How to control ADD when the side effects of meds are too much?
January 2, 2014 6:33 AM   Subscribe

I have pretty bad ADD, and have consistently underperformed throughout my life. I got on meds a little while ago, and it was life-changing experience. I actually got things done! Unfortunately, the side effects forced me off of the meds, at a time when I need structure more than ever. I would advice for non-medicated coping methods from others who have been in a similar situation to me (that is, couldn't handle meds and learned to manage without them).

The meds I tried were:

Concerta (In the distant past): A disaster. I never had bruxism before taking this med, and now I do. Made me feel wired up.

Adderall XR: The dose at 20mg was a lifechanger, but I got muscle tension in my shoulders which grew to be debilitating. It was eventually diagnosed as thoracic outlet syndrome, and the doctor did not think that there was a connection between the Adderall and the symptoms, but I never had them before I was on the med and the shoulder tension all but disappeared after I got off. I also tried 15mg, which was a bit better but not enough to justify staying on, and I crashed HARD later in the day.

Vyvanse, 30mg: Fewer side effects than the Adderall, but a bit of muscle tension still reared its ugly head. Also, it didn't manage my symptoms as well as Adderall did.

Wellbutrin XL: This was recommended and worked well for a while (also helped with the mood), but I got muscle tension on this too!

I am now unmedicated and am relying on coffee, which seems like the strongest stimulant my body is able to handle without body tension. I know there is still Strattera to try, but I have not heard great things about that medication so I figured I'll try going 'all-natural' for a while and see if positive habits will help

It's not working out so well thus far, and I would like tips on how to keep focused (particularly in the early day) in an unstructured environment, which I have always had a difficult time with.
posted by Thanquol180 to Health & Fitness (15 answers total) 24 users marked this as a favorite
What is distracting you? Could you describe your workflow (or lack thereof, heh)?
posted by semaphore at 6:39 AM on January 2

You can look into mindfulness meditation and/or (preferably and) cognitive behavioral therapy. The problem is that you're asking your brain to do something it wasn't taught how to do. There are some things that come naturally to some people. Everything else needs to be explicitly taught, learned and practiced. These are proven methods for teaching someone how to focus.
posted by bleep at 6:50 AM on January 2 [1 favorite]

This is slightly OT, but I notice that you didn't mention trying the non-XL/XR versions of Adderall or Wellbutrin. It may not make a difference for you, but I have trouble taking any extended-release medications; the effects are too intense, and I respond better to the old-fashioned formula.
posted by The Underpants Monster at 6:52 AM on January 2

Well, the "workflow" info throws a monkey wrench into the question but - I recently had to quit my job without anything lined up for various reasons I won't get into, and would like to make a career change, but I am not sure what to delve into. The thought of researching careers overwhelms me, and is such a nebulous concept to me that I end up getting little productive done during the day. Basically, since I'm not sure what I would like to do, I have a hard time even knowing how to get started. Trust me - it is difficult enough when there is a concrete task for me to accomplish! There is an anxiety element at play as well. Even when I have structure, almost anything can distract me (even this site, hyuk hyuk!) If a task requires sustained mental effort, I have a tendency to put it off ad infinitum.
posted by Thanquol180 at 6:56 AM on January 2

What have you tried to mitigate the muscle tension?

I found exercise first thing in the morning + rigid daytime routine (including diet designed to keep blood sugar levels fairly constant) to lead to more focus and productivity in the days before ADD medication.

I also did whatever I could to mitigate/lessen the effects of a lack of focus on my productivity. Mainly, calendars with alerts, flowcharts/important phone numbers/procedures printed out and taped to the wall by my desk so that when co-workers interrupted me with questions, I could quickly refer to the wall and get back to work.

Also, lists. I never left my desk at work without 1. de-cluttering it and 2. writing out on a physical piece of paper my prioritized to-do list for the next day. I then put in right on my keyboard so I wouldn't miss it when I got there.

I also changed my work schedule so that I came in at least an hour before everyone else, so I wouldn't have chatty co-workers distracting me while I made progress on the list. (Co-workers were a huge distraction at my last steady gig, in case you can't tell).

Improved sleep hygiene was also key to staying focused throughout the day. I made it a point to be in bed, lights low, reading a physical book by 10pm so I'd be asleep by 11pm. Sounds boring, maybe, but that is what I had to do to be successful in those days.
posted by Schielisque at 6:57 AM on January 2 [2 favorites]

I don't have bad side effects, but I have had to stop taking my ADD medication while trying to get pregnant (I could take them in between times, but the up and down kind of kills me, and my psychiatrist doesn't want to prescribe more while I am trying). The two crucial things that keep me functioning are getting enough sleep and setting timers. By the latter, I mean I work all day via timer.

I also want to note that your situation is going to be difficult for anybody, ADD or not, so please be kind to yourself. It is HARD to live without external structure when you have ADD. What I'd try, if I was in your situation, is deciding to spend two or three hours a day working on career research, and then setting timers in increments of 20 minutes (with short breaks in between 20 minute blocks) to make sure I hit that mark. I would make that my ONLY goal of the day, unless I had incredible success and felt like I could handle doing something else that mattered.

I wish you luck and good brain.
posted by hought20 at 7:02 AM on January 2 [1 favorite]

You need to create a structured environment for yourself. I've suffered from ADD my whole life, and have never gone on medication for it (no objection, I just chose another path). What helps me is to make sure that my days are very structured, that my tasks are regular and predictable, and my things (physical objects) are always put in the same place.

So this means getting up at the same time every day, doing your morning ablutions at the same time and in the same order, eating at the same time, devoting the same amount of time to tasks (in your case, looking for work...break it into tasks, as in, "I will review LinkedIn and write down or copy down all the jobs that look promising from 8-9am, I will send resumes from 9-9:30am, I will take a break and eat some yogurt from 9:30-10am, etc.)

It sounds regimented, and that's because it is. Eventually, you can work some flexibility into that, but training your brain to make order out of chaos is a really good first step.

Of course, a therapist helps immensely in achieving this goal.
posted by xingcat at 7:29 AM on January 2 [2 favorites]

I have bad ADD and had to stop taking ADD meds about 7 years ago due to heart issues. Here is what I do:

1. Diet: get sugar and processed carbs out of your diet. This is the one I struggle with the most (I've just started a new commitment to it) but it really helps. Look into low-carb or paleo diets, there are a lot of ideas for how to eat without this stuff in your life. In my recent question there were a lot of good tips given, particularly PaleoPlan and Linda's Low Carb.

2. Exercise: get some every day. Hard cardio exercise that gets your heart rate up. Preferably first thing / early in the day. Getting my body moving regularly helps me stay focused, and if I'm having a really hard time staying on task, sometimes I'll run around the block to reset myself.

3. Sleep: get enough. For me this is 8-9 hours a night, and it's really hard for me to go to bed on time (I have a toddler, so the only me-time is after he goes to bed) but when I have a full night's sleep on board things are way easier.

4. Calendaring: I put every little thing in my life on my calendar, and assign alerts to them as needed. Outlook, Google Calendar, whatever works for you. Set multiple reminders if needed (I frequently do one the night before, and then one just in time for me to get where I need to be). This can be a hard habit to get into but it helps so much. If you have a smartphone find a good calendaring app that lets you enter and edit events easily.

5. Just get started. First thing in the morning is hard, you can get distracted and never get back to what you need to do. It's best to develop a habit of just diving in, not starting with something that will lead you down a rabbit hole of unproductivity (she says, posting to AskMe first thing in the morning).

And this one is one that I can't use but it might help you:

6. Timewaster blocking software. If you have a hard time getting things done because you get distracted by the Internet, look into installing software that won't let you do this. I can't install anything on my computer at work, but lord how I wish I could.

Best of luck to you.
posted by rabbitrabbit at 7:41 AM on January 2 [9 favorites]

Exercise has been the most effective when my Meds aren't available. Like rabbitrabbit hard cardio seems to be the best for me. I know I read in Driven to Distraction it can be almost as effective as Meds. I do take adderall ir as opposed to the xr version. Have you tried a smaller dose of ir.
posted by lasamana at 8:02 AM on January 2 [1 favorite]

Wow, I could have asked this exact same question. I am reading this thread with interest.

Just wanted to nth the diet and exercise--preferably hard cardio exercise, and a sugar-free diet. Low on the high-glycemic carbs, too.

I also have a to-do list as a Word document saved on my computer, and any time I have a new task I immediately add it to the list. I have a problem with losing to-do lists written on physical paper--the electronic format is a lifesaver.

Finally, I drink as much coffee as I can without it messing with my sleep (which isn't a whole lot, actually).

Good luck!
posted by whistle pig at 9:20 AM on January 2

Oh, and I meant to respond to your update--I have the exact same problem of being overwhelmed by possibilities. I have found that what helps is to:

1. Figure out something to try next. Doesn't have to be the right thing--it just has to be something.
2. Break up that task up into its smallest possible components (I want to apply for a job--what steps does that entail? Revising resume, cover letter, and filling out online application. You might even want to get more detailed than that).
2. Writing each of these steps down on the to-do list.
3. Methodically working through each of these and crossing them off of the list one by one, dismissing any needling thoughts along the way that I should actually be working on this other unrelated thing.
4. When I reach a point where things are "good enough," I complete the project and wipe my hands of it. This is the hardest part for me. I have a tendency to get three-fourths done with something, convince myself that I'm "wasting my time" or am "not good enough," or am aiming for perfection or whatever, and then abandon it. No matter what you start, finish it!

Thought I'd share that in case you have similar issues.
posted by whistle pig at 9:31 AM on January 2

I was recently diagnosed and can't take ADD meds because of a heart arrhythmia. Now that I know why I have never been able to finish things, I'm learning how to deal with it.

The best solution for me has been setting aside a few minutes to make a list of what I need to get done in a given time period (whether during the work day, or this weekend, or on payday, or whatever). It helps me to break each task down into its necessary steps. So, instead of "clean the kitchen," I have:

Clean kitchen:
Empty dishwasher
Load dishwasher
Wash by hand the things that can't go in the dishwasher
Wipe down the countertops
Clean the stove
Shake out rugs and put in the washer
Take recycling out
Sweep the floor
Put cleaning products away

If I don't do that, I start emptying the dishwasher, at which point I realize the floor is dirty and I start sweeping and then I realize that the recycling bin is full and needs to go outside and when I take it outside I notice that a branch needs to be trimmed and I trim it and etc. And meantime, the dishwasher is still open and the clean dishes are still in it. With a detailed list, I can see where I am and where I need to go.

When my brain gets buzzy and I can't focus and have no idea what to do next, I do a couple minutes of mindful breathing. It's like a reset button for me -- the problem is remembering to do it.
posted by mudpuppie at 10:03 AM on January 2 [5 favorites]

Creating structure is the way to go. Give yourself commitments in small, manageable chunks. For instance, if you have trouble getting out of bed in the morning try setting yourself up with some kind of appointment that you have to be at by a certain time, so that you will have a reason to get out of bed promptly.

Also, avoid burn-out. Take short breaks whenever you feel yourself getting strained by a task. Breaking the task up into the smallest possible pieces will also help.

Finally, you might try Adderall IR. It wears off faster than XR, and you could just take it on an as-needed basis whenever there is something important to do that you're really struggling with. Perhaps you would see fewer side-effects that way. There's also Ritalin, dexedrine, and provigil (off-label) which you might look into.
posted by Scientist at 11:26 AM on January 2

Just as a data point: my husband has the same basic complaints about stimulants as you. He went on Strattera about twelve years ago, and it's worked well for him. He's tried some other meds, but nothing's worked as well.

Behavior: once a routine is established for him, it's basically okay, unless he has to interrupt that routine for a few days. Then it's back to square one. So, we have a list posted in most rooms of the house. It consists of the things he does each morning. (Shower, use deodorant, brush teeth, etc.). It lists approximately what time he should be doing these things. Ideally, he does them in exactly the same order at exactly the same time every day. No matter where he is or what he's doing, the moment he realizes he's been sidetracked he can pick up the routine again.

I think most mornings he doesn't need the list anymore, but it's still sometimes helpful.

Also, reminders on his ipod. Also, I help him keep track of stuff. Do you have anyone in your life who can help you stay on track?

Finally - as others have noted, outside structure is pretty important. Are there activities you can commit yourself to throughout the day? That is, commit to someone else so you won't put it off? Could you sign up for classes at the gym, or call a different friend/family member at the same time each night? My experience w/my husband has been that it needn't be exactly the same activity each day, but it does need to be a pretty similar activity at exactly the same time each day.

The absolute most important thing, and biggest struggle for him, is that when something needs to be done, he must do it immediately. No waiting until the next save point or commercial. If we're in the middle of a conversation and his watch goes off, we don't finish the sentence until after he does whatever that alarm was for.

Actually, the absolute most important thing is to know that you're still going to forget stuff, and that's okay. Nobody is on top of everything all the time, so you don't have to be perfect. Be gentle with yourself, and congratulate yourself on any success and all your effort, even if not all your efforts are obviously successful. Even the "failures" are successes, because you're still actively training your brain.
posted by tllaya at 5:19 PM on January 2 [1 favorite]

Whenever I move from one place to another, I whisper my goal as I go. So, right now I'm thinking "what's the next task?" and when I hit "Post" I'm going to start whispering "floss/brush/floss/brush" and when I'm spitting toothpaste it's "bedtime now."

ADD + short term memory loss but I'm coping good-enough.
posted by Jesse the K at 7:42 PM on January 2 [1 favorite]

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