Undiagnosed ADHD - Next steps

February 15, 2023 10:37 AM

Recently I’ve come to the conclusion that my lack of focus isn’t just a personal failing, but due to undiagnosed and (mostly) untreated ADHD. I’m in the midst of a very complex project rollout at work, and there’s a huge waitlist for mental health care, so I’m trying to figure out how to manage this best over the next few months.

Since my sophomore year of college, I’ve had repeated problems with losing focus. In college, there was a clear difference between classes that had final exams (As and Bs) versus final papers (Fs and INCs). In my career I’ve always started new jobs with a hot streak, quickly picking up the nuances of my new position, only to wind up getting written up for a lack of focus and attention two years later. I’ve been able to stay employed, thanks to upping cardio significantly when I start to slip, but even then I wind up burning out because it takes me so long to complete my daily tasks.

Which is where I’m at today—context switching between different facets of my job means that I am losing hours each day as I jump back and forth, and there’s not currently enough slack for me to still get everything done reliably. I can tell my boss is very frustrated with me, and it’s not like this is fun for me either. Cardio is still helping but it doesn’t get me excited about repetitive testing of a project I’ve already been on for two and a half years.

I’ve been trying to set up an appointment with a therapist, but the timing has been difficult: I started the process six weeks ago when I still thought I was only having anxiety issues, and I still don’t have an appointment scheduled. I reached out to my GP to see what can be done about an ADHD diagnosis, but the waitlist for a psychiatrist through their affiliates is up to a year. I also don’t have a diagnosis from childhood, but I do have memories of teachers and family members often talking about how I was off in my own world—which seems like something caused by inattentive ADHD but is obviously not documented.

In theory the therapist has a psychiatrist they work with, but that also could be a significant time period before I’m able to get meds.

So, this weekend I remembered that I did NOT seem to have the same problems with attentiveness in high school that I did before and after, and also that I spent those years taking prescribed Claritin-D daily. That pill was 10mg loratadine and a 24 hour dose of pseudoephedrine. I continued taking that prescription until my sophomore year of college, and my academic performance declined after that. So I decided yesterday that I was stuffy enough to take a 24-hour Sudafed to see if it would help my focus as well. And the difference was clear as night and day: little things on my commute didn’t irritate me. My boss joining a call didn’t give me an anxiety spike. I noticed things about the office that I’d never noticed in the past, and I went on to have a very productive day. I’ve taken another today with mostly the same result. I’m not jittery; I feel calmer than I have in weeks.

So what are the next steps? I don’t want to keep taking Sudafed if I can help it. I’m also worried that doing this will make it harder to get a proper diagnosis and prescription later. On the other hand, my options are either off-label use of an OTC drug, picking up smoking again, or getting fired.

Should I pursue a tele health appointment with a psychiatrist anywhere in my state that takes my insurance? Would that be relatively quick? (I am in PA if that helps).

Should I tell my boss?

Are there major concerns with continuing to take a 24- or 12-hour dose of Sudafed for a few weeks to get me through this complex time at work, and should I be worried about psychiatrists negatively judging me ahead of a proper ADHD diagnosis?

Throwaway email is [e-mail]

Thanks!

posted by anonymous to Health & Fitness (22 answers total)

I can't answer the medications question, but have a few ideas / suggestions:

• If you haven't already done so, leverage your company's Employee Assistance Program to find a counselor/therapist ASAP. No guarantees they will be any faster, but at least you have multiple options to find a service provider.
• If the context-switching is the main issue, tell your boss, but focus on that and not the maybe-ADHD. "Boss, I know you've been frustrated with my work recently, and I have been, too. The issue is with my context-switching. It would really help me to focus on and complete X, if I could give away Y (for now / forever?). This is critical for X's success. Whom can I transition Y to?"

posted by tinydancer at 10:59 AM on February 15, 2023 [2 favorites]

So interesting that this has come up today. I, a 58 year old woman, was recently diagnosed with ADD. I was subscribed a few different meds (not stimulants) but I had side effects so I'm on just an antidepressant at the moment . But I brought the ADD up with my therapist and it turns out she also has ADD. I cannot tell you how amazing it was to hear her describe herself and see myself so clearly. This just happened Monday! I am hoping that at our next visit, we can talk some more about it, talk medicines and other interventions.

I don't know the answer to your other questions, but if you didn't have bad physical reactions to Sudafed and it works, it could be a good stopgap until you find a therapist/psychiatrist.

I wish you all the best. It's been both a relief and depressing to be diagnosed at my age. I'm trying not to think of the time wasted--I'm old enough that I never would have been diagnosed as a child--but rather, how much better things will be in the future.
posted by ceejaytee at 11:15 AM on February 15, 2023 [3 favorites]

I'd be worried about being flagged for using Sudafed since apparently it's some ingredient in meth making and I hear that makes it harder to get.

(note: I haven't tried using it since circa 2002-3 when I had some kind of post-pneumonia syndrome, but the whole meth thing was brought up then.)
posted by jenfullmoon at 11:25 AM on February 15, 2023

There are websites where you can be connected with a doctor who will screen you for ADHD and prescribe medication if appropriate. It feels a little shady because I don’t know how many people get misdiagnosed. And you might have to pay for it out of pocket if your insurance won’t cover it (I think they charge an initial fee, then monthly for refills). And it might not be possible for you depending on where you live as it’s telemedicine and that’s not kosher everywhere. But that’s an option.

Anecdata: a family member gets a prescription this way. I think the intake process was pretty quick. It’s in the ballpark of $100/month plus the prescription. I don’t know if insurance covers any of it. I think the prescriber has a lot of patients so sometimes they have had to schedule appointments at odd hours (8:10 p.m., for example). But they get their prescription and it helps them function. Good luck.
posted by kat518 at 11:28 AM on February 15, 2023

I'm not sure what happened when you called your GP - did they refuse to see you for this issue? GPs can generally prescribe psychiatric medicines, though whether they will do so might depend on things like how well you fit the typical profile, how comfortable they are with you, and how they feel about the discourse around overmedication. They might be more likely to do so if it's a temporary measure while you wait for an appointment with a psychiatrist.

That said, many people take Claritin-D daily for allergies, like you did. It has a relatively low number of side effects.

Sudafed is not hard to get in my state (don't know about PA). You have to show your ID and there are purchase limits, but these limits are such that you can buy 30 12-hr doses in a month. These limits are federal, I believe, which means they should be the same in PA unless there are more stringent state laws there. I don't want to comment if that would raise red flags for later diagnosis/interaction with doctors.
posted by Kutsuwamushi at 11:32 AM on February 15, 2023

Do you have to be referred? If not I would reach out to your insurer or their doctor -finding service and get your own psychiatrist (not counselor, you need someone to prescribe meds).

So the advice I received was this: tell your Dr/insurer that you are worried that your lack of focus negatively impacts your ability to work..in fact it may have been the reason for losing previous jobs. For at least some doctors, this seems to persuade them when worries about simple inattention do not. I assume we can blame capitalism for that but whatever.

There are several kinds of meds, which again you need a specialist to discuss. I talked to mine on Zoom and they started a prescription that day. It has markedly helped my focus and anxiety.
posted by emjaybee at 11:39 AM on February 15, 2023 [2 favorites]

Please ask a mod to update with what country you are in.
posted by DarlingBri at 11:53 AM on February 15, 2023

Please ask a mod to update with what country you are in.

The OP specifies that they are in PA.
posted by Kutsuwamushi at 12:04 PM on February 15, 2023

You should pursue all avenues.

See if telehealth gets you anywhere. In the meantime, or that gets you nothing:

Self-medicate with other stimulants (coffee, tea, energy drinks, caffeine pills)

If your cardio is running on a treadmill, try something that takes more mental calculation. Cycling is one of the best forms of exercise for ADHD. Any exercise will help, but "the best sports demanded constant physical exertion and a suite of technical movements that engaged brain functions dealing with balance, timing, error correction, decision-making and focus. [Source is an article about cycling. The first half is narrative. The information starts at the section called "What is really going on inside Adam Leibovitz's brain?"]

From that same article: There's another aspect to it as well. Call it gallows focus. "The prospect of the gallows doth wonderfully concentrate the mind," Samuel Johnson once famously wrote, and something similar can be said for exercise that involves a touch of risk. Let your attention drift in the peloton, and you might crash into the rider in front of you. Distraction in the dojo is rewarded with a painful body blow. By contrast, a soccer player who loses his concentration is just a guy standing in a field of grass.
posted by meemzi at 12:15 PM on February 15, 2023 [3 favorites]

I’m also worried that doing this [taking Sudafed] will make it harder to get a proper diagnosis and prescription later.

Document the effects of taking the Sudafed (as you have done in your question). It's another data point and could help the (eventual) diagnostic process.
posted by heatherlogan at 12:20 PM on February 15, 2023

IANAD, but if you take claritin in accordance with the instructions, it seems like it should be ok.

Congratulations on realizing that "my lack of focus isn’t just a personal failing." That can be a huge weight that holds you back from being more productive in itself. Accepting that, listening to your body, and planing around what you are actually capable of (as opposed to the way in which you think you should be able to) can be helpful in attacking your project in a way that will be successful.
posted by bruinfan at 12:21 PM on February 15, 2023 [2 favorites]

If you're good at handling new things is it possible for your next job to be something with more novelty? I dunno, you also mention context switching as a challenge which maybe works against this, but if you had a new client to work on every six months, would that be enough novelty? A lot of my ADHD-diagnosed or adjacent friends do well in various forms of crisis response, or troubleshooting roles (like high level service engineering, where you can write a procedure to mean you don't have to deal with issue X again and you just have to deal with new or strange things). But even those jobs do have *some* repetitive parts, so it depends on where you and your current job fall on the scale
posted by Lady Li at 1:13 PM on February 15, 2023

As far as telling your boss, I would strongly advise against it.

I disclosed depression to a boss once and then he wouldn't let me use my paid sick time when I'd been out with depression.

If you can trust HR and work with them for what you need, that's the best.

Idk who your boss is, obviously, but most bosses don't care why work isn't going as expected.
posted by mermaidcafe at 1:57 PM on February 15, 2023 [2 favorites]

I would urge strongly against disclosing any kind of mental health issue to your workplace. You may have a sympathetic manager / HR dept that is able to deal with this information in a sensitive, professional, and respectful way, but IMO it is highly unlikely. Even the best of us often have horrible, regressive views towards mental health and disability.
posted by sid at 2:07 PM on February 15, 2023 [5 favorites]

You might also consider taking the Time Management Fundamentals course by Dave Crenshaw on LinkedIn Learning (which you might be able to access through work or through the public library for free).

The instructor has ADHD and so it might work for your brain.

Then no worries about trying to self medicate, but you might still find an improvement.

Also, through my HMO there's an intro course on adult ADHD with no diagnosis necessary to take it. They also suggest non-medication strategies.
posted by skunk pig at 2:20 PM on February 15, 2023

If you're concerned that disclosing use of a substance to a doctor will cause them to unfairly judge you unfit to be prescribed stimulant medication, I personally wouldn't feel bad not disclosing that thing depending on the context. For example, I know some people now diagnosed with ADHD who previously had tried friend's prescription medication and found it helpful. I would never tell that to a doctor though. Some doctors will be normal about it, and some have weird ideas about stimulant medication for ADHD not supported by scientific literature.

I also recommend caffeine and caffeine pills in moderation.

Don't tell your boss. If you can come up with any way of structuring the work differently that would allow you to do it more easily, you could potentially ask about that, but not framed as a limitation you have, rather as a way to make things more efficient.
posted by lookoutbelow at 4:08 PM on February 15, 2023

I get by with caffeine. A cup at the start of the work day, and then another 4 hours later.

I start tasks I really don't want to do about 20-30 minutes after drinking one of those cups.

It's made a huge difference in my life. At one point I caffeine wasn't agreeing with my body for a while, and it was hard to continue functioning. I've since been able to reintroduce it (but not as much as before) and once again it's super helpful.

You may need something stronger (prescription drugs). Or something lighter-weight like tea might be better for you.

The downside to caffeine is addiction, but it's an easy and relatively cheep habit to maintain in our society.

It might or might not work for you, but it's something you can try right now with low risk (unless you have heart issues or advice from a doctor to avoid caffeine).

Start out with something low dose (green tea for instance) if you don't already have a caffeine tolerance. Maybe black tea after a few days or a week, then try a cup of coffee after more days or a week. Don't start out with a ton of caffeine at first if you're not used to it, because overdosing is no fun.

Avoid routinely getting a bunch of sugar with the caffeine for long term health reasons (i.e. avoid sodas).

Anyways, I hope this helps.
posted by DrumsIntheDeep at 7:47 PM on February 15, 2023

A neurologist is your best bet—therapy doesn’t do nearly as much good as Adderall/Rx.
posted by Ideefixe at 9:21 PM on February 15, 2023

How’s your sleep?

I find that my ADHD is much more manageable when i’ve gotten a solid 7.5-8 hrs of sleep. If i have a poor night’s sleep, the Adderall and caffeine are *much* less effective, sometimes not at all (for the Adderall). An underslept brain of *any* kind is going to struggle with some facet of executive functioning.

Be careful with stimulant use beyond midday; a good night’s sleep is at risk. Don’t work at cross purposes with yourself, by making your ADHD harder to manage due to lack of sleep brought on by stimulants taken at 4pm.
posted by armoir from antproof case at 10:08 PM on February 15, 2023 [1 favorite]

Another person suggesting caffeine as a stimulant. It works really well for some people, and comes in various palatable forms. If you need to drink copious amounts of red bull to get by until you get something else sorted, then do so.

But I think it's fine to continue with Sudafed as long as you don't get flagged as a potential at-home drug manufacturer. So really only a very short term solution.

With work, I think you can tell your boss that you struggle with switching between tasks as long as that's not fundamental to your role. I would not tell them you suspect you have ADHD. Plenty of people have poorly informed views, and even more look down on self diagnosis. See if you can get the task switching reduced, and look at ways you can work with your brain to get things done, there are lots of ADHD-hacking tips all over the internet.
posted by plonkee at 1:18 AM on February 16, 2023

I get that you need something to help with the acute symptoms you're presently experiencing, but please do start the process to get a referral, even if it takes some time. A good psychiatrist will do a proper differential diagnosis and take the time to find the right medication and therapy regime. Getting proper care is therapeutic in and of itself!
posted by sid at 8:29 AM on February 16, 2023 [1 favorite]

Have you had Covid, and did the headache persist for long time? I and a number of colleagues have independently found post-Covid that our lack of focus has exploded. More than one person, including me, describes it as being used to juggling 6-7 balls, transferring focus between them, and suddenly you can only handle 3-5, and when you reach for that sixth ball there's nothing there, whatever it was that you'd been holding in mind in that position has vanished.

I'm afraid I don't have a solution, just observation of a correlation, but in my case it's been useful in getting the NHS to take my problem seriously. Very best of luck.
posted by Hogshead at 4:42 PM on February 17, 2023