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I take ADHD meds to function, not to have fun

A woman speaking with a doctor in his office.

Every week, I fill my little pill box and inventory my prescriptions. I fill the nighttime spaces with my nighttime drugs, like an allergy pill (spring in the Pacific Northwest is brutal), lithium, and sometimes a melatonin or CBD tab.

In the daytime spots, I put my anti-anxiety meds, my vitamins, and my ADHD medication methylphenidate (the generic of Ritalin, also called Metadate).

It’s a routine that I find very comforting, except for when I’m almost out of methylphenidate. At which point, I have to immediately rush to my computer to order more before I forget. Because if I do forget — even if I delay by just a day or two — I might be in for a very miserable, scattered, spacey, anxious few days.

With my other meds, my doctor (or, really, any doctor; they kind of automate it now) prescribes comically large bottles with three- or even six-month supplies. But methylphenidate is a controlled substance.

That means that every single month, a doctor has to sign off on a new prescription and allow it to be filled. And every single month, I have to wait for it to show up in the mail.

Some months, my doctor may just decide not to fill it, which is what happened last month. And because I ordered the meds online through my provider, I didn’t get a phone call or anything to let me know. A physician who was not my actual primary care doctor just sent me a little note like hey, we’re going to discontinue these meds because we want to. Sorry bye!!!

Lest you think I’m being dramatic, allow me to show you the actual note that I received about my ADHD medication from a health care provider who, again, is not my regular doctor.

An actual note from a doctor who was not my doctor. “Your last few blood pressures were high so Metadate is not considered safe. I recommend you come in for blood pressure recheck. You can make appointment on kp.org — use blood pressure check and or call main number 503 813 2000 to schedule with nurse treatment room. If you can get a blood pressure cuff at home, that would also help us make decisions.”

It deserves to be noted that I have a blood pressure cuff. I’ve had approximately one million expensive tests and scans to figure out why I have high blood pressure, and so far the answer seems to be “because I keep having to deal with doctors like this.”

This note infuriated me, mostly because it reminded me that for many members of the medical profession, the kinds of drugs prescribed to people with ADHD are viewed as optional — nice, but not necessary. Like we’re perfectly functional without them and they just make us feel better. Like it’s no big deal if you just quietly decide to stop prescribing them without even a conversation.

Maybe if they understood the impact, they’d do a little better.

On the days when I don’t have my medication, my thoughts elude me. Sentences that should easily fall into place swim just beyond my grasp. Often I find myself trapped in a fixed gaze; I tilt my head back and look at the ceiling fan, trying to remember what I was trying to say or why I opened that tab.

Everything takes longer. By the end of the work day — which I have a hard time completing — I am worn out. I spend the rest of the night yawning a lot and hunting for things that can make me feel better, spike my serotonin.

On these days, I eat more, I drink more diet soda, and I revert to old habits, like picking my nails.

I’m somehow both twitchy and slow at the same time. Eventually it gets better, or I get used to it. It’s an exhausting ritual to snap in and out of every month when my prescription runs out.

This isn’t right. We need to talk more about how the broader stigma around ADHD makes people — including doctors — so cavalier about our medication.

ADHD meds are actual medicine

Most of the drugs used to treat ADHD — dextroamphetamine-amphetamine (Adderall, Adderall XR), lisdexamfetamine (Vyvanse), and methylphenidate (Ritalin or Metadate) — are nervous-system stimulants.

Here’s a good explanation about how they work. But basically, these stimulants help ADHD brains transmit information more effectively. This helps control symptoms by regulating the information our brain gets.

Stimulants give everyone a short-term boost, which is why these drugs have been the targets of abuse. They make neurotypical brains feel extra well-connected (although there’s no evidence it makes them perform better).

“For people with ADHD, they just kind of make us feel normal. And without them, our brains tend to sort of grope around to understand the world.”

For people with ADHD, they just kind of make us feel normal. And without them, our brains tend to sort of grope around to understand the world.

This is why substance use disorder is disproportionately common in people who have ADHD and don’t take medication for it; we will medicate our brains somehow and are often driven to try just about anything to help us feel (if not actually be) better.

The abuse of these medications led the United States government to list them as Schedule II drugs that can’t be refilled. In an attempt to crack down on recreational abuse, they’ve made getting vital medication more of a chore. That puts people with ADHD constantly at risk of having the bottom fall out, thanks to the whims or human error of a single physician.

I get it. These medications are serious — I jokingly but also seriously call it my weapons-grade meth. And they were, for many years, easier to use or abuse for non-clinical purposes.

There’s also still a kind of hangover from the hype around the perceived overprescription, especially to children, in the 1990s. So much hand-wringing over whether it was right or wrong to medicate kids created additional stigma and made these medications seem more optional than necessary.

And now, there’s also a lot of concern about people self-diagnosing — and about companies like the online mental health care site, Cerebral, that are lowering barriers for prescriptions.

This has created a general narrative that drug-seekers just want to take pills that make them feel good. As a result, longtime users are now getting the side-eye from their medical providers.

Physicians have a lot of power over the daily lives of people with ADHD. People for whom these drugs are not a cool, fun time. People who don’t take them to improve their performance — who are taking them to get through the day.

The power of stigma

Thanks to one doctor’s decision about my health care — a decision not at all informed by the reality of my ongoing treatments and trials — I was off my meds for a full two weeks.

During that time, I had a hard time forming a thought. I was tired all the time. I didn’t know how to tell people “Sorry I’m having trouble meeting that deadline. I got cut off of my ADHD meds and now I feel like my head is underwater all the time.”

I’m aware of the stigma. I’m aware that whenever I tell someone I take Ritalin, they (almost without fail) say something like “Oh, I should be on that! I’m so forgetful!” And I chuckle patiently and then exit the conversation — rather than try to explain that these medications are not like vitamins that anyone and everyone could benefit from.

It wouldn’t be so bad if it was just conversations at parties. But the flippant way a random doctor decided she knew what was best for me served as a huge reminder that even people in health care see ADHD medications as optional or minor.

But I can tell you, as a person who’s been on them for the better part of a decade, there’s nothing optional about it.

This for/by piece was brought to you by Understood.

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Hanna Brooks Olsen

Hanna Brooks Olsen

I wrote that one thing you didn’t really agree with.