Our work is not done. I am heartbroken this morning after speaking with… let’s call her Carol.

Carol and I have been working together for about two years and have achieved moderate treatment response for her mood and anxiety issues through both talk therapy and pharmacotherapy efforts. She is a high-functioning mother and wife, working full-time, and truly just an amazing person all around. However, Carol has had a long history of attention deficit and hyperactivity disorder (ADHD), which was successfully treated during her teenage years but has gone untreated for years. It is now seriously deteriorating her quality of life in multiple ways: you guessed it—at home interpersonally, at work with her productivity, and even affecting her self-image.

The limitations of my clinic in treating ADHD are significant. I have been fully telehealth since COVID and never had a nurses’ station to monitor the necessary vital signs or perform an EKG (heart rhythm monitoring), which is required during treatment with ADHD-indicated amphetamines. My standard practice has been to collaborate with the patient’s community primary care physician (PCP). I send my clinic note along with my contact information for any questions, provide treatment recommendations and parameters, and then follow along as the consulting clinician while the PCP prescribes accordingly. This process works out about 80% of the time, I would estimate. I am very grateful for the collaborative relationships I have built with our attentive and generous community physicians, whom I’ve had the pleasure of working with over the past 23 years in our area.

On the rare occasion over these past 23 years, however, things haven’t gone as well as one would hope. Carol had such an experience. And, of course, I thought of you, dear NAMI people—you who are so vocal and active in fighting community stigma related to mental health.

Carol started a norepinephrine agent approved for ADHD and followed up with her PCP… let’s call him Dr. Dan, to consider an amphetamine. Unfortunately, she experienced a relapse in her anxiety due to the norepinephrine agent. By the time she was able to see her PCP, Dr. Dan, she was having full-blown panic attacks. These were occurring out of the blue, even awakening her from sleep, leaving her absolutely terrified.

Dr. Dan, in brief, gave her the riot act: “You need to stop eating carbs and lose weight. You are on a lot of really heavy meds. If you did, you’d be able to get off of those meds. Think of your kids…” And I thought, “Noooooo!” My skin even hurt as I listened to Carol recount this. It was so painful.

Dear Peeps, we are not done. Data shows that the best way to combat stigma is through peers—not through doctors or clinicians. Wow! So, please, please keep talking and living out your beliefs in mental health. You make an enormous difference for an enormous need.

Self-Care Tip: Everything starts and ends with “Me”. To decrease stigma, start right here, with Me and let it spread. Even to your PCP!

Question: How has stigma affected your mental health journey? Please speak! Keep on!