March 28, 2013

A Response to a Reader's Question about Medication.

I got a comment just now from a reader which included questions about their medications. They take methylphenidate and Strattera and are wondering about the length for duration, or of the overall effectiveness of their medication.

As a non-professional, I responded as follows, and hope that it clarifies my own understanding of medication as it relates to ADHD treatment. I would be very interested to hear from readers their thoughts on my perspective, and the advice I gave...

I wrote (I have modified it slightly for clarification below):

"Have you spoken with your doctor or psychiatrist? Methylphenidate and the amphetamine class of psychostimulants work for some and don't work for others - it can't really be predicted, depends on the individual. There are dosage aspects, metabolism issues, concurrent medication useage, and a host of other factors involved, not to mention your own personal level of change or stress due to situational factors (New job, school, city? Change in relationship status? Problems in your personal life? Are you getting sufficient sleep?)

Strattera didn't really work for me by itself, and I no longer take it. But I do take another NSRI class medication - buproprion (trade name Wellbutrin). Some of the NSRI meds can be useful in reducing some of the anxiety which may be brought on by taking the stimulants and may assist executive function, or so I understand.

What form of methylphenidate are you taking? Long release like Concerta or Adderall XR, or short release, like short release Adderal or Ritalin?

A good psychiatrist with a clear understanding and training in psychopharmacology should help you tweak your medication. I would definitely speak with your doctor about this, though.

To get the most out of your appointment, I'd recommend the following:

Try to track your cognitive senses throughout a few days in a notepad - i.e. Your focus level between 1 and 10, attention.

Track your emotions also - and your reactivity, irritability, grumpiness, ability to manage transitions or to shift out of hyperfocusing without being too pissed off(!). Basically, your level of attention self-regulation.
Track impulsive behaviors - interrupting, acting out, moving on to an inappropriate task or activity, when you should be sticking with the one you're already on.

Also try to document your ability to get priority items done, your ability to be organized, your level of overall 'effective functioning' in various arenas of your life. That is, how well you are managing at work, home, school, parenting, relationships, hobbies, sports, personal care, etc...

Bring this tracking information to your doctor / psychiatrist and it should help them better understand how to help you find an effective medication regime. Hope that helps.

Note that I'm not a medical professional, so just take my advice as you see fit. All the best, and let me know how it works out!"


All Kinds of Stuff and Things and Objects Found in Boxes

That's the best title I could come up with. It's 4 am, I just changed my daughter's very poopy diaper, and I figured that there's no time like the present to kick start my blog.
Just a heads up: Thumb typing on my Android might result in tortuous sentences, embarrassing hippopotatypos, and my 4 am brain might be prone to sentimentality - so be forewarned.
So. My house decided to get sold. So it is causing me* to pack up boxes of useful, important items, and boxes of useless, and seldom used crap. It is also causing me to wander about trying to figure out what to do next. It made a painter come in today (yesterday?) and massage paint into its tired seams, corners, and surfaces, and is working very hard to make me replace several basement ceiling tiles. I'm staying in Toronto. Hopefully close by. But the market's good, I am led to believe, and so it seems like a good time.
I'm fond of this house. And I trust that it wouldn't try to get itself sold unless it knew I could manage it, with an overload of big-life-things. It will encourage potential buyers to loosen their purse strings and cause my bank account to breathe a deep sigh of relief, encourage me to order pizza, and do what it can to have me settle in to watch some YouTube documentaries, or even go out and meet another human and do things involving hamburgers or cheese or something.
In the meantime, I'm looking for a contract or a full time gig.
I also started the ball rolling yesterday afternoon on a twenty year old dream of mine to get my Masters in psychology. Do what you love, right?
Here's a few things - in case you've made it this far into my post - you may want to know about what I've figured out in recent months.
1. I'm stronger than I ever thought I could be.
2. Everyone is carrying a frighteningly raw crate full of hurt, terror, longing , desire, insecurity, and fear within their psyches - and it is always demanding to be opened, and exposed to the searing light, and fresh air. Find a way to own it. Find out how to become acquainted with it so that it becomes your strength, and not your burden. And all that... And be decent to everyone you meet. But have a plan to fuck off (multiple egress routes) at the first sign that they wish to fuck you over. :-)
3. I have too many pants, too many shirts, and altogether too much stuff.
And so it goes**.
I was interviewed by a reporter from NYC a couple of weeks back for an article she was editing on Adults with ADHD, and it was published, and it was cool to read my experiences online in someone else's voice.
Also, I was interviewed last fall for a book coauthored by a Canadian psychiatrist specializing in ADHD, and a Harvard Medical School psychiatrist. It's now out, and look forward to reading a little snapshot of the story of how my own train wreck of a life, crumpled self-esteem, and hopelessness was halted by an assessment, and a subsequent diagnosis of Attention Deficit Hyperactivity Disorder (Combined Subtype) and Generalized Anxiety Disorder, and competent treatment. And how it was transformed into a full-on awesome adventure of rediscovering life, my strengths, my buried feelings, and (did I mention?) my strength.
Oh. Hey. After 20 years of drinking 8 to 10 caffeinated colas, and coffees a day, I figured to stop. So 34 days ago, I chugged back a Diet Pepsi, and haven't looked back yet.
I don't drink. I don't smoke. I don't drink caffeine. But don't cross me, and don't test me. And expect the worst in a knife fight in a dark alley, if you ever try to start one with me. Metaphorically of course. I'm not a violent person. I'll simple pin you down, wait for you to calm down, and let you go with your pride intact, but without your weapon.
But dear readers - I beseech you. If I ever tell you I'm going vegan, or some such nonsense, you have my permission to chloroform me, tie me to a chair, and once I've woken up, to force feed me a huge medium rare Porterhouse steak au jus, smothered in horseradish, with a side of baked potatoes. Thanks in advance.
There's a boatload more I would love to write, but there's only so much my thumb will put up with, now that I've been thumb typing for an hour, and my eyes are tired.
And for some reason I have Motörhead's Ace of Spades roaring through my head. So, time to sleep.
Actually, here. Listen.
Going back to sleep.
Love and danger,
*Note that the house appears to have agency in my post. This literary device was inspired by the beautiful writings of Kurt Vonnegut.
** This animistic narrative transition is brought to you by the 116 occasions Kurt Vonnegut in which he used this phrase in his fascinating and raw book Slaughterhouse 5, a title inspired by the name of the building ("Schlachthof-fünf") in which he and other Allied prisoners were kept. In this building, they took refuge and consequently survived the horrific massive incendiary bombing (total of 200,000 incendiary devices) of Dresden, Germany in WWII which resulted in an enormous firestorm which engulfed 12,000 dwellings, killing in one night 20 to 25 thousand civilians, and which was brought to you by Marshall of the British Air Force, Sir Arthur Travers 'Bomber' Harris, AOC Bomber Command, and signed off upon by Prime Minister Sir Winston Churchill.

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