Be warned, this is a long post and it get's a bit complicated about ADHD treatments and medications. I try to explain as best as I can and simply share my experience with the drugs.
Oh man, these past few weeks have put me through the wringer!
It's been 1.5 years since my ADHD diagnosis, a little less since I started medication.
Remember Charlie? You know, my elephant? He went away, thank fuck. But then the Strattera made me motion sick, like, all the time and I threw up into a public trashcan two days before Christmas. Goodbye Strattera, back to Ritalin - long acting this time, called Concerta. I take the tab in the morning and it releases amounts of MPH into my bloodstream throughout the day. Peachy.
Basically, since the beginning of 2012 my life has mostly been awesome thanks to Concerta. I thought I had it all figured out by now, would simply pop 18mg of Concerta every morning and go about my life. Until it started to be less effective. I didn't notice it at first but in retrospect it started to wane when I started working and leading a more active life, having longer days, in August/September 2012. Then the anxiety started. Then I noticed. Oh boy, did I notice, about 1-2 months ago.
I can't really tell because it snuck up. At first I thought: "Oh I'm just having some rebound issues in the evening" and I'd pop a booster Ritalin and be fine. Then it turned into a sort of constant reboundish feeling, then into a tenseness that I can only describe as ongoing anxiety. MPH can exacerbate anxiety but you see, I never had anxiety. Yes, I'm a worry wart but that's not anxiety - I don't usually grit my teeth, clench my jaw and contract what feels like ALL THE MUSCLES in my body ALL THE TIME.
|This is how I feel inside recently. W00t! Anxiety!|
|This is how it makes me look on the outside.|
The major problem with ADHD is that it's such a volatile thing because they still haven't figured out the exact brain science behind it. There is no physical sign in the human brain for it but it's not just a psychological thing either because it has to do with dopamine levels. And dopamine is tricky. One medication will help one person but not another. Sometimes it stops working. Sometimes the body adjust and the dosage needs to be raised. Sometimes the body adjusts so much that the medication loses effect completely.
For some people stimulants (Amphetamine, Methylphenidate) work. Others can use non-stimulant medication (i.e. Strattera). Not all drugs are licensed in all countries. Canadians and Americans have more options. For instance in Europe Vyvanse (Lisdexamfetamine) still isn't available.
Exercise and diet have some form of impact on ADHD (medication) as well but it's an ongoing debate as to how much exactly. Some claim supplements can help - omega fatty acids, glutamine, vitamins (I've been taking high amounts of Omega-3 and Omega-6 for a while now). ADHD is generally poorly researched in adults because for a long time it was believed to cease in adulthood.
With all this going on it is no small wonder a lot of ADHDers opt to ditch the meds and to continue muddling through.
Experiment 1: The Med Holiday
I didn't take my meds for four days to reboot my system, basically. It went somewhat like this:
INT. COFFEE SHOP - DAY
Andie is sitting in a comfy chair, laptop open. Her friends has just left.
I want to get some work done like I usually do. Oh hai, looksie, there are people talking. What are they talking about? It sounds interesting. I'll just listen a bit. Oh wait, I wanted to work.
Andie opens her browser, mail client, twitter.
Oh look! Someone posted a video to twitter. Funny! Oh hai YouTube, you have more videos for me? Awesome! Oh people! Talking! Listen. Do I know her? She seems familiar. I could ask her if she's that girl I think she is. But what if that's weird? Also: I have work to do. She sounds like her too. I'll just ask her. Oh crap that was awkward. But at least now I know that I know her. Why does it help me to know that I know her? I think my pulse is really high. Is my pulse really high? I should get out of here, like, stat. Get home, calm down. Maybe going cold turkey is a bit crap.
After four days off of medication Andie has calmed down. All her ADHD symptoms are back but the anxiety is gone. She's also super sluggish and depressed and feels like she's not getting anything done. A lot of WoW is played during those days. All the food is eaten. Sleep is apparently overrated.
Experiment 2: Going Back on the Old Dosage - Monday
After successfully having rebooted my system I started back on the 18 mg of Concerta. This proves a useful method for most people so it was worth a try.
Monday and Tuesday went pretty well. Uneventful.
On Wednesday I had some rebound and took a Ritalin booster in the evening.
Thursday I was PMS-ing like hell which always means less effect of medication.
Friday my period came in the morning and major anxiety struck in the afternoon, I supplemented with a booster and calmed down somewhat. It had become obvious that 18mg wasn't going to do it. Which led to...
Experiment 3: Double the Dosage
(No, I didn't do this without my doctor's consent.)
On Saturday I took two Concerta tablets in the morning putting me on a 36 mg dose. Around mid morning all hell broke loose. If you follow me on twitter, you'll have noticed some of the shit that went down during that time. I was home alone and I had to talk to someone, no matter what came back because I was having all the fucking issues!
I was hyper alert but in a useless, tunnel kind of way. I felt like I was coddled in cotton balls and locked behind a big ass sheet of security glass. I was crying uncontrollably. My skin was crawling, my hands were sweaty, my muscles tense. It was horrific. It finally started wearing off around mid afternoon so I forced myself to go and meet my friends at the cinema in the evening like we had planned. And even though it scared me I took 5 mg of Ritalin to prevent a rebound effect coming off that massive dose of Concerta. It helped with the ADHD symptoms but my body was tense and hurting from the day's ordeal and still chock full of anxiety. I went to bed at 9 pm. Slept like a baby because I was so exhausted.
Experiment 4: New Order - Sunday
I took 5mg of Ritalin booster in the morning followed by 18mg of Concerta. Better than the fucking disaster the day before but not controlling my ADHD at all. The night brought on Insomnia like back in the day. I capitalise Insomnia because that's how it makes me feel. I'm on a first name basis with it so I think it's fitting. Unsurprisingly, I hadn't really missed my old fiend much in the past year but Insomnia doesn't care whether I want it. There it was, putting me smack in the middle of tired-but-not-being-able-to-fall-asleep territory, right next to waking-up-every-couple-of-hours-to-pee and gritting-my-teeth. When my alarm went off at 5:45 I got up in a daze and got ready for work, even hurrying to fix breakfast - only to discover that the idea of eating made me nauseous.
Experiment 5: Titrating
Even knackered as I was that Monday morning (= yesterday) I worked out that going from 18mg to 36mg, doctor-approved or not, was a seriously dumb move and that I'd need to titrate just like I did when I first started taking MPH. Enter my good old Ritalin:
6 a.m. - 3/4 of a tab in the morning putting me at about 7-8mg instead of the usual 5mg
8:39 a.m. - fearing rebound effect I took another 3/4 tab at work. As it turns out that was a bit too early (3-4 hours would've been preferable in retrospect). Within 20 minutes I felt like I assume people on Valium feel. I was so fucking slow it was comical! Sometimes people were already halfway past me when I finally managed a "Good Morning." Sometimes I couldn't manage to utter the words that I wanted to say. I stayed calm (haha!), figure it would wear off - and it did.
1:30 p.m. (I think) - I waited until I was certain the double effect had worn off until taking the next 3/4 tab and it worked fine. I went to see my doctor after work and worked out some plans with him (Yay! New Experiments! Sigh.)
6 p.m. - another 3/4 tab. slight comedown around 10 pm but compared to the past weeks it was NBD. As in actually warranting the acronym instead of spelling it out - that's how No Big Deal it was, surprisingly. And Insomnia didn't even show up at night. Aw bless, a good night's sleep!
Experiment 6: Mix and Match
Since apparently the higher dosage was working well for me - if titrated - we decided to put me on a combination of my 18mg Concerta and my Ritalin so I could raise the dosage carefully. Doc also prescribed me a different product, called Medikinet Retard, which releases MPH during the day like Concerta does but instead of a steady stream it releases in two doses set a couple of hours apart. The idea is that I try a couple of combinations
- Concerta + Ritalin throughout the day
- Concerta twice a day
- Concerta in the morning / Medikinet Retard mid-day OR the other way around
- Medikinet Retard twice daily / possibly double dosage or supplemented with Ritalin
Complicated much? Ya think? ;)
I tried the Concerta + Ritalin thing today and while I was on the same amount of MPH as I was with just the Ritalin yesterday I'm A BALL OF ANXIETY today. It's no fun. And it's not fucking relenting. So by now I assume that somehow, for some weird fucking inexplicable reason, it's the Concerta I'm not handling well anymore. It worked fine until a couple of months ago. Now not so much. It makes no sense. Not to me, not to science. But it seems to me that I'm just going to have to accept the illogical and go with it. I've decided to stay away from Concerta for now. I haven't bought the product again although I do have a prescription.
I did get the Medikinet Retard and I've ordered the same brand's equivalent to Ritalin, because the Ritalin has wheat and the Medikinet doesn't (and in my case that's what stands between me and a morning spent on the loo, having the shits). So tomorrow I'll give the Medikinet a try and pray to the whatever higher power there is that it fucking works and that it isn't going to give me anxiety.
For tonight there's not much that I can do except wait for my body to unclench and distract myself, like I did with this blog post, and hope for a halfway decent night of sleep. If you made it this far (THANK YOU FOR READING!) I think you deserve a good night's sleep as well. Or at least some music:
* For clarification:
Ritalin releases MPH (methylphenidate) instantly
Medikinet release MPH instantly like Ritalin (but it's wheat-free)
Concerta releases MPH over time
Medikinet Retard releases MPH over time though not in a constant stream like Concerta but in two major releases