Cross-posted from Twitter, lightly redacted, and expanded:
I don’t intend tweeting/writing/generally sharing that much about ADHD-related stuff (at least right now). It’s just on my mind at the moment as I’m starting my 2nd drug for it (Vyvanse).
Despite some setbacks (pro tip: if you forget your morning dose, don’t take it after lunch, at least if you intend sleeping that night) treatment is going well.
Right now, I’m feeling very optimistic and hopeful about what the future may hold.
And about how finding the right treatment might make it a lot easier for me to function in the world as an adult with responsibilities and bills to pay and clothes to wash (oh, how my ADHD hates washing clothes).
Also way too many people still think that ADHD is a “children’s problem” or that ADHD-ers are just industrious people that have figured out a way to hack the medical system in order to get a steady supply of neurostimulant medication.
Both of these ideas are straight-up fallacies.
Although the extent to which these ideas are entrenched in society can sometimes be oddly entertaining.
Sometimes, when I wander into online ADHD communities I feel like I’ve accidentally stumbled into a moms’ coffee hour: it’s mothers trying to figure out if their ten year old should be on Adderall or Ritalin.
I feel weird. A bit icky. Like I really shouldn’t be there (pro tip two: there are also dedicated communities for adult ADHD-ers and many communities have a more equal focus).
ADHD is not a children’s “impairment” (I’m trying to use descriptors carefully, but I think that one is accurate). Science has repeatedly affirmed that it frequently persists into adulthood.
ADHD is also not a monolithic entity that can comfortably be satirized on television with a hyperactive child who can’t sit still.
Hyperactivity can manifest as restlessness or the feeling that your brain simply won’t stop turning when you need it to — this is the manifestation I relate to.
The lack of focus can involve somebody quietly staring out a classroom window when they should be paying attention to the blackboard. This was me during much of my time in high school. (Note: while ADHDers can often compensate for impaired focus in high school, things can get harder as life’s challenges — and those of the education system — become more challenging).
We know now that there are many variants to ADHD including the passive inattentive (PI) subtype which doesn’t fit that picture. The picture I painted above — my ADHD diagnosis isn’t differentiated, but my guess is that’s the subtype I have — fits that bill.
I also discovered something interesting during my own diagnostic process which I’d like to share here.
Picking apart ADHD, anxiety, and depression can be difficult even for experienced professional psychiatrists (apparently childhood provides a big clue to help differentiate the three).
ADHD is frequently comorbid with these conditions and these conditions can, in turn, cause impaired focus.
So what comes first: the ADHD or the mood disorder?
Furthermore, when you begin treating your ADHD with a massive daily barrage of caffeine — liable to cause anxiety even in neurotypical people — determining cause and effect becomes even more challenging. Add that to my list of reasons why attempting to self-medicate ADHD with caffeine really isn’t a smart idea (disclaimer: I did precisely this for more than a decade; if you want the rest of the reasons see the addition at the end of this article).
But really. Think about that for a moment.
Even for the pros picking out cause and effect can be difficult and involve trialing their patients on a variety of medications (my diagnostic process had the additional complication that I can’t remember much of my childhood).
All the more reason not to go through the needless and exhausting process of trying to figure out — and treat — these things on your own. A psychiatric professional is far, far better placed to undertake that painful diagnostic work.
One more mistruth to counter.
ADHD also doesn’t mean that those who have it can’t focus which is the simplistic shorthand that people like to use to think about the condition.
It’s like saying that all people with depression are bedbound all of the time. Or that people with anxiety all experience panic attacks. It’s simply not true. There are subtypes and variants. Presentations can differ.
Impaired focus in ADHDers simply means that their system for engaging focus in appropriate contexts — like when they’re washing clothing but not really interested in washing clothing because it mores them as it does most of us — is impaired. Alongside other manifestations of problems with executive function.
The good news is that these days ADHD is treatable through a variety of interventions that can and may help. These include medications, therapy, and organizational skills training.
The better news again is that even within option A — medication — there are choices. Stimulant and non-stimulant drugs. Off-label approaches. Etc. I repeat again: there are more and better options for treating ADHD than dosing endlessly on caffeine (a drug which, by medical standards, has a pretty awful side effect profile).
Finally on the subject of caffeine / coffee which is kind of the substance that has defined my journey to figure out this condition.
It’s true that everybody gets a jolt from coffee. Give Ritalin to a neurotypical and they’ll probably do better on their exam. Few people are unfamiliar with the buzz that comes from drinking a couple of espressos.
The difference which ADHDers is that our baseline is impaired. These substances bring us up to a normal level of functioning. They’re not our attempt to gain an ‘edge’ on the rest of the population.
ADHDers really aren’t trying to hack the pharmacy system.
Every time I visit the pharmacy to fill a prescription for a controlled substance I’m reminded of the fact that even the process of getting treated isn’t necessarily pleasant. Nor is it easy. There’s paperwork to sign and bureaucracy to deal with.
When I wanted to move to a slightly higher dose of Vyvanse I need to physically return my previous medication. (According to the computer’s calculation, I was missing one pill — I forgot that I keep a backup in the car. The pharmacist insisted that I return with it before accepting the returned pills and issuing me with the higher dose.) This isn’t easy.
And I encourage anybody who thinks they may have it to begin the process I did.
(The rest of this story is my story as shared on Twitter):
Let’s start with what not to do if you think you might have an actual medical problem with focus: That’s also precisely what I did and what many ADHD-ers that have gone before me have done and attempt to drown it under a sea of coffee.
(Actually it could be worse: there are people who try to self-medicate their ADHD by receiving an adrenaline kicks in other forms, such as by jumping off buildings.)
I began obsessively drinking coffee at about 18 (Leaving Cert time in Ireland — major exam).
I don’t remember much about my childhood (another day’s story). But throughout high school / secondary school I remember daydreaming and having trouble focusing.
ADHD is actually a much more interesting and less monolithic condition than many imagine it to be.
It’s not necessarily about an inability to focus but rather, for many, inappropriate focus and executive control deficits.
ADHD people (especially me!) commonly get hyper-fixated on niche subjects (there are few phases I’ve yet to go through — flags was probably the weirdest one).
But if they’re not fascinated by something, their brain often simply doesn’t pay attention.
This often happens to me washing clothes. I can space out of watching a TV show the moment I lose interest in it.
This can create a lot of problems.
Growing up people sometimes called me an “absent minded professor”.
I guess because I find relatively hard things interesting (e.g. tech). But sometimes struggle with basic thing (let’s go for laundry as the example again).
The part of it they were missing was that focus isn’t something I can necessarily control.
I embarked upon a 12 year voyage of self-medication with caffeine that started out as tea (the gateway drug!) then quickly progressed to coffee.
Ultimately, coffee became caffeine pills. Which oddly made it easier to get proper treatment as … if I’m taking a pill anyway.
I had my gallbladder out 15 months ago. I developed bile reflux gastritis which I’m still struggling with. I began looking at what I was ingesting. Coffee and alcohol were two problematic substances.
I still enjoy drinking socially but I was also drinking a couple of beers here and there to dampen down the anxiety that my daily caffeine intake was inevitably producing.
So I asked myself again: why can’t I get rid of the coffee
What’s it doing for me that I can’t function with it?
The search for answers led me to read a book — Driven to Distraction — that seemed to describe my life story.
A frustrating feeling that I can’t quite fully access what my brain is capable of.
Of fighting a daily battle to self-medicate a problem that I’d never bothered to get to the bottom of.
Taking my fist Ritalin tablet was a monumental experience. That feeling felt like it was lifting. Like caffeine. But a bit better. I could stick with a book. I could get the laundry done and things I was actually interested in. From one pill. Overnight, fighting the battle for focus got about 10 times easier.
In retrospect, the dumbest thing I think I believe was that I was convinced I was some kind of unsolvable medical mystery.
This actually kept me from getting help for years.
I assumed getting to the bottom of my situation would be an exhaustive process because I hadn’t been able to figure out a way to manage it on my own (at least well).
It took me years to acknowledge that addressing this challenge was beyond my skills. I think I still struggle a little with this feeling.
The psychiatrist I saw, however, seemed particularly unperturbed and recommended an ADHD med or an SSRI (in case depression was the root cause; depression and ADHD are often comorbid).
He also diagnosed me with ADHD. He retired so I had to find another psychiatrist who said essentially the same thing. I never once got the feeling that my case was some kind of unsolvable mystery that he was struggling to solve.
The first drug I tried was Ritalin.
Then Concerta. That had a horrible comedown.
Now I’m happily trialing Vyvanse.
As I type this, there’s a restaurant moving and making tons of noise.
Sound sensitivity is actually one of the hardest things I deal with. It made working in open offices nigh on impossible. The people moving doors into a van outside are making minute pulls at my attention.
When somebody close to me is cooking and the smells waft into my home office … I have trouble concentrating for a few minutes afterwards. With Vyvanse … this is all getting a lot easier.
True story: I once lived without a refrigerator for almost two years because the apartment was too small to put it somewhere that the compressor noise wouldn’t drive me crazy and prevent me from focusing.
I went to an ENT to check out if there was something wrong with my hearing. She said it was fine. She was also the first doctor to mention the possibility of ADHD to me.
Reasons Not To Self-Medicate ADHD With Caffeine
Finally — having done this for more than ten years — I feel pretty strongly that attempting to use caffeine as an ADHD treatment makes little sense. I’ve also developed a weird aversion to the smell of coffee. I’m not sure I ever actually like it. I liked the caffeine it contained. But only because it helped me function.
Something true: there actually are ADHD-ers who advocate using the caffeine / l-theanine (CLT) stack for treating ADHD. But I feel like caffeine is a poor choice.
Why does caffeine work for ADHD? Because it’s a naturally occurring mild stimulant.
- There are better options out there that have been developed by scientists. There’s little point in ignoring the product of hard scientific innovation.
- By self-medicating ADHD with caffeine, you’re essentially using an approach that could have been employed centuries ago by anybody with access to caffeine-containing plants like tea and coffee. Instead, you can avail of today’s medical treatments.
- By using prescribed ADHD medications you’ll be forced to work with the medical system. These guys will keep tabs over your dosage and watch out for any side effects you may experience.
- If you self-medicate ADHD with caffeine and it works sort of well — as it did for me — you’ll delay or entirely miss the diagnosis thus foregoing the possibility of receiving any of the better options mentioned above.
- Caffeine in large doses is highly likely to produce both insomnia and anxiety. You may end up diagnosis with a mood disorder that’s actually the product of your attempt to treat a root problem. This again will delay and complicate the diagnostic process.