of stigma around medication because, you know, a lot of people have these stories of, you know, little boys, younger boys getting on medication and it totally zoning them out. And so should I be putting myself or my child on medication, on stimulants? Stimulants specifically. So would you mind explaining what exactly a stimulant is doing to an ADHD brain?

I have a really good visual for this because it's something that comes up all the time. And really it's about, I mean, it is about the level of dopamine in the brain. So if you think that you haven't got enough dopamine, it's when you're in that sort of sad and slow and sluggish mode. And if we can get you up into the right zone, if you like, of dopamine, it means that you've got that, um, motivation, that ability to kind of do things that maybe are a little bit more boring, that might be administrative, that sort of thing. But then if you get above that level of dopamine, that's when you get into the kind of irritability and the hyperfocus and, and crankiness. So it's about levels. And so, so the two different stimulants, one has a slightly more direct effect on the dopamine and one is sort of a little bit more neurodegenerative. Adrenaline direct but indirectly stimulating dopamine. So it's all about the levels.

It's essentially about recognizing that as an ADHD person, your brain works differently and the way it absorbs and regulates and finds its dopamine, sometimes the stimulants can assist that to be more level or more accessible more often. Is that— does that—

yeah, I mean, I think that's a good way to explain it. Yeah, and, and people have good strategies, um, when they're not medicated to find ways of getting dopamine. Going out for a run actually releases those natural hormones that makes you feel like you've got the dopamine levels in your system that you can then become motivated to do things.

When you say that, um, it sort of leads me to think about one of the other questions, which are what are non-medication strategies for supporting someone with ADHD? Let's say someone says, I don't want to, and just doesn't align with me to medicate.

Sleep first.

What else would you recommend for someone?

Um, good question. But I mean, there's, there's a host of things. Obviously it's about sleep is the foundation. Yeah. Of good health.

Yeah.

For mental health and physical health. And sometimes that can be a really huge thing for people. So having that good sleep hygiene is a start.

Yeah.

Getting regular exercise, you know, releases the natural levels. Having the nutrition, like all the foundations of good physical health.

Absolutely. And what we tend to find is, you know, when people are presenting maybe postpartum or in these different stages of their life, and they are like, my ADHD is more obvious now. Often it's because a significant lifestyle change has shifted and they're no longer accessing regular exercise or those self-care kind of things that— sleep patterns, good sleep patterns that, um, allowed them to function previously, right?

Yeah, their previous strategies are no longer working or available.

Another thing that I say is a really, really valuable non-medication strategy is education. Psych education around why you feel and behave the way you do. How does my ADHD brain work? And in what environments or circumstances am I using a lot more energy or using less energy? And I, I find so often just simply Really understanding how your brain works allows a person— this was certainly my own experience, you know, when I was diagnosed with ADHD, I thought that I was going to start using medication because I really felt like I was at a point where I wasn't functioning the way I needed to, right? But what I actually found, and I trialed medication and it just didn't really align with me, what I found was more valuable was just I was, you know, hyper-focusing on understanding what was going on in there, because once I understood what was going on, I could provide a different level of support to myself. So historically, where I might have felt shame or embarrassment for functioning the way my brain functioned, I actually— I could have more self-compassion. You know what, you're ADHD and that shit's really hard for you. But if you, you know, if you're going to do those things, then make sure you've done your exercise that day.

Yeah, yeah, absolutely. I think that's really important. That level of understanding is, you know, the, the first part of healing really is. And you're right, medication isn't right for everybody. Yeah, you know, it might well be that you do a trial and that you get through all of it and decide that it isn't right. I suppose I would also point out that there are other medications that can support your mood. It might well be— yeah, you know, it's not just a stimulant or these alpha agonists like Intuniv or Clonidine, but antidepressants can actually be something that helps your ADHD and is one of the sort of second-line treatments that we have for medication.

Well, and we also get that situation where depending on, uh, the client's age, you know, particularly perimenopause for women, I know I have referred clients to you in the past who have been like, I feel ready for an ADHD medication, and after consulting with you, they've actually started to trial, you know, hormones and hormone replacement hormones first. Yeah, with a sort of, well, this is also going on for you, so why don't we focus on whether it's hormones or mood or other things first because they feel more, you know, problematic, dysfunctional for you.

Well, and also the sort of underlying reason why you've presented now.

Exactly. Yeah, what is the problem right now that we could maybe fix or help support with something else before we decide to do that?

Because then you might need Whereas if you treat the, the other one that is the cause of the presentation at the moment, then maybe you don't need the other.

So it is quite complex. Absolutely. The whole medication discussion, isn't it?

Yes, yes it is. And that's why you need 10 years of training. Yeah. And I really hope that that helps explain why it is such a complicated process and that people get the benefit of having that awareness so that when they come and see a psychiatrist, they understand that, you know, it can be really difficult for them to go through that process and it can actually be really rewarding at the outset rather than, you know, feeling like you're coming along just to get a medication.

Yeah, exactly. I love that. Okay, so the other thing we were going to talk about today was GPs. Yeah, if I remember, it was late last year in 2025, there was this huge social media, like, focus on GPs are now able to diagnose ADHD and prescribe medication.

Yes, they are. So look, it's a really complicated area and I don't think there was enough information that was given to the wider community. And I think that's why it's really good to talk about it here. Really, the number of training positions that were allocated in New South Wales are limited and they're actually limited to kids at the moment.

Right.

So the training has been around providing GPs with the ability to diagnose and prescribe in kids. And the reason seems I would postulate, I guess, is that because with kids it's generally not going to have a lot of comorbidities. When it presents, it's that, you know, it's a lot easier to do that. Whereas once you get into adulthood, if you've lived with this for years, you're going to have a complex situation. You know, it could be trauma or it could be depression, it could be anxiety, it could be all of the above. It could be all sorts of things.

There used to be this sort of belief that, you know, we can't diagnose that adult with ADHD because they've got trauma, right? And now we're like, yeah, but someone with ADHD often finds themselves in traumatic situations because they're impulsive, they're spontaneous. There's a lot more risky.

Yeah, that's right. And they can coexist.

Absolutely.

But we need to look at what's the kind of driving force as to how we approach the management of it too. Yeah.

Sorry, I digress. Back to—

so, so at the moment, the focus is is— we keep coming back to focus, ironically— is that GPs can do it for kids. Now, now that's not to say that some GPs can. Yes, yes. So my understanding is that GPs diagnose, uh, sorry, they can continue to prescribe stimulants for adults. So you still go to the psychiatrist, you get the, the workup, you get the levels, you get the right medications at the right dose, and then Once you're stabilised, then you can go back to the GP and the GP can take over prescribing. I don't say take over care because as the original prescriber, I would still want my patients to come back and see me every year in case there's increase in tolerance or changes in their presentation. Yeah. Or everything, anything that could actually change the management.

Yeah.

Means that then the GP can take it on once we've worked out what the changes are. Yeah, because GPs, when they apply for the application to be able to prescribe, it's up to a dose and that tends to be on the same management level. So if there are any changes, you go back to your psychiatrist to do it.

So essentially, like, it's not this big thing that all GPs can diagnose and prescribe.

Not yet.

However, if a GP has done certain training and has that is allowed? Is it a, you know, they have to apply to be able to do it, or they have to tick the box that they've done the training?

So it's a really new area. They're saying that they can do whatever, but I think the reality is the training positions are limited. They're focused on kids at the moment. The diagnosis you're still doing with your psychiatrist.

Okay, but what you can— what is happening now, and we're in New South Wales, so we can specifically comment on that, is if I am your client and I have ADHD, and for— we've been working through the medication titration.

Yeah.

Yeah. For a period of time where I'm now stabilised on a certain dose, um, then you can hand over and you actually have to contact my GP and there has to be this consent or this handover, doesn't there?

So what I usually get you to do is go back to your GP and say, are you prepared to take over prescribing? Because the GP has to do an application to do it.

To an application to you?

No, to the—

Correct. Yeah.

The PRU. So this is the Pharmaceutical Regulatory Unit in New South Wales. So they have to do an application for you specifically and every year for you. So it is actually an extra process for them. So once they've, they've agreed to do that, I need the communication from the GP to do that. And then when I next see you, because I won't do it out of session because there's a whole lot involved in it, is that you come back, we might do your medication script for that session, and then I I do a whole letter outlining what the GP needs to do in order to do the prescribing. Yeah. You know, part of the how to do the application and everything as well. And then they can take over the prescribing, but still coming to see me.

And then interestingly, I still would have to see you once a year. Mm-hmm. And I actually only fill my prescription twice a year. So it's really just removing one appointment a year with the psychiatrist, right?

Essentially.

Yeah. Okay.

Yeah. But it means that when you come to see me, I'm not doing your meds. I'm actually finding out how things are going, what's, you know, going on around it. Is there anything we need to address?

So again, it's just having more people on your team. So it's not, it's not a negative from your perspective that GPs are helping, is it?

No, absolutely not, because if it means you have better access and it is cheaper for you to get your medication, brilliant, do it.

Yeah, and typically it's easier to get in with your GP than with a psychiatrist, right?

Correct.

Yeah, what were those stats on how Oh, that was psychologists and psychiatrists.

So 26,000 psychologists and 3,000 psychiatrists. Yeah, but I think it's— oh, I'd have to check on the GPs. Yeah, it'd be similar.

So I think that answers all of my questions that I wanted to ask you and also all the questions that came through. So thank you for being here today and talking about ADHD and medications with us.

Thank you. You're welcome. It's great to be here to be able to do this. I think it's really opportunity to be able to have, you know, both of us, psychologists and psychiatrists, to be able to clarify some of these things.

Well, attempt to clarify it, because like I said, our view is our view, and we are very aligned on it. Um, but I think it's really nice for people to, to hear us say it is complex. You know, if people are struggling to understand this and struggling to navigate this system, it's usually not a you problem. It's, it's because it's a complex system.

Yeah, yeah, absolutely.

All right, well, thank you for listening. Dr. Kate is to be doing a series of episodes with me. So if you really enjoyed that, then come back because we are going to be doing one on burnout and hopefully one on perimenopause as well.

Great.

Amazing.

Let's do it.

Thank you for listening.

Bye.