Category: ADHD

One Comment

My Adult ADHD Experience: End of 2023

  By

So, here we are: the end of the year—and what a year it’s been.

If this is the first article you’ve seen in this series, I’ve been on a bit of a quest to learn about my own brain and the way it works; a quest that resulted in a prescription for ADHD medication and a great deal of self-reflection along the way (Want to see some of that journey? The full series is in the ADHD Category). Things have been going really well.

But first, my medication status. Since my last update in October, I’ve asked for a dosage increase from my doctor. During the consultation, I mentioned my concerns that the dosage felt insufficient as the days grew shorter, and he cautioned me to be on the lookout for seasonal depression (also known as Seasonal Affective Disorder). This is something I’ve had trouble with in the past, though it didn’t feel quite like that feeling of spiraling despair and gloominess that S.A.D. hangs over my head. In any case, he increased my dosage; I’ve now been taking the 12.5mg dosage of Adzenys XR-ODT for about two months.

And it’s working amazingly well. Amid a project of increasing complexity at work, I’ve found myself to be able to commit executive function and focus to the tasks in a way that I’ve never been able to before. And with the Christmas season in the rear-view mirror, I can now see that the extreme whiplash of switching between contexts—from work, to kids, to kids’ school, to spouse, to friends, to shopping, to church, and back again—hasn’t caused the same level of executive paralysis or mood problems that it has in years past.

I measure the effectiveness of my treatment in the following realms: alertness, focus, motivation, executive function, energy levels, mood, temporal perception, memory, and cognition. And over the last two months, almost every category has seen massive improvement. Focus and executive function have seen the greatest improvement; the other categories have seen more modest (though still considerable) gains. Notably, in situations where I would ordinarily have written off an entire day as “just one I have to make it through”—that is to say, days in which I didn’t expect much if anything in the way of work done, usually due to poor sleep the night before—I’m actually surprised to find I am more alert and have higher energy levels than expected, and I’m able to put up some decent productivity.

The only category in which I haven’t seen a vast improvement is temporal perception; I’m regularly startled to discover that it’s after 2pm, and I haven’t eaten lunch yet, for instance. Interestingly, this is a bit of a regression for me, as that’s actually one of the first improvements I noticed about this medication months ago. I have a theory that in the past my lack of focus provided a check against time-blindness, and my focus improvement is now overriding those gains; but that’s a theory that I haven’t had a chance to interrogate or investigate at all. Still, of all the factors, my temporal perception is the easiest to build coping skills around, with techniques like Pomodoro or more strict schedules. I’ll be following up on the results of those experiments here in the future, if they’re interesting; perhaps even with a new series.

One thing I’ve discovered is that there’s a “virtuous circle” of focus: since my medication increase, my focus is such that I can regularly check off a task (or at least a significant chunk of one) nearly every single day, which provides a new feedback loop as my brain realizes that accomplishment is possible, leading to my being able to check off more tasks the following day.

This feedback loop, I’ve discovered, applies to motivation (motivation is a very transferable commodity within my brain), executive function (once I’ve started on a task, it becomes easier to start the next one), mood (calmer David in the morning usually leads to calmer David in the afternoon), and cognition (once I’ve begun creating heuristics and lenses through which to solve problems, creating them for other problems becomes simpler). I’m curious to discover if this also applies to alertness, energy levels, temporal perception, and memory; if so, this seems like a tool that I could use pretty effectively in the future for even more productivity.

And this isn’t the first time I’ve discovered such a tool that I can use “against myself,” to accomplish things or otherwise exceed my ordinary mental limitations. As CGP Grey and Myke Hurley of the Cortex Podcast describe it, within your mind is a “monkey brain” that insists upon redirecting your brain to the next shiny thing. The “monkey brain” has control of your dopamine (and other chemicals), which means that it is able to exert considerable influence over your conscious mind as well; simply trying to “push through” the monkey brain’s insistence that you simply move toward the next exciting thing can work for some people, and making the monkey brain do your bidding through logic or force of will works for others; but for most people (especially neurodivergent people), we should expect to make use of clever trickery and tomfoolery to get any work out of our monkey brain. I’m hopeful that this new feedback loop will be helpful in allowing me to be more productive.

If you’re one of the people who has found the saga of my fight against the monkey useful or interesting, I really appreciate your presence and well-wishes. Thank you so much for going on this quest with me. If it’s helpful to you, please let me know below. Next time, we’ll be talking about psychological evaluation and the process by which I have been pursuing an official diagnosis.

In any case, thanks for being with me on this journey this year. Happy New Year to you all, and here’s to knowing ourselves better in 2024!

2 Comments

My Adult ADHD Experience, Six Months Later

  By

If you’re just joining us, since April of this year I’ve been documenting my ADHD experience in the hopes that it will help anyone who’s struggling with similar issues. I began by talking about my symptoms and what I tried before admitting it might be ADHD and seeking treatment. Then I wrote an update about my mixed results with the first medication I was prescribed, followed by the more promising results from the second medication. That was in June, and it’s October now; so what’s happened over the last four months?

I’ve been continuing to take Adzenys XR-ODT since I was originally prescribed the medication. We’ve increased the dose from 3.1mg (which I’ve since discovered was actually lower than the recommended pediatric starting dose, which makes it all the more surprising that I actually had some good results while taking it) up to 9.4mg (still below the recommended adult starting dose). For comparison, Adzenys XR-ODT 9.4mg is comparable to Adderall XR 15mg (which is not currently available in most of the country). I’ve stuck with the 9.4mg dose for two months now.

The modest improvements in attention, focus, and executive function that I noticed when beginning the medication have become significant, and the effect continues to be consistent over the course of the workday rather than concentrated immediately after I take a dose. I still don’t feel manic, and I still feel like myself. The concerns about blood pressure haven’t gotten worse, despite the dosage increases; and I’ve actually been able to make some improvements in that regard since being medicated since I’ve actually been able to exercise somewhat regularly without it feeling like an impossible task. My wife has noticed externally that the improvements in my home life have continued, as well. My alertness, focus, motivation, executive function, energy levels, mood, temporal perception, memory, and cognition (the factors by which I think about my attention levels) all seem to be greatly improved, though I do think there is room for more improvement.

But probably the biggest thing that proves it’s working comes from when I haven’t taken it. There have been a few days when I’ve forgotten to take it (the early mornings are when my ADHD is the worst, since it’s been the longest since my previous dose), and on those days I notice a distinct regression in my mental capacity; most clearly in my focus and motivation, but affecting all the aspects I’ve been monitoring.

Even that, though, pales in comparison to the change that happened when my wife and I went on a mini-vacation and I forgot to take the medicine with me (early mornings, I’m tellin’ ya). Over the course of three short days, I felt myself regressing significantly; to the point where, on the last day, I could tell that my mental status was probably comparable to what it would’ve been on a bad day before medication. Do you remember Daniel Keyes’ short story Flowers for Algernon? I remember reading it (and frankly being haunted by it) in Mrs. Anderson’s sixth grade class. In the story, a man named Charlie recounts his experiences with an experimental treatment to increase his intellect and mental capacity, a procedure previously performed on a mouse named Algernon. It’s told in first person, and demonstrates his rapid transition over the course of days or weeks from a state of intellectual disability to a super-genius, and the associated increase in his confidence. But at a certain point, the mouse Algernon begins to decline in intelligence, and Charlie realizes that it will happen to him, too; for the remainder of the story, he relates his experience with the knowledge that he will lose his intellect as well, and his fear and dread as it all slips away.

That’s what it felt like to not take the medicine for a few days. I know that sounds dramatic (and, to be fair, it is), but there is a marked difference between medicated and not medicated; and I can tell more acutely when I’m not medicated.

Dramatics aside, as noted above, I do think there’s room for more improvement; I’m planning to ask for another dosage increase the next time I have the medication refilled. I’ve noticed that there’s a steep curve of improvement that tapers off after the first couple of weeks on a higher dose, and this time that curve seemed to last a bit longer before normalizing, so I think we may be close. Winter is coming, though; and I’ve had issues with seasonal affective disorder in the past, so we’ll see if I need to make adjustments for that.

I’ll continue to provide updated here; as always, thank you for your kind words of support, and I hope that people continue to be helped by these posts. Please let me know if there’s anything that you’re concerned or curious about; I’d love to share more, and I appreciate your presence with me on this journey.

No comments

My Adult ADHD Experience, Month Two

  By

A month and a half ago, I posted about the beginning of my ADHD treatment journey. A couple weeks later, I posted an update, detailing my mixed results with Strattera (Atomoxetine).

So, a little more than two weeks ago, I talked with my prescriber about my experiences. I essentially told her everything that I put in my previous article: on the whole, it gave me more good days and fewer bad days, but it didn’t really make either of them better. She was very understanding, and was willing to move me onto another medication. I told her about a medication that my pharmacy was able to get (and I knew that because a friend of mine was on it), and she prescribed me an orally-dissolving formulation of Amphetamine, the same medication that is found in Adderall. After a brief delay with insurance (they required a prior authorization, but the drug manufacturer offers a coupon program that makes it $50 per month without insurance, so we opted to skip the insurance claim), they were able to order the medication and I picked it up the next day. The day after that, I was going out of town for the weekend with my family, so after forgetting to take either medication for a day, I took my first dose of Adzenys XR-ODT.

On that first day, we were driving home from our weekend trip, and I immediately noticed that there was a significant difference in my awareness while I was driving. Usually I have to make regular stops, drink lots of caffeine, or have an active conversation in order to not feel drowsy or distracted when driving for long distances; but on that day I just didn’t need any of those coping mechanisms. I experienced no side effects, and I didn’t feel like I wasn’t myself. I also didn’t have the same “warm brain” feeling I did with Strattera.

The next day at work, I was pleased to discover a decent improvement in attention, focus, and executive function; the very things I was missing with the previous medication. I also appreciated that the Extended Release nature of the medication means that boosts seem constant throughout the workday, rather than wearing off over time. The overall effect wasn’t to the level I wanted it to be (and in fact it still isn’t), but I do feel like I’m in the right medication family; now I just need to dial in the dosage, and monitor my blood pressure. Over the past two weeks, I’ve been pleased with the improvements I’ve experienced in those areas, as well as the huge reduction in my time blindness; it’s much more rare for me to be surprised that it’s “already 3:00 in the afternoon.”

Maybe the biggest thing I’ve been surprised about in this ADHD journey is the different facets there are to the seemingly-simple word “attention.” Before beginning this process, I thought it was just one thing; and while they are interconnected, what I thought was just “attention” is actually a combination of alertness, focus, motivation, executive function, energy levels, mood, temporal perception, memory, and cognition (and there may be more, but those are the ones I’ve noticed so far). Some coping skills and treatments have improved some of these facets and not others; and deficiencies in some of them are problems during the workday while others are a problem in my family life. Do note, these are not medical or psychological terms, but here’s briefly what I mean by each:

An Executive Function deficit.

  • Alertness: My ability to remain aware of my surroundings for a long period of time, particularly when they’re “boring” or when I’m focused on something else. This is different from energy levels.
  • Focus: My ability to concentrate on one task, conversation, text, line of code, etc. Most often a problem at work.
  • Motivation: My desire to do things, even things I enjoy doing. Closely tied to executive function, but not exactly the same thing.
  • Executive function: My ability to start or switch tasks, or make decisions. This deficit is usually either called laziness or decision fatigue.
  • Energy levels: My capacity for continuing a task or interpersonal interaction. This is heavily affected by but not completely controlled by sleep.
  • Mood: The thing I have the least problem with. I know a lot of people experience anxiety or depression with their ADHD, but I’ve never really had trouble with that.
  • Temporal Perception: The deficit of this is called “time blindness.” I’m notoriously bad at estimating time (past or future), and before medication I almost always had a moment—usually at around 3pm—where I think “Whoa, it’s [whatever time] already?!”

    • A memory deficit. Well, a deficit of useful memory.

  • Memory: I’ve never had a particularly strong memory. Or, more precisely, I’ve never had a particularly strong ability to recall important information, despite being able to remember irrelevant data almost instantly.
  • Cognition: My ability to process information. I’ve historically not had as much trouble with this mental function as with some of the others.

Since I’m seeing improvement in a lot of these areas, I’m really excited to see how this particular part of my journey progresses. I’m looking forward to seeing if a dosage increase helps me perform at the level I want to be able to perform at.

But of course, I’ll continue to talk about it here. I continue to be staggered by all of the people who have been interested in—or even helped by—my documenting this experience; thank you again for your kind words of support, and I hope that people continue to be helped by these posts. Please let me know if there’s anything that you’re concerned or curious about; I’d love to share more, and I appreciate your presence with me on this journey.

4 Comments

My Adult ADHD Experience, Week Two

  By

Two weeks ago, I posted about the beginning of my ADHD treatment journey, and I talked about my first day on Atomoxetine, a sNRI medication for ADHD that is also sold under the name Strattera.

Unfortunately, after some initially hopeful results, the rest of my titration has been fairly unremarkable. The feeling that my brain had more capacity has remained, though after the initial feeling that hasn’t borne a great deal of fruit; and my wife has noted that I’ve been remembering and noticing things a bit better over the last two weeks (though, counterpoint, I forgot to take the trash out to the curb today for the first time in months). In addition, as far as focus goes, I’ve had more “good days” and fewer “bad days,” which is certainly nothing to sneeze at. It’s certainly not making things worse.

But the real problems I’ve been encountering —focus, attention, and executive function—haven’t seen particularly spectacular results. Neither the good days nor the bad days are better than they were before, there are just slightly more of one and slightly fewer of the other; and honestly, that’s what I would expect around this time of year anyway, with the sun coming up earlier and staying up later. After a week, I assumed it was just the lower dose; then, I thought maybe I was just not seeing changes that were actually happening. But when I heard about the results a friend of mine encountered when she got on a different medication, and how dramatically her life had changed, I could tell that I wasn’t experiencing the same thing.

Everything came to a head today, at the two week point. Work today went well; but I’ve had good days before the medication. It was when I realized that it was no better than one of my best days before medication that I decided to write up this post, and in the process of composing it in my mind (I’m writing this while rocking a baby to sleep), I realized that the takeaway would probably be that Atomoxetine just isn’t doing it for me. I’m sure it’s great for some people, but barring any sudden improvements before then, I’m going to tell my provider at my next appointment that I’d like something else.

So what’s next?

I’m not entirely sure. The stimulant shortage continues, at least partially due to an increase in prescribing; according to the CDC,

Prescription stimulant use, primarily for the treatment of attention-deficit/hyperactivity disorder (ADHD), has increased among adults in the United States during recent decades, while remaining stable or declining among children and adolescents. [Since the pandemic], the percentage of enrollees with one or more prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021. The percentages of females aged 15–44 years and males aged 25–44 years with prescription stimulant fills increased by more than 10% during 2020–2021.

To make matters worse, the DEA has not increased their manufacturing limits on the controlled substances, meaning that drug makers cannot legally keep up with demand.All of which means I’m not likely to have an easy time finding a stimulant medication in stock, though some of my friends’ experiences give me hope in that regard.

So I don’t actually know what’s next. I’ll certainly bring all of these concerns to my provider at our next appointment, but that’s another two weeks away. In the meantime, I’ll continue taking the medication I have and monitoring for any sudden improvements.

In any case, I’ll be updating you here. The reaction from my first account of my journey was overwhelming; thank you for all of your kind words of support. It’s not over yet.

7 Comments

My Adult ADHD Experience: Day One

  By

I’m thirty-eight years old. Over the past several years, I have been noticing problems with my mental state that could be described as ADHD. I’ve had trouble with alertness, attention, focus, motivation, executive function, energy levels, mood, and cognition that I didn’t have before at this level; and those things were causing problems in my work life and in my home life. I’m getting treatment now, and while I know that everyone’s brain and experience is different, I’m hopeful that my experience can be helpful to others.

It was only a year or two ago that I was willing to call this a problem. Growing up in a rural community in the 90s, that diagnosis (well, as ADD) was reserved for students who were doing poorly in school and who were running around all over the classroom; I was doing well academically, and even though I had trouble with focus and attention, I was able to make up for it. I came up with coping strategies, and found things I liked, and simply made it through.

In college, the problem compounded as I essentially lost the ability to read long books. I was a voracious reader in high school, but the combination of boring textbooks and a more difficult workload that caused reduced sleep made my brain connect reading with sleep. My coping strategies began to fail, and I found myself struggling more. It took eight years for me to graduate, and I wandered through four different majors in the process. Still, with the development of new coping strategies and the help of my wife (whom I met in 2006 and married in 2010), I was able to graduate and eventually get a job in the tech industry, doing something I enjoyed.

Identifying what was wrong with me became a greater priority a few years into my career, as my family began to grow and my ability to focus on work began to dwindle. It was like I had a certain number of lanes in my brain; and with my work, church, wife, children, and hobbies, there simply wasn’t enough bandwidth to go around.

I first talked to my doctor about this experience a few years ago. He suggested that we rule out other possible issues; things like depression and sleep disorders. First he recommended increasing my activity, so I made it a point to take daily walks or bicycle rides; this worked great to improve my mood and energy levels, but didn’t affect the other issues I was having.

Iterating on the problem, he suggested that I get assessed for a sleep disorder. I did indeed have sleep apnea and began on a CPAP nearly two months ago. While I was cautioned that I probably wouldn’t see immediate results, I actually did: my alertness, motivation, and cognition increased almost immediately. Still no real impact on focus, attention, or executive function, though.

Independent of my own journey, my children were also being assessed for potential ADHD. While filling out the assessment paperwork for my oldest two children, I noticed a lot of things that not only apply to me now, but also would’ve applied to me as a child. What are the odds that a disorder which runs in the family would show up in at least two of my children (and maybe more) but not in myself or my wife? So I made an appointment to follow up on the treatment.

In that appointment, I laid out essentially everything I noted above. The nurse practitioner performed a similar assessment on me to the one that I had filled out for my children, and noted that while I scored high for ADHD, I scored low for depression and anxiety. When diagnosing the disorder, she said, the usual process is to identify the symptoms and then make sure that they couldn’t be explained by anything else; and that our previous attempts to solve the problem with exercise and better sleep indicated that ADHD medication could be a good next step.

It was there that we encountered another problem, though. See, it is mid-2023 as I write this, and there’s a nationwide medication shortage for ADHD stimulant medication (such as Adderall). The Adderall shortage in particular is making other stimulant medications more scarce, leaving only very expensive non-generic stimulants behind. So we made the decision to begin our medication attempts with a drug called Atomoxetine (the generic name for Strattera), a Selective Norepinephrine Reuptake Inhibitor (sNRI) which reduces the brain’s removal of norepinephrine, the neurotransmitter that mobilizes the brain and body for action. sNRIs are related to SSRIs like Prozac and Zoloft, and are also classified as antidepressants, but are FDA-approved for adult ADHD treatment. We began with a low dose of 40mg, with the understanding that seeing the full results would probably take a few weeks.

I took the first dose this morning.

Initially, I didn’t notice any changes. About an hour after I took the medicine, my brain felt “warm;” not in a bad way, per se, but in a way that felt like it was using more energy.

In the hour after that, my brain activity started to feel “smoother.” I’m not entirely sure how else to characterize it. While I would ordinarily experience sharp spikes in mental activity, motivation, and reward, it felt more regulated. The experience was noticeable, but not game-changing.

It felt in the hour after that like my brain had more capacity; like the lanes that I had were operating at a higher rate, or maybe that there was another lane. And the fact that I’ve written this entire blog post in one sitting (and intentionally begun every paragraph with the letter “I”) either means that my focus is better or I’ve found a new hyperfixation.

I can tell that there are changes going on in my brain, but I don’t know whether they’re good ones or not; and I don’t know what effects are the medication and what are placebo. Still, I’m willing to follow along with it for at least another day or so.

I hope that this account of my experience was helpful to someone. I’ll continue documenting this journey here and on Mastodon.