Getting ADHD help (Methylphenidate)

[HoaiNam]

Hi all,

I'm new to this forum. I've never been to Thailand. I'm currently staying in Vietnam and wish to continue to stay here for personal relationship reasons etc.

I was diagnosed with adult ADHD (predominantly inattentive type) sometime in 2013 after a series of meetings with a therapist where I discussed problems I have had my entire life (the 'straw that broke the camel's back' so to speak that caused me to finally seek help was almost flunking out of community college due to poor grade and too many Ws. I am still pursuing my online program but hanging by a thread and if I don't get help soon it is unlikely that I will be able to transfer to a 4-year degree program. This is a pursuit that I began with a great deal of enthusiasm but the same issues that plagued my K-12 education have persisted).

I have since learned that my biological father was an ADHD sufferer. I'm not going to go through a laundry list of symptoms and difficulties I'm having in my life because those who are familiar with ADHD are already familiar with them. I will just say that my symptoms lean heavily towards disorganization, forgetfulness, lethargy (when faced with difficult tasks, textbook reading etc.) as opposed to hyperactivity (though it is a bit difficult for me to sit still) impulsivity etc.

The reason that I haven't been diagnosed with stimulant medication thus far is because I spend most of my time in Vietnam. The psychiatrist I saw in the U.S. (not the doctor who provided the diagnosis, at this clinic you see a therapist first and then see the psychiatrist for a prescription) believed that it is better to try non-stimulant medication first so prescribed me with generic Wellbutrin. I took it for some months but did not see any improvement to my symptoms and stopped taking it. There is a new psychiatrist at this facility now (the reason I was going there is because I had/have a very low income and they provide very low cost visits and prescriptions for those with low financial resources) and on my most recent trip to the USA a couple months back the therapist expressed a lot of positivity regarding my likelihood of being prescribed stimulant medication upon my next trip however left a voicemail just before my return flight to Vietnam expressing scepticism that I would be able to get a prescription from the new psychiatrist due to the need for follow ups, a new prescription to be written every month etc. and suggesting that it might be better for me to seek help in Vietnam. This suggestion was a huge letdown as I was already aware that, when it comes to stimulant medication, there is no help in Vietnam.


I apologize if that was too much detail but I thought that someone who has been through all this might have some additional insight (I do know that some travellers are able somehow to get 3 month prescriptions and/or their doctors up their dosage for travel periods longer than 1 month. Vietnam allows 3 months worth of medication - the length of my visa).

All I have now is a copy of the paper confirming my diagnosis (with therapist contact info etc.). I am wondering if I am likely to receive help from a doctor in Thailand. I have read numerous threads on this topic in this forum which reference a range of medications, hospitals, and a range of prices from as little as 4-6 baht per pill to over 10 times that amount. Medication cost is a factor but the cost of travelling to Thailand monthly (RT airfare, visa, hotels etc.) is downright cost prohibitive. I'm only explaining this because the info I have found in the threads is not complete.

I believe I would be a good candidate for one or another brand of methylphenidate (and I believe the 4 hour variety might be best as I have significant issues with falling asleep).

I know that some doctors are more or less likely to prescribe and more or less likely to be generous with the ol' prescription pad. It is not my intention to abuse any medication (I don't use illicit drugs and drink only rarely) however I am hoping to find someone who will be understanding about my situation. Also a hospital that will be likely to have a sufficient supply of any medication the doctor sees fit to prescribe. I could probably visit Thailand to see the doctor and get refills up to every other month (though every 90 days would be more ideal).

If you have any specific recommendations for me (hospital, doctor name, medication, cost) please feel free to send me a PM if you don't feel comfortable sharing all info publicly. I would like to get as much information as I can prior to making the journey.

Thank you in advance and sorry for the length.

[Sheryl]

Mehtylphenidate is available in Thailand only from hospital pharmacies and I am very doubtful they would prescribe more than one month supply at a time.

It is also available in Viet Nam, under brand name Concerta. Listed in their MIMs (drug reference book). I do not know however what the restrictions may be i.e. if it has to be gotten from a hospital. But I would expect so or that at a minimum it requires a prescription.

While approved for use in Viet Nam, it may be difficult to find a place that has it in stock, especially since there are no private psychiatric hospitals. I suggest you contact the distributor of Concerta in Viet Nam to find out which hospitals (and pharmacies if any) they have supplied the drug to :

Saigon Pharmaceutical Company - SAPHARCO.
Address: 18-20 Nguyen Truong To Street, Ward 12, Q4, Tp. Ho Chi Minh City - Tel: (08) 39400388 - Fax: (08) 39401975 - Email: [email protected].

If this fails then in Bangkok Manoram Hospital is the best (though not least expensive) option as many Thai psychiatrists are unfamiliar with adult ADHD. However I am not sure, even on a repeat visit, that they would be able to prescribe more than a one month supply. http://www.manarom.com/index_eng.html

Air Asia flights between VN and Bkk, if booked far in advance, are pretty reasonable.

[HoaiNam]

Thank you so much for your reply Sheryl,

I was very surprised when I read your reply. I had been googling this issue on and off for the past year and even had a local friend who is working as a nurse while studying for her doctorate look into this for me last year and she turned up nothing.

I went to see a local doctor and brought a letter from the USA stating my condition. I explained to him some of the difficulties I have in daily life and presented the paper. He seemed skeptical and looking over the letter remarked "you don't have ADHD" I was bracing myself for a certain onslaught of sudden extreme annoyance syndrome at this point as he continued "only children have that". However he went on to say "what you have is ADD". Okay, I'm aware that in some countries they make a distinction between the hyperactivitic tendencies of ADHD kids and the relative detachment of their adult counterparts...the doctor continued to seem a bit skeptical but I think having my gf there, who he spoke with in Vietnamese, really helped a lot.

We showed him the link you provided and he wrote me an RX for Concerta (only for 1 week asking that I return to see him after the first week was up). He remarked that this is a highly controlled medication in Vietnam and I said something else that I don't clearly remember (and didn't clearly understand at the time) but it was something to the effect that either he can't keep writing the prescriptions on a continual basis or that I wouldn't be able to obtain the medication on a continual basis.

We called Sapharco and they gave my gf hospital pharmacy to call, and they provided her another number to call, and that person provided another number to call...eventually we ended up in touch with a woman who owns a tiny little pharmacy here in our small(ish) city who we went to visit. She seemed to think she could order the medication for us but remarked that I didn't seem like I had ADHD because I wasn't running around in circles (lol).

I believe she spoke with my gf once since then, something to the effect that she called someone and they didn't have the medication currently in stock so she needed to make a couple more calls. We've called her a couple times since then but no answer.

My girlfriend tried calling Sapharco back and the woman told her that she didn't know when they would have that medication again because it has to be imported. She didn't want to provide the names of any hospitals or pharmacies we could check.

It's starting to seem like a trip to Thailand may not be the worst option. Nonetheless the task seems a bit daunting to me having never been and speaking not one word of Thai (well I can learn a few of them before I go but not enough to be especially useful).

I may very well visit that Manarom hospital you mentioned. I'd still like to get some other leads if possible. I'm thinking of coming for one week and hoping that's enough time to find a doctor that will listen to my symptoms (I guess a print out showing how poorly I've done in my online studies couldn't hurt), take into account the full scope of my situation and provide a realistic dosage for at least 1 month (now that I think about it I don't really mind returning after 1 month but every month is not realistic financially with flight, visas etc.).

The fact that Manarom has doctors experienced with adut ADHD is actually very encouraging. But because of the wide discrepancies I've read in terms of medication cost I'm still hoping someone will chime in with a specific recommendation for a hospital that is on the lower end of the spectrum in terms of medication cost (some have said as little as 4-6 baht each but some report costs much, much higher, I'm wondering if there's a way I can make a new local friend there who would be able to help me navigate my way through one of the cheaper hospitals?).

One last thing. Can we be sure that it is legal for me to transport this medication a) out of Thailand and into Vietnam as a U.S. passport holder? I found this answer to someone's inquiry about mailing Concerta on the Vietnam Customs webpage and after googling the referenced circular and skimming/reading as much as I could muster the answer still wasn't clear to me.

http://www.customs.gov.vn/Lists/EnglishSupports/Details.aspx?ID=2382&language=en-US

Thank you so much again for your reply Sheryl, I see that you have replied to many inquiries on this topic before and on behalf of the ADHD community we sure appreciate the help. I'll go back and look at the old threads again for specific hospital recommendations as I've forgotten most of what I've read googling around for every possible solution (finding a private practice doctor for my next trip back to Cali, Singapore, Japan etc.).

Thanks again (P.S.- any fellow ADHD peeps who can post or pm me recommending a specific doctor and/or hospital?)!

[HoaiNam]

I just realized someone did reply to me with a very helpful PM. Still looking for recommendations from anyone who has gone to see someone at one of the cheaper hospitals locals go to but maybe it would be better to go to one of these foreigner (farang...my first Thai word ) dealing with places the first time...maybe later I can switch to a cheaper place. My main thing is just making sure that the trip won't be fruitless (some say they got the RX but then the hospital was fresh out of the prescribed medication or didn't have a whole month's supply).

Do these doctors tend to be available all days (I mean individually I'm sure, or at least hope, they take some days off but for example are they all off Sunday like most here in Vietnam?)? Is it better to try to see them on certain days of the week?

Should I try to set up an appointment or two before I make the trek or just show up willy nilly?

[hooperx]

yes you can get it, go to ram hospital , fourth floor, book an appntment with a psych, they dont have dexamphetaine and they dont have 20mg ritalin, only 10. the whole process takes about an 30 mins an your meds will cost you idk about 80$ concerta is crazy expensive idk tho ive never tried it

[Sheryl]

Hooperx: Which Ram hospital do you refer to? CM Ram? Other?And what is the cost? If it is brand name Ritalin I wouldn't think much cheaper than Concerta..or are they prescribing the ocally made generic equivalent? (BTW dexamphetamine is completely illegal in Thailand even for medical use. No hospital has it).

OP: Yes, you should make an appointment and you can do so online if coming to Thailand for private treatment. In private hospitals plenty of availability on weekends. However given that you have now verified that the drug is available in VN I think you will be better served to just continue to pursue treatment there. You need though to find an actual pyschiatrist, not just any local doctor. This will get around the nonsense of prescribing it only a few times. But you will likely still have to come in at least monthly for it, in both VN and Thailand, there is a limit on the quantity that is issued at one time for a controlled substance. By law u also can't take more than a one month supply out of Thailand.

As to less expensive alternatives in Thailand...that would be government psych hospitals which would be extremely difficult for a non-Thai speaker not familiar with Thailand to navigate. Bordering on impossible. Even long time expat residents here usually need to bring a Thai speaker with them for at least the first visit. In addition, while consultation costs will be minimal, and drug cost much less (as they will use a locally made generic equivalent) you will have to spend a lot of time to the point of extra nigh hotel bills. Add to that airfare and this becomers not such a cost saver...

If a private hosp dispensing the locally made drug can be identified. that will be cheaper hence by question to hooperx. (I don't know for a fact that Manarom doesn't also have the generic , just suspect otherwise).

Regarding exporting from Thailand into VN, I have no idea what VN rules are. But for Thailand, you can only take out a maximum of a 30 day supply and it must be clearly labelled with physician name etc.