Bartelby Ain't Got Nothing On Me

December 20, 2010 7:25 PM

I've been diagnosed as ADD/ADHD by 3 separate professionals through my life and on medication to treat it for nearly a year. The meds don't work, and I've been on a lot of them (i.e. Ritalin, Vyvanse, Strattera and now Adderall.) How can I give myself a swift kick in the butt to become a productive, organized individual?

I'm a woman of Midwestern extraction in her early 30's. I have always, ALWAYS had problems with time management, organization and procrastination. (In fact, I've wanted to write this question for months.) If you give me a "Could YOU have ADHD?" exam, I'd pass it. I can be inattentive, interrupting and impatient early and often.

Furthermore, these behaviors can be seen in most of my maternal relatives. My mom was medicated for ADHD for a while, but I think she stopped because she didn't want to become dependent on the medication?

These problems have manifested themselves in my surroundings, my relationships and my career. My house/dorm room/apartment/office/car has always been messy, I've been fired from a couple of jobs due to poor performance brought on by my problems, and my husband is at his wits' end with me because of what he sees as my lack of inaction.

I could write a novel about what I've given up and settled for due to the way I am. Most of the time, I feel like I've dug a big hole for myself that I can never escape.

This would be a convenient time to mention that I've been depressed and anxious for much of my life. The list of antidepressants I've been on is legion. In fact, when I was first diagnosed as ADHD at 21, I was prescribed Wellbutrin. The doctor felt that it would help my ADHD and depression. Instead, I went into an year-long episode (not helped by the removal of my thyroid and subsequent thyroid cancer treatment) that left me hospitalized one night and suicidal for much of that year.

A few years later, another psychatrist diagnosed me as Bipolar II based on my recounting of my behavior during that time.

But enough about that. What do I take today? Every day, I take 2.5 mgs of Abilify, 60 mgs of generic regular Adderall, and 200 mcgs of Levothyroxine. The last time I had my thyroid hormone levels checked was in September.

I started taking the ADD meds last January. Vyvanse didn't do anything except give me a dry mouth, Strattera gave me wicked insomnia, Ritalin did nothing. Adderall? It keeps me upbeat and works with the Abilify to make me think that I'm more than a burden to others.

None of these drugs gave me the life changing experience I've seen other MeFi users mention. None of these drugs make me want to do more than surf the web, stuff my face and sleep.

I recongize my problems need to be solved by me and not a pill I take daily. But where do I begin? I recently got out of therapy after a couple of years with the same therapist... we were doing CBT but I couldn't stay focused on the same issue for more than a few weeks at a time due to a flareup of something I'd see as a crisis. I've tried GTD and the various to do lists online. I've tried FlyLady. I've tried willpower. But I always fail.

I've talked to my current psychatrist about how the ADD meds aren't providing me with results. (I am satisfied with the Abilify; I wish I weren't on a antipsychotic, but there you go.) He said he didn't have much else for me. Have I not tried hard enough?

Has anyone out there been in the same boat? How did you change your course?

(tl;dr: I have ADHD or something closely resembling it. I also have had a bipolar II diagnosis and am hypothyroid. I've been medicated for ADHD consistently since last January. In that time, I've been on four medications with little success. I recongize that a pill isn't a panacea, but other methods I've tried to improve my procrastination and disorganization haven't worked. Have you been in my shoes? What's worked for you?)

posted by anonymous to health & fitness (9 answers total)

Sometimes, houses, and lives will be messy. It's ok. Just getting that out first.

Your post has a lot about what meds are supposed to do for you. Have you ever had a time when you asked yourself, or when a therapist asked you what you want? From reading what you write, you seem very focused on what you think you should be, but not much about what is actually "wrong" with how your life currently is.

As far as what you asked, what works for me is to have routines. M/W/F, the cat boxes & bathrooms are cleaned. T/Th, the wash is put into the machine, my husband puts it into the dryer and I fold it when I get home. Sundays, I start all the cooking for the week. M/Th, we vacuum and wash the floors. It's like that old nursery rhyme.

Good luck -it's not fun. I do the day of the week thing to keep track, and forbid anything happens to my schedule! Please feel to contact me if you want.
posted by kellyblah at 7:45 PM on December 20, 2010

I recongize my problems need to be solved by me and not a pill I take daily. But where do I begin? I recently got out of therapy after a couple of years with the same therapist... we were doing CBT but I couldn't stay focused on the same issue for more than a few weeks at a time due to a flareup of something I'd see as a crisis. I've tried GTD and the various to do lists online. I've tried FlyLady. I've tried willpower. But I always fail.


wow i could have written this. i wish i could offer something more concrete, but i just want to say you're not alone.

every med i've been on (including abilify and adderall) works for a time then stops working or makes me feel worse. abilify also made me want to eat all the time and then sleep. weird.

the whole "MWF" this happens, "TR" this happens has never worked for me. i'll make a schedule for a week, get to weds and the whole damn thing falls apart. i constantly fight with myself in my head. i've tried Feeling Good by Burns and can't even do that consistently because it's so overwhelming to parse all the cognitive distortions.

but i will say that even if i'm not perfect, learning about cognitive distortions and working on a few of the big repeating guilt trips i lay on myself has REALLY helped a lot. it was one of the hardest things i've done, rewiring some of my circuits. the idea that i might have to continuously go through that process for the rest of my life is daunting tho. i'm only adding this because i get the idea you may feel similar.

i would have me-mailed you but this was anon. so, in short, recognizing my cognitive distortions has helped me at least be less hard on myself, with or without meds. the docs and therapists are still out on whether i'm actually ADHD-Inattentive, GAD, Bipolar II, mix of two or all or just GAD.
posted by sio42 at 8:03 PM on December 20, 2010 [1 favorite]

I am surprised the Vyvanse didn't work as good or better than the generic adderall. It is the same drug with a different delivery method. The dosage of vyvnase in mg should be about twice the adderall xr dosage.

Have you tried the organization methods at the same time as being medicated?

Because the medications don't give organization or purposefulness. They just restore the ability to focus to that of a "normal" person. You still have to do the work of organizing your thoughts and work.

I can be inattentive, interrupting and impatient early and often.

But what is your mind doing at that time? Those are sort of sub-symptoms of ADHD, or how ADHD appears to other people. The main deal is that the mind is distracted- you forget someone is talking, you forget what you are doing because something else pops into mind. You start out to organize the junk drawer and an hour later you are painting the garage and you have no idea how you got there. And the drawer isn't clean.

I'm not doubting the diagnosis, but I might be doubting the level of support and instruction you have been getting from your psychiatrist. Drugs are at best, half the battle.
posted by gjc at 8:05 PM on December 20, 2010 [1 favorite]

I am not a psychologist, and I hope one will comment here, but I'd like to add my personal experience. Those supposedly magic drugs, Ritalin and Adderall, did nothing for me. Strattera made me feel vaguely focused, but eventually made me throw up, so I stopped taking it. Unlike your situation, I've been healthy since then, masha'Allah.

I just wanted you to know that it's not abnormal to see little success with medication. Keep testing drugs, and try to make a habit of other kinds of calming practices as well. There is something out there that works for you.
posted by shii at 8:31 PM on December 20, 2010

Sometimes it's hard to see the effect from the inside, until you go without for a little while and realize how much it is actually doing. Have you tried leaving off the meds for a few days to see if it's making a difference? The amphetamine meds like Adderall are short acting enough that you should notice the effect or lack thereof if you miss it one day. Obviously this is something you should discuss with the doc before trying.

If they're really not working, perhaps ADHD is genuinely the wrong diagnosis? There are a couple of other problems that can cause issues just like ADHD. One is a sleep disorder--and you can have a sleep disorder while thinking that you're getting plenty of sleep. I don't know all of the various issues that can mimic ADHD, but I do know that there are more. Perhaps it's worth finding a good primary care doc and investigating with them--a doc who can help you figure out what type of specialist to see, and keep track of what you've done and what else you could try. Sometimes tracking down something like this takes a few different tries.

I do agree that if you've had ADHD all your life and never learned to do things like organize, the meds won't do that for you. They just make it possible to learn to be organized; the learning and the organization itself are still hard work, especially after a lifetime without.
posted by galadriel at 8:36 PM on December 20, 2010

Something that I've found that helps me is to have an external monitor. You have to be careful with this, as it has the potential to poison a friendship/relationship, but having someone around to check in with at regularly intervals can help with the habit building bit. Once you reach about 2.5 months or so, things get easier. Hitting that mark, on the other hand, isn't easy at all.

Part of it, for me, at least, has been developing coping mechanisms. I'm not great at them and I don't use them as often as I should, but I think I've reached the point where I recognize when I'm not using them, which sometimes compels me back into the groove.

For your husband and you, I'd recommend a book on working with ADHD/bipolar in a relationship. The one I was going to recommend is out of print and looks to go for $200, so I'm not quite sure, but I'm sure there are some good resources out there.

Good luck.
posted by Hactar at 10:44 PM on December 20, 2010

I have the same issues and can only offer anectdotal: I take Vyvanse (40mg daily) and it works wonders for me. Yes, it is definitely a crutch of sorts, and when I don't take it I lose all motivation, focus and end up feeling like a zombie, so I definitely need it. However, I found that the best thing for me is to keep my life as simple as possible. I went through a period of discovery and acceptance over the past 2 years, and have learned to accept my shortcomings. Meaning, I know what I'm good at and what I'm not-so-good at, and I'm okay with it.

So I do my best to keep my life as basic as possible. To the point where I had to explain to friends and family that I loved them, but I would not be able to function at the level I had been for years. It takes some tender explanation, depending on the person you are talking to, and some folks may not understand what you are trying to achieve, but those who really know and love you for you will ultimately understand.

Figure out what the Very Important Priorities are (job? family? finances?) and vow to focus on getting those in order. This should be your promise to yourself only. Right now I'm focusing only on my son (special needs child), my job search and my recent cohabitation with my SO. I check in with friends and family to let them know I'm still here and that I love them, but I have also created firm boundaries to protect what is my hard-earned sanity.

tl;dr: Simplicity in your life. Meds as a bolster.
posted by sundrop at 5:08 AM on December 21, 2010

None of these drugs make me want to do more than surf the web, stuff my face and sleep.

Maybe it's just a turn of phrase and your word choice doesn't mean much, but in my experience, ADD is not at all about what you want to do and medication doesn't help by changing what you want to do. For me, I typically have desperately wanted to do all sorts of new and interesting things-- new hobbies, writing a novel, exploring my city, going out and meeting people, etc, etc. And the most frustrating thing about ADD for me is the way that despite genuinely wanting to do fun things, to do well at work, and accomplish all sorts of other goals, ADD makes it so damn hard. (Someone in the big ADD thread described this as "it feels like there's some kind of plastic bubble over the tasks I need to do. My mind just slides off of them. I can't get any sort of foothold." which I think is just perfect.) And so even though I really want to do so much more, I often end up just mostly sleeping and eating and surfing the web because of how hard it is to get myself to do other stuff. The great thing about the meds is that they make it a lot easier to get over that hump. The way I like to think about it is that accomplishing stuff unmedicated is like pushing a ball up a huge steep hill, and the medication makes the hill way shorter and more manageable-- but it's still uphill and you still have to push. (For example, my messiness at home isn't much better than it was before, because fundamentally I don't want to clean so I don't push myself very much and consequently don't clean much.)

So not wanting to do stuff doesn't sound to me like a symptom of ADD-- but it does sound like a symptom of depression. And so I would think the better way to address it medically wouldn't be through changing ADD meds, but antidepressants. And that maybe if you are suffering from depression right now and can make improvements to that (through meds, exercise, diet, whatever), you'll find some of the symptoms lessening that you may be either misattributing to ADD, or that are caused by ADD but are much harder to address with depression (or anxiety for that matter) in the way.

Even if I'm just reading too much into your phrasing, I hope there's something valuable in this anyway... that it's hard to untangle ADD and depression and anxiety but that working on all of them is important, and that when you're trying and failing to force yourself to do something, it's worthwhile to try to figure out if it's something you want to do and can't, or whether you actually don't really want to in the first place. (Telling yourself you want to do something because you think you should, but deep down you actually really don't? I've totally been there.)

Oh, and have you ever read The Now Habit? (Subtitle: A Strategic Program for Overcoming Procrastination and Enjoying Guilt-Free Play) Don't know if it will be helpful for you, but I found it really great. It sounds like it's about an organizational system, but it really goes pretty deep into looking at causes of procrastination and acknowledges how miserable it makes you feel and tries to help you stop beating yourself up about it among other ways of addressing the problem.

Good luck!
posted by EmilyClimbs at 7:13 PM on December 21, 2010 [2 favorites]

The following may be useful. You won't find all of this together in any textbook as it is based on my experience and over 35 years of research. You may want to try it and if works for you good. These are my theories on ADD/ADHD which may be helpful, but I am not a professional so just saying. With that said here is what I believe about ADD. If you read many of the post related to ADD/ADHD they refer to being tired or Lazy. This has several components. First of all it appears that most ADD people may have a low thyroid. The Barnes basal temperature test is a way to tell if your thyroid is low at home and won't cost you anything if you have a regular mercury thermometer. (Look it up on Google on how to run the test if you want to try it.) The book "Solved The Riddle of Illness" by Dr. Stephen E Langer, M.D, while not specifically address towards ADD, is a good resource on hyperthyroidism. Another apparent trait of ADD is that they do not absorb vitamin and minerals very well which contributes to a low metabolism. Therefore supplements are important. For example, I use the Spring Valley (Wal-Mart Brand) Super B-Complex to increase my metabolism. The biotin in this is an essential ingredient and if you purchase any other brands it is important that they have biotin. A good source to learn more about the vitamins is 3StepsADD.com run by Jon Bennett. His book is only $7. He also discusses the importance of eating healthy “brain food” or oils which is what our brains pretty much run on. I could talk a lot more about this, but if you read his info it is pretty in depth. There are a number of other keys to concurring ADD which I haven’t found connected directly to ADD but they apply to me it appears. I have never read this anywhere, but it appears that another component of ADD/ADHD is the inability to fully metabolize sugar.(I may get myself tested someday.) This apparently causes the depression and confusion. The confusion appears to be caused by low vitamin D levels. The metabolism of sugar also leads to low levels of potassium resulting in muscle weakness. I developed a test for myself. I would eat two sugar water popsicles and they caused my muscles to feel weak. The antidote is a banana or 400 mg of potassium gluconate. Eating modified sugars seems to not have the same effect, for example, sweet and sour sauce, as the sugar’s chemical composition has been modified by the heat. I would like to hear if this helps you, or anyone else. Please MiFi mail me if you find this helpful. Just saying.
posted by LightnKnowledgeQuest at 5:34 PM on January 9, 2011