Working with a Psychiatrist for ADHD: What to Expect and How to Get Started
Introduction
You aren’t alone in the overwhelm. It can feel overwhelming to seek ADHD support as an adult. Realizing that your brain works differently than others—or that you’ve been “white-knuckling” through life—can be scary. Seeking support is a brave first step.
ADHD is real, valid and treatable. It is not a flaw in your character or a lack of willpower. It is a neurobiological condition, and with the right guidance, it is highly manageable.
A psychiatrist brings clarity. We do more than write prescriptions; we help untangle your symptoms to create a holistic roadmap for your life.
Local support is here. As a psychiatrist working with clients throughout Durham, Raleigh, and the Triangle, I see every day how high-functioning adults can thrive once they have the right support system in place.
Understanding Adult ADHD: It’s More Than Just Distraction
When people hear "ADHD," they often think of a hyperactive child bouncing off the walls. In adults, however, the presentation is often much more internal and subtle. It isn’t just about being unable to sit still; it’s about how your brain regulates attention and emotion.
Common symptoms in adults include:
Time Blindness: Consistently underestimating how long tasks take, leading to chronic lateness.
Impulsivity: Making hasty decisions with finances, eating, or conversations (interrupting others).
Emotional Dysregulation: Feeling emotions intensely, particularly rejection (Rejection Sensitive Dysphoria) or frustration.
Executive Dysfunction: Knowing what to do, but feeling physically unable to start the task.
Many of the clients I see in Durham, Raleigh, and the Triangle are high achievers—researchers, tech professionals, and academics—who have gone undiagnosed because they are smart enough to compensate. They rely on anxiety and adrenaline to meet deadlines until, eventually, the stress becomes too much and burnout sets in. ADHD can impact careers, relationships, and daily functioning in subtle but significant ways.
What it looks like: You might be the person who successfully manages a massive project at work but can’t seem to remember to pay the electric bill or text a friend back for three weeks. You might be very sensitive to to comments made by colleagues while others seem to be able to not take feedback so seroiusly.
Why See a Psychiatrist for ADHD?
While primary care physicians can prescribe medication, a psychiatrist offers specialized expertise in the nuances of brain health.
Differential Diagnosis: Difficulty concentrating isn't always ADHD. It can be anxiety, depression, trauma, or sleep disorders. A psychiatrist is trained to tease these apart.
Medical Perspective: We rule out biological causes for attention issues, such as thyroid issues or vitamin deficiencies, ensuring we are treating the root cause.
Co-occurring Conditions: It is very common for adults with ADHD to also struggle with anxiety or depression. A psychiatrist can treat these conditions simultaneously, ensuring one medication doesn't negatively interact with another.
Long-Term Partnership: ADHD changes as life changes. A psychiatrist helps you adjust your treatment plan during major transitions, such as starting a new career, pregnancy, or menopause.
The ADHD Evaluation Process: Step-by-Step
Fear of the unknown often stops people from making that first appointment. Here is what the evaluation process typically looks like in my practice:
1. The Intake Interview This is a conversation, not an interrogation. We will discuss your medical history, your current struggles, and your childhood. We look for patterns of behavior that have persisted over time. This often includes speaking with a family member that has known you for a long time and can speak to the persistence of your symptoms.
2. Screening Tools We often use standardized rating scales, such as the ASRS (Adult ADHD Self-Report Scale), to quantify symptoms. Rating schools to assess for anxiety, depression, and other mood disorders may also be administered.
3. What to Bring To help paint a clear picture, it can be helpful (though not always mandatory) to bring:
Past school records or performance reviews.
Notes on specific examples of forgetfulness or impulsivity.
Observations from a partner, parent, or close friend who knows you well.
4. The Diagnosis A diagnosis is not made by a computer or a checklist alone. It is a clinical judgment based on the holistic picture of your life. We want to understand you, not just your symptoms.
Treatment Options: More Than Just Medication
Medication is a powerful tool—often considered the "first line" of treatment—but pills don't teach skills. A comprehensive treatment plan includes:
Medication Management:
Stimulants: (e.g., Adderall, Vyvanse, Ritalin) These increase dopamine and norepinephrine levels to improve focus.
Non-Stimulants: (e.g., Strattera, Wellbutrin) excellent options for those who cannot tolerate stimulants or have co-occurring anxiety.
Therapy & Coaching: Cognitive Behavioral Therapy (CBT) helps reframe the negative self-talk ("I'm just lazy") that plagues many adults with ADHD. Executive function coaching can provide tactical strategies for organization.
Lifestyle Strategies: We focus heavily on sleep hygiene, exercise, and nutrition.
Digital Tools: implementing time-blocking methods, body-doubling (working alongside someone), and utilizing digital calendars effectively.
Follow-Up Care and Ongoing Support
Getting a prescription is not the end of the road; it is the beginning of the relationship. Follow-up appointments are crucial for:
Titration: Finding the "Goldilocks" dose, one that provides maximum benefit with minimal side effects.
Monitoring Health: Checking blood pressure and heart rate to ensure safety.
Tracking Progress: Are you sleeping better? Is your anxiety lower? Are you finishing tasks? Are your emotions more regulated? Do you have a better understanding of how to cope with your symptoms, including emotional ones such as shame and guilt? Do you feel more equipped to tackle meetings at work and face your personal and professional relationships?
Judgment-Free Zone: If you forget to take your meds or miss an appointment, we don’t judge. We understand that is part of the condition, and we work with you to get back on track.
ADHD and Life in Durham, Raleigh, and the Triangle
Living in the Triangle presents unique challenges for the ADHD brain. We are surrounded by high-pressure environments including top-tier universities like Duke and UNC, a booming tech sector, and a fast-paced medical community.
The Local Context:
The pressure to "keep up" in this academic and professional hub can lead to severe Imposter Syndrome for those with undiagnosed ADHD.
The sprawling nature of the Triangle (and I-40 traffic!) can be a nightmare for those with time blindness.
Community Resources: My practice is tailored to the needs of this community. I also frequently refer clients to local support groups and executive function coaches in Durham, Raleigh, and the Triangle who understand the specific demands of life in the RTP area.
Frequently Asked Questions About ADHD Psychiatry
Can I have ADHD if I did well in school or have a successful career? Absolutely. Intelligence has nothing to do with ADHD. Many people "mask" their symptoms through high IQ and extreme anxiety until they hit a wall in adulthood.
What’s the difference between ADHD and anxiety? Anxiety usually stems from worry ("What if something goes wrong?"), while ADHD stems from an inability to regulate attention. However, untreated ADHD often causes anxiety because you are worried about dropping the ball.
Do I have to take medication forever? Not necessarily. Some people take medication only on workdays, while others take it daily. As you learn behavioral strategies, your need for medication may change. You are in the driver's seat.
What if I’ve already been diagnosed—should I still see a psychiatrist? Yes. If your current treatment isn't working, or if your diagnosis was made years ago, a fresh evaluation can ensure you are on the most up-to-date and effective treatment plan. ADHD and your needs may change over time. Having a relationship with a psychiatrist ensures you have the support to be able to respond to these changing needs.
Is virtual care available if I’m in Durham but working remotely? Yes. Telepsychiatry is a fantastic option for ADHD clients, removing the barrier of commute time and traffic stress.
Final Thoughts: Clarity, Structure, and Support Are Possible
You do not have to live life in a constant state of chaos or catch-up. With the right tools and expert guidance, you can harness your strengths and manage your challenges.
A psychiatrist can help you build a customized, supportive path forward, one that honors how your brain works rather than fighting against it.
We are available in person or by telehealth to treat adults with ADHD, or if you are curious if you may have ADHD, in Durham, Raleigh, or the Triangle. We can also treat anyone located in the state of North Carolina via telehealth.