I wanted to keep this here for reference, for anyone considering meds or going through this process now:
I have a therapist that I’ve been seeing off and on for ten years. She’s a psychologist and doesn’t prescribe, but she’d been making comments about, “that sounds like an ADHD” thing for years and was all on board with my wanting to try medication. I didn’t want to add yet another psych person to my list, but she told me I could just see a doctor. I considered this, but having had many bad experiences with misdiagnosis and people who just don’t know any better, I wasn’t keen to see someone who didn’t have in in-depth knowledge of ADHD and other psychiatric conditions. I began searching on PsychologyToday.com (which is actually a GREAT resource to search for therapists/psychiatrists/psychologists by specialty, location, and insurance coverage) and came across someone who specialized in medication management for psychiatric conditions, including ADHD. She’s a nurse practitioner, and when I told my therapist, she said, “Oh, nurse practitioners are wonderful!”
I agree! If you don’t have the resources and can only choose one person to see, I highly recommend seeking out a nurse practitioner who specializes in psychiatric conditions. (If you live in the Seattle area, East Side, please feel free to email me: Nikki [at] toomanyshinyobjects [dot] com. I’d be happy to give you my person’s information and any other help or suggestions.) If you can, though, I also really recommend a therapist as well. Talk-therapy really is wonderful and makes ADHD easier to navigate. Cognitive behavioral therapy in conjunction with or instead of medication management is also very, very useful.
So. My nurse practitioner put me on Adderall XR. She said she prefers Vyvanse, but insurance won’t cover name-brand Vyvanse unless other meds have been tried first. (I speak from the experience of having tried many psych meds throughout my life. Generic versus name brand really does matter and make a difference in some cases.) I started on 10 mg and got lucky right off the bat: I’m not experiencing any side effects so far. That could change if I continue upping the dosage. The point of tritation is to slowly increase your dosage over time to find the point where it feels most effective, and the benefits outweigh any negative side effects. I’m seeing small changes and benefits, as I describe in several posts. I don’t really know what to expect or how “good” it can be, so I’d like to go a little higher yet to see what happens. She said the highest she would probably go with me is 30 mg. I’d like to see what a higher dosage can do, if the side effects stay away, but overall I’m really happy with where I’m at now. (If the Adderall doesn’t work out, there are many other medications to try!)
My medication, as I’ve said, is Adderall XR not Adderall. XR is extended release, which means I take it once per day instead of twice. My understanding is that the XR contains the regular Adderall that goes to work immediately AND Adderall that dissolves slowly over time. For me, I can definitely feel a slight “coming up” feeling again around the four- or five-hour mark. I had thought it lasted around eight hours, but information online says up to ten. The good news is I know it’s worn off after at some point, but I don’t feel it happening. It’s a very smooth transition, and I don’t have any mood swings or feel irritable as it wears off. (I’ve read that this can happen.) The worst aspect for me was the first couple of days—my heart was pounding (I think partly from the drugs and partly from anxiety about it) and the dry mouth. It was some serious dry mouth, and it SUCKED. After those first couple of days, it eased up considerably and is barely noticeable now unless I go too long without drinking water.
One of the potential side effects is increased blood pressure. I have very low blood pressure to begin with, and I mean very low. So that was a side effect I welcomed! I think my blood pressure has elevated just slightly because when I went in for my last appointment, she said my BP reading was “great.” (At initial appointment to be assessed for meds, she’d taken my BP and said, “You weren’t kidding about low blood pressure!”) I think think my low blood pressure was part of why I felt so crappy those first couple of days, too. My body was like, “WOAH! WHAT’S ALL THIS BLOOD RUSHING AROUND!” I found that drinking two full glasses of water in the morning, from before I take the meds to they time they kick in has been really helpful. This is something I should have always been doing because of my low blood pressure, meds or no meds. On average, I drink more water than most people, but it still hasn’t been enough. No joke, I feel like I’m on the road to being healthier than I’ve ever been because of these meds. I’m trying harder. I’m being more diligent about my health.
Oh! And several people have said they needed to give up coffee, or at least on days they take Adderall. I really, really didn’t want to do this. I went slowly with it at first, but I’ve only ever been a one-cup-a-day person (minus the occasional afternoon latte). It also takes me a couple of hours to finish that one cup because I’m a slow sipper. I’ve tried days without the coffee and with, and I’m so relieved that there’s no difference whatsoever. I get to keep coffee!!!!
As to the dangers and potential for abuse—self-medicating is big among people with ADHD. I’ve done acid, mushrooms, speed, marijuana, and a ton of ecstasy. Drugs always slowed me down and quieted all the noise in my head. That’s what I was drawn to. Sleep issues are another major issue with ADHD. I don’t know what it means to sleep well; I’ve had trouble sleeping since I was a kid. (My mom said I stopped napping entirely at fifteen months and that was that.) I have trouble falling asleep, I wake up often, have trouble getting back to sleep, and I have sleep inertia when I wake up in the morning. Marijuana is legal in Washington State, so I’m free to take edibles for sleep, which I have done frequently. I hate smoking so I stick to edibles. When I take edibles, I still feel like hell in the morning but at least I fall asleep quicker and don’t wake up as often. The nurse practitioner warned me that THC and stimulants aren’t a great combo. I asked her if I should stop taking edibles then, and she said I don’t have to since the stimulants will be out of my system by the time I go to bed—BUT I should stick to sattiva strains if possible. I can’t find much research on this, so I’ve cut back drastically on the sleep aid. The Adderall hasn’t made sleep any worse than usual.
My point is: I’ve done a lot of drugs. I’ve abused drugs. I’ve never gotten addicted to anything or even close to it, but it’s still something I’ve always been very cautious about. Most of my drug use was in pursuit of that “dopamine hit/excitement,” and an effort to quiet all the noise in my brain. Abusing my prescription isn’t something I’m interested in doing. Taking it for anything other than helping me function better throughout my day isn’t a consideration. Having a prescription for something that can quiet all the damn noise in my head for a few hours is incredible. I’m so happy to have figured all this out, and there is no way in hell I’d do anything to ruin it for myself. Besides, these are low doses, and I have ADHD. Stimulant medication helps bring me up to the baseline—I’m not getting jacked up and pulling all-nighters! I’m taking a low dose in the morning and calmly getting work done. I’m more present and relaxed with my kid. I’m not as anxious. And if I were the kind of person who took naps, I could easily take a nap in the middle of the day while on my meds.
People who abuse stimulant medications are generally not people with ADHD. Not everyone who has a prescription has ADHD. There are plenty of ways to fake it or convince a bad doctor that you have ADHD to get a prescription. Generally speaking, the people who abuse stimulant medications don’t have ADHD, and they’re making it hard for people who actually need it.
Though people will try to tell you otherwise, research has consistently shown that there is no long-term damage from taking prescription stimulant medication. Now, if you try to google anything about that, the information that comes up is primarily warnings about addiction and damage for people who abuse stimulant medications. The information about people with ADHD who take stimulant medication as prescribed is really hard to find because it’s buried under pages and pages and pages of stuff about the people who abuse it.
In fact, there’s been research showing that teens and adults who take prescribed ADHD medication are at a lower risk for abusing drugs and alcohol. Know why? Because people with ADHD self-medicate and engage in risky behavior because our brains are constantly seeking novelty and a dopamine hit.
If I had known about my ADHD when I was a teenager and been given the chance to take stimulant medication for it, I probably would have been in a much better place and not started drinking (and drunk driving) at sixteen. I might not have chased down the drugs I did in my early twenties. I will get around to telling the stories, but please know that I’m not exaggerating when I tell you: the fact that I’m still here today is a fucking miracle. It might be hard to imagine for anyone who knows me these days, but my teen years and early twenties were dark. I was doing stupid, dangerous shit from the age of fourteen. I was afraid of nothing, and I was addicted to the high I got from all of it. There were certainly other factors and things going on at home, but the ADHD pushed my behavior over the edge.
Thankfully, this story has a happy ending. Having a kid tempered my stupidity, and my impulsiveness isn’t as destructive as it once was. I’ve found healthier and more creative ways to get my thrills. (This is why I love to travel so much—my brain loves the novelty and excitement of wandering around an unknown city in a new country where I need to stretch my language skills.) But when people start lecturing or arguing about the omg dangers of stimulant medication, I just have to laugh. I’ve done worse. I mean, if medication could have prevented me from getting drunk every weekend at sixteen, which do you think is worse? If I wound up in the hospital for a recreational drug overdose? There are a million scenarios—that actually happened and that could have happened—that were far worse for me than being on stimulant medication from a young age would have been.