On the maplessness of medication...

I had someone ask me a few questions offline about meds. Of course, I can only address this question as someone who is currently a guinea pig, not as a medical professional. I'm addressing this in a post because I think others are often wondering the same things about trying meds...I know I do. Know too that I am writing as someone who is still searching for a good combo...I have only been on this road for about 6 months. Anyway, here goes:

Meds can hit everyone differently. Some people try meds and nothing happens. Some people, like me, try meds and EVERYTHING happens/the side effects kick me in the ass, and everything in between can happen too. This fact can make it a little hard to feel like you really know if they are "doing something" or "doing what they're suppposed to do".

When you are a really busy person, it makes it even harder to tell, because you might have so many things coming at you at once that it's hard to know if you're coming or going, nevermind if your meds are "working".

Also consider that if you are taking meds, but not doing therapy, you may be slapping a band-aid on a broken leg. You could be so used to hobbling around on the leg that you don't really see that the band-aid is not changing your relationship with that leg. Once you heal the leg the band-aid might be helpful for more cosmetic issues...which is what it is meant for, but band-aids don't fix broken legs. You can't use something for a purpose that it was not intended for, and them blame "it".

All of that said, in my experience, it seems like the stimulants are pretty straightforward drugs. Overall...it seems to me that based on my own experience and what I've read of others' experiences, IF you are having an effect from a stimulant medication, you will KNOW it. Either a particular drug will "work" for you or it won't. And for me that means I get an intense and pleasant state of focus where my brain just chills out, and my thoughts slow down a bit, and I can just keep working away without the distraction of "thoughtsplosions". There is nothing subtle about it, it is absolutely obvious that the focus is occurring. The other effect I seem to have with a stimulant (currently, for me, that means Vyvanse) is a very particular feeling of calm. Clear, light calm. It does not make me feel heavy, or speedy, in fact it's like a breeze blowing across my brain, making my energy focus a bit, and allowing me to just "do" whatever it is that I'm doing. It also puts me in a really good, light mood. Sometimes this can make me just a tiny bit oblivious about things going on around me while I'm working, but it does make me more productive so I consider this a good thing, and I can switch to focusing on something new without feeling grumpy. Again...there is nothing unmistakeable about this sensation.

Within these sensations, I still have to choose to make better decisions about how I spend my time, and what I blow all that focus on, and sometimes my choices are better than others. If you are taking a stimulant and truly do not notice any difference, I would go back to your prescriber, give them this information, and see what they say. The good news about stimulants is that there are several of them these days...so you can try others if the first ones you try don't seem to "do" anything.

The only other drugs I have experience with are anti-anxiety/anti-depressant meds. I get the sense from reading other people's experiences that working with these drugs (mostly SSRI's, SNRI's and the like) tends to be a much more subtle experience. Allegedly, it takes a little longer to see a result, during which time some interesting side-effects might pop up. In other words, you're not likely to take one dose of one of these types of drugs and magically feel like a whole new better you. It could be more like 4-6 weeks before you settle on a good dose. If you're like me, that could be a totally different experience...I have been "hit" by these drugs within an hour, and not in a good way, lol, BUT, most people, thankfully, are not that med-sensitive, so I would hardly report my experience as representative.

I have taken Strattera (an SNRI), Citalopram (generic for Celexa, an SSRI) and Mirtazapine (generic for Remeron, a tetracyclic antidepressant). Other than Strattera, they are not really intended for improving focus...I take them for generalized anxiety. Strattera gave me some cool focus, but was a little heavy for me otherwise...in that it actually made my mood feel a little "heavy". The focus was also not very consistent. This was a much wishy-washier experience than the stimulant. It did calm me down, and that, I liked, but overall, I tried it for a looong time, and it just didn't pan out.

Citalopram was another barrel of monkeys entirely...I've already blogged about that, but I will say this...whatever it was doing, for me, was not good for a lot of reasons, and it was REALLY OBVIOUS.

Remeron, now that I'm on a smaller dose, seems to be adjusting to me quickly, and this is giving me hope that I will be able to find a dosage of it in the next couple of week that will give me some real benefit.

When a med isn't working (or is "doing" something lame!) there are a lot of things that could be wrong. Wrong dosage, wrong drug for you, wrong diagnosis. The best way to address it is always by giving a prescriber and a therapist, if you have one, as much honest information about how things are going for you as possible, so they can help you figure it out.

So final summary, in my experience...seems like if a stimulant is "doing" something you will feel it. If you don't, might mean you need more of it, might mean you need to try something different.

Anti-depressants are more subtle and take their time. Again, if you feel no effect after a few weeks, tell your prescriber. If bad things are happening, then tell them that too, and right away so they can help you if there's a problem.

After you try a few, you will start to develop your own "map" in your head about "if" something is happening. And definitely ask your prescriber lots and lots of questions about each drug.

Lastly...if you're like me and your life is way too busy, do yourself a favor and take a few things off your plate so that you don't have a ton of stuff adding to your stress and making it harder for you to be able to "see" if anything is happening. Seriously...I am a terrible role model for that, but I'm trying...I really am, and I swear it's worth it.

Gonna go work on that one right now...

Peeking through...

...just when I was beginning to think "this is just me learning to be organized, this medication isn't doing anything for me" suddenly the medication stopped working. How do I know? I was suddenly aware that the old familiar feeling of overdrive was back. The pacing, the not sitting, the thinking-thinking-thinking and the irrational aversion to simple tasks that the logical mind knows are not difficult.

And after a couple weeks comprised of mostly relative "quiet" in the brain, this was jarring.

See, it's a good trick. The medication doesn't alter my personality. It doesn't take away my creative ideas and thoughts. It makes them behave more politely, and ask before interrupting my train of thought. They "poof" into my mind instead of exploding. The rubber band between the new thought and the space station (my brain) is allowed to slacken at times, rather than being constantly stretched by lack of gravity. You get the idea. (And please forgive the terrible metaphor. I'll blame the ADHD part of my brain for that one.) Because the medication does not make me feel "not like me" I thought it wasn't doing anything. I thought "oh, look at me, I'm just so organized, I must be that amazing that will-power just kicked my behavior issues in the ass, even though that hadn't happened in the 33 years prior to my taking the medication".

This isn't to say that I don't have stellar coping skills, or that my cleverness hadn't helped me work my way around all manner of deadlines and obligations over the years. But it was hard work to make it happen...harder work than it should have been all this time. The medication makes it possible to just BE organized instead of fight to appear that way. It takes some of the struggle out of staying on task. It creates an actual thought process rewarded by results where before there was mapless inspiration buoyed by anxiety (and often followed with an "OH SHIT! I HAVE TO TURN THIS IN TOMORROW!" and a last minute miracle).

The medication doesn't make me perfect, or make my thought processes perfect, but it takes the edge off, and lets me be me in a more reasonable time frame and with less anxiety. How can it be so subtle and change my life so much at the same time? I guess for me, it really points out the difference between me and my symptoms. ADHD is part of me, part of my brain's functioning, part of who I am. But it is a set of symptoms, it is not the core of me, it is not my personality. And the medication seems to let me see more of my personality without the obstruction of the symptoms. Lets me enjoy the upsides of ADHD, but helps to keep some of the more frustrating ones at bay.

So I'm grateful for the "peeking through" that allowed me to appreciate the subtle charms of my medication. As a result, we upped the dosage on the meds a little and voila...life feels just a little more manageable.

The power of choice...

Medication is, of course, one treatment that people may choose for ADHD. It's easy to think of the medication as a quick fix though and that's truly not the most useful way to think about it. First of all, different medications may do or not do different things for different people. Second, medication sets the stage for focus, but is not necessarily the thing that ensures that you will. It does create the conditions so that it is easier for you to simply stay on task and not be pulled in 5 other directions, but even in a life made less scattered by medication, there is still free will.

I can choose to finish a pile of work, or not. It's more likely that I will finish it, with a medication soothed mind, because I will not be as propelled to stray...but even a calmed mind can choose to watch television instead. Or choose to drive to the ice cream stand. Because honestly...with my mind a little quieter, THOSE things are more fun because I can actually focus on them, too, not just the work, and sometimes it's more fun to choose those things. The difference manifests when you realize you can choose to do or not do things...rather than being urgently compelled to dart around. What a wonderful feeling, to be able to choose.

I am still adjusting to medication, so I don't know for sure yet if this drug will end up being a long term thing for me (it's not a stimulant and the adjustment period is subtle and slow)...but even at this point I have moments of lovely quiet in my mind where I can steadily pace through a stack of undesireable work tasks, or choose to pull my bike out of the garage and slowly ride around town and just enjoy it without thinking about 5 things I am afraid I'm going to forget to do later because I don't have a pen and paper in hand.

Day 8, with Mr. Strattera

We've taken to referring to the Strattera, in this house, as "Mr. Strattera, the crazy Italian". As in "I have another date with Mr. Strattera, the crazy Italian" and my boyfriend says "Say hello to him for me..." with a very bad, stereotypical Italian accent. It's too soon to tell if he's doing what he's supposed to be doing to my brain, but he seems to be busy anyway. Day one he was busy hitting me upside the head with a crazy Italian baseball bat of anxiety. Since then, side effects and effects have ranged from paralyzing to motivating. The NP says I'm apparently "sensitive to the medication". Um. Yeah...pretty much.

Ironically, Strattera is the drug they give you if you have ADHD accompanied by symptoms of anxiety. It's supposed to give you focus, without exacerbating your existing anxiety. One of the initial potential side effects at the beginning however...is anxiety. Mean trick. Though when he's not torturing me with anxiety (like so many bad boyfriends before him), I feel interestingly calm, my mind refreshingly still. It will take several weeks to determine if the crazy Italian is the "right guy" for my brain. Here on Day 8 though, things seem to be going in a decent direction. I am at peace with the fact that this process will take time and I think I can stick out the rough patches.

The therapist and the NP have both given me the homework to "practice focusing on the really boring stuff and see what happens". Well the other day I did just that and got a 6-month old backlog of work done. Holy cannoli Mr. Strattera! Keep this up and I'll be moving the boyfriend out and YOU in, full time.

And I'm only on Day 8.