Willpower or Ritalin?
June 14, 2009 11:34 AM   Subscribe

ADD Filter (YANMD): Willpower or Ritalin? Your anecdotes, advice, opinions, options, and facts are all welcome here.

As a child, I was diagnosed with ADD. They had me on Ritalin during 4th and 5th grade. In retrospect, it worked. I remember being able to go upstairs, sit down, and do all my math homework. I loved that.

We moved, my parents got different insurance, and they no longer insisted that I take the Ritalin before school, so I stopped taking it.

Last year, a good friend of mine sat me down and had a conversation about ADD with me, and suggested that I should consider medication. He explained ADD as a chemical imbalance that should be rectified. "Do you have ADD" is something that I've heard many times over the years, and I've pretty dismissively just acknowledged that I was diagnosed with it as a child. Since that conversation, however, I have done some reading, and acknowledge that yes, I do, in fact, as an adult, have ADD.

So now, here I am. I am 26, healthy, happy. I have a regular sleeping schedule, I get from A to B by foot or bike.

I think of it as a personality trait. I feel like there are traits that are associated with ADD that folks associate with me. For instance, my short attention span: like the way I skip a conversation from one topic to the next. I feel like, if I'm bored with the conversation, or if the topics relate in my head, why not? When folks say I'm "unique", I feel like this is one of my traits that they are referring to. ("but we're all unique." "no, no. You're unique differently.")

I took some years off before I went to college, for traveling and adventures and such, and now I'm in school. I did fine at my community college, it was pretty much just like high school, and I got my A.A. with an honorable mention. Now I've spent a year at a quality university on a quarter system, and my grades have dropped dramatically. This trouble I have with focusing, it has been called out.

My usual tactics aren't enough. I give myself enough time to get things done, I keep my days free enough. So mostly I spend a lot of time saying "I'm going to do homework" and failing to get it done. I've got the organization part down. I keep everything in one notebook so that nothing gets lost (papers that accumulate throughout the quarter are admittedly everywhere by the end, but I can usually find what I need, and the notes stay in one place), and Google Calendar has been incredibly useful for sending me email reminders to let me know when my homework is coming up due.

It's not enough, though. There comes a point where one must sit down and focus. Everyone else that I know, when they devote long chunks of time to sitting down and studying, they sit down and they study. Me? I sit down, and I doodle. Or I write, but not about homework. Or I voraciously browse MetaFilter, at least until I turn the Internet off. Then I work on it for ten minutes, feel victorious after accomplishing a sentence or a paragraph or an idea, and wander off to feed myself or find some other distraction. And I hate a completely sterile environment. There has to be, at a minimum, food, and room to sprawl. I work really really well when there are people with me who are concentrating on their own work, and who I can chat with briefly, and then we both go back to our own thing, but even in those instances, they manage to accomplish thrice as much, for my thoughts, they wander. That sort of study buddy is hard to come by, and not a practical solution.

I really want to keep doing it my way. I want to struggle through school on my own. It's really hard for me to be getting these grades, but I try not to let it get me down, and mostly I'm successful in that.

Here's the thing. I want to be able to go to grad school. In order to get into one of the two grad school programs I am interested in, I need a 3.0 GPA for my last two years of school. Right now I'm struggling to stay above a 2.0. I plan to stay an extra year so that I can bring my grades up, but I need to be changing my habits right now. And I'm practically at my wit's end. (P.S. I enjoy going to school.)

I'm pretty biased against 'fixing' problems with medication. It doesn't seem like a long-term solution. Especially since, according to Wikipedia, Ritalin is pretty similar to Cocaine, and has a list of side-effects a mile long.

What am I missing? The Internet (and my friend last year) say it isn't a matter of willpower, it's a matter of chemistry. Am I wrong in trying to willpower my way through this? If Ritalin, why is that your opinion? If willpower, what new tactics do you suggest I take?

I plan to go talk to a school doctor, but I would like to have sorted out my own ideas and opinions better before I go. Thanks for your help!
posted by anonymous to Education (17 answers total) 25 users marked this as a favorite
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posted by meerkatty at 11:51 AM on June 14, 2009

I had always assumed that when I finally got around to talking to my doctor about A.D.D., he would prescribe Ritalin. That was not the case. After a drug that didn't work so well, we wound up with Adderall. It's been a very useful thing, giving me the impetus to actually do some of the stuff that I kept on saying that I wanted to do, the stuff I kept on promising myself that I'd develop the willpower to do. There's a few different meds out there.

Before going to the doctor, I spent 5-6 years telling myself..."Hey, I should really go to the doctor and talk to him about this A.D.D. thing." But there was all the paperwork, and the appointments, and the insurance, and I couldn't get my act together for a long long time.You don't sound like it's been as pressing an issue, so that's cool.

Part of the thing that I've tried to do with my newly found impetus is develop a living routine that works for my life and personality and interests. That way, at some point, I can ease off of the meds and see how it goes if I stick to the routine that I already know works for me (with doctor's assistance).

It sounds like you might be worried about losing the A.D.D. parts of yourself, because you like yourself, and you feel like those A.D.D. traits help make up the interesting person that other people like. In my experience, I didn't lose the personality stuff. Maybe I did a little on the first failed prescription, where I felt a leeeetle bit like I had rocks for brains, but the only thing I've really noticed since I reached a healthy dosage is that I do a lot less stream-of-consciousness writing. If I write something, I tend to be able to structure it more. And somehow that's lead to me doing a lot more complex visual art, which I had always sort of done but not totally been able to follow through on.
posted by redsparkler at 11:53 AM on June 14, 2009 [2 favorites]

I'm 32 and was recently diagnosed with ADD. Through much of my life a few people thought I may have had it, but I never went to the doctor for it. So in a way, I have adjusted around it for most of my life, although not with the same knowledge of having it as you had.

Looking back, based on the benefits I get now I do wish I was diagnosed back in highschool. For example, the subjects I was interested in I excelled at (math/science), subjects I didn't care that much about I didn't do as well. A similar vein lasted through college, although since I went to an engineering college a large percentage of my classes were things that interested me so I could stay engaged. Another aspect that I had a hard time with was doing "busy work" - such as regular homework. Usually my grades suffered the most (even in subjects I liked) when a large portion of the grade would be based on regular homework. So, looking back if I had medication for ADD back then, I have no doubt I would have been a 3.8-4.0 student based on what typically lowered my grade.

When I started in the work force, I initially did consulting for a few years, and the high-energy and constant changes in projects helped me stay focused on what I needed to - so I didn't notice it much there. But, I've seen the ADD impact my current job where I have been there for eight years. At first, it was like consulting because I was helping build/expand something new. A few years ago I started getting really bored at work - it was very difficult to do the day-to-day "boring" parts of my work, and it usually wasn't until there was a crisis or I had procrastinated so much and put under a deadline did I feel I really performed well. For the regular, "Office Space"-like job that I have, it was hard to really fit in and be normal until now when I'm on the medication.

Since being diagnosed, the medication has helped me immensely. For reference, I am currently taking Focalin XR. I am without a doubt more focused and productive at work. Also, my doctor specializes in ADD stuff - and it wasn't just a "here's some Ritalin, and here's the door." He initially prescribed me two different meds (Vyvanse and Focalin), and then we upped the dose one level at a time for each until I found not only which med worked best, but which dosage, too. For me, Vyvanse sucked ass - it did its job, but I crashed like crazy when it wore off and was very , very irritable and angry. Focalin, on the other hand, worked great for me. My doctor was also anti-generics for ADD. The main reason is the generics don't have to be as accurate in their formulation versus non-generic as far as the stated dosage on the pill. Since the ADD meds are usually so fine-tuned per person, this type of variance in strength can really effect the dose for ADD meds. He doesn't have the same issue for most other generic meds, though. In the end, this means that I do pay more out of pocket for things - both Vyvanse and Focalin XR are non-generic. Then again, I can usually go +- 5mg on my Focalin XR without too much detriment, and that's about 20%.

From my experience, I would go back to medication if you can. I don't feel like I've changed, but rather I have just improved all the other things in my life that were half-assed due to being so uninterested or not caring about. The "quirks" that I would attribute to my ADD (for example, constantly switching hobbies), are still there...but augmented in a way that just makes them better or not so manic.

I, too, had reservations about meds as well. Part of the reason I was probably never diagnosed at a younger age is due to family being anti-ADD and meds for that sort of thing. In some ways, you are definitely right - the ADD meds are stimulants, like cocaine. From my point of view, there's a lot of demonization in our society about most recreational/illegal drugs when compared to how prescription meds are shilled by pharmaceutical companies. Heck, even the ADD meds are Schedule II and a pain in the ass to get prescribed, filled, etc compared to other types of meds. In the end, though, it worked for me, and so I don't feel about about using it regularly. I get a lot done now - at work, at home, everywhere.
posted by JibberJabber at 12:17 PM on June 14, 2009 [3 favorites]

Another thing to add - my doctor suggested this book as well: "Time Management for the Creative Person" by Lee Silber
posted by JibberJabber at 12:27 PM on June 14, 2009

For instance, my short attention span: like the way I skip a conversation from one topic to the next. I feel like, if I'm bored with the conversation, or if the topics relate in my head, why not?

Why not? Consider whether it might be nice to be able to listen to your friends and actually converse with them, instead of flitting away from the subject they're talking about without engaging.

It used to be that a large part of the working population indulged every hour or two in a drug that works quite well as a treatment for ADHD, without any need for a prescription. That drug is the nicotine in cigarettes. Unfortunately, nicotine has an high rate of deadly serious side effects, and the usual drug delivery methods for nicotine are so dirty that they supply considerably more lethal side effects of their own. Prescription ADHD medication is tremendously safer and better than the old non-prescription self-treatment, in spite of that list of side effects you read. As long as you take it in only safe dosages, it's a vastly different experience from cocaine. You might not like the first medication your doctor prescribes, but another one might suit you just fine.

Don't dismiss medication until you've tried it again as an adult. See a doctor, try it out, and then you will be able to make a fully informed decision. If you're worried about not being yourself, some medications can be taken during class time and study time, leaving you unmedicated the rest of the time.
posted by Ery at 12:32 PM on June 14, 2009

One thing that I found out when I started taking ADD meds is that many of my coping techniques for anger were based on my ability to get distracted easily. That is something that your doctors may not mention, so be aware that you may need to find new techniques for dealing with things that upset you.

However, the medication has made a huge difference for me.
posted by slavlin at 1:00 PM on June 14, 2009 [1 favorite]

How is "willpower" working out for you?
posted by LittleMissCranky at 1:02 PM on June 14, 2009

I think it's interesting that you have put this forth as a "willpower vs. medication" thing; really, it's not that kind of either/or situation. You may as well ask: "I need to dig a hole. Should I use a shovel or dynamite?" The answer is going to ultimately depend on how big you need the hole to be, and what's more, even if you do need the dynamite, you're still going to need the shovel, too.

Medication for any kind of mental disorder isn't something that can be used on its own. When used correctly, it is a tool that is only one part of a larger strategy. It can sometimes have harmful or undesirable side effects (just like dynamite!), and so it's better not to mess around with it if you don't need to. But if (and only if) it's the right tool for the job, there's no shame in using it carefully and responsibly, under the guidance of a good doctor.
posted by Commander Rachek at 1:21 PM on June 14, 2009

You should at least see what it's like to be on the right medication before you make a decision. None of the ADD medications that I know of are long-term commitments if you don't want them to be.
posted by The corpse in the library at 1:43 PM on June 14, 2009

Do the meds. Seriously. For me getting on Ritalin was nothing less than revolutionary.

My backstory is very similar to yours: did Ritalin as a kid, then went off it as a teenager/adult. Didn't even remember being on it - must have been around 4 years old, maybe 5?

But my adult life was fraught with problems from being undiagnosed - relationship trouble, job trouble, didn't finish college trouble. I always just chalked it up to "being creative" - I'm an actor, a DJ, a poet, all the usual suspects.

BUT...I was also pretty damn miserable most of the time. People who got to know me well knew I was a total flake and wouldn't follow through on things. I was always one of those people who kept coming up with new versions of themselves, new projects, new ideas that went nowhere or died in medias res when I'd pick up something new.

So, finally, after one divorce, and too-many jobs later, I got on Ritalin as an adult, fairly recently actually (within the last several months). Everything has changed.

I can focus now, and track conversations. I'm more patient, more directed, more active. I can follow through on everything I put my mind to, and take new projects on and fit them into a schedule. I'm being seen more and more as a leader in my community and a go-to type of person for all manner of things now.

Don't think you can' "willpower" this out. It's a chemical malfunction in your brain that is very cheaply and instantly remedied. Give yourself the chance to experience your life without constant distraction and see where it leads.

I guarantee you it's worth it - and you won't lose the "creative personality" parts of your self at all - just the opposite. You'll find a million and one achievable projects to put them towards that will bring enormous amounts of happiness and fulfillment into your life.

Don't cheat yourself - get with a good doctor and start living a bigger life.
posted by Lipstick Thespian at 2:30 PM on June 14, 2009 [3 favorites]

Try to will yourself not to hear an ambulance go by, sirens blaring? If you're like me (and it sounds like you are) not only do you hear it, you put a lot more processing into the observation than most people do. If there were sabertoothed cats running around, we'd be the ones who lived. As it is, there aren't any sabertoothed cats. There's a lot of low stimulus mental work that people want us to do, and WILL YOU PEOPLE SHUT UP! I'M TRYING TO THINK HERE! AW CHRIST - THERE'S THAT DAMN AMBULANCE AGAIN!

Er, anyhow, once you've gotten to a point where you realize your distracted and try to willpower it away, it's too late - you're already distracted. Having to do attention span damage control every minute or three is never going to compete with someone who just filters and dumps their environmental noise before their higher brain functions even catch on that it's there. Well, at least until a sabertoothed cat shows up.

Is Ritalin (or whatever) a long term solution? Well, you pretty much have to take it every day you think having an attention span might come in handy, but I've been doing that for the past few years and it's worked for me.

Obviously, you need to pay attention to side effects, particularly the common ones. As for some of the other, I'm not going to dump a long boring paragraph on pharmacokinetics on you, but you wouldn't say carbon monoxide is pretty similar to oxygen, right? The "it's like cocaine because it occupies the same binding sites" line of reason is exactly like saying carbon monoxide is similar to oxygen.
posted by Kid Charlemagne at 2:32 PM on June 14, 2009 [1 favorite]

I was going to comment with my story, but Lipstick Thespian covered it pretty well.

I recommend Driven To Distraction, as well.
posted by elfgirl at 2:40 PM on June 14, 2009 [1 favorite]

For instance, my short attention span: like the way I skip a conversation from one topic to the next. I feel like, if I'm bored with the conversation, or if the topics relate in my head, why not?

Please consider that, for those of us who are not ADD/ADHD-having folks, this conversational "style" can come off as really rude or dismissive, and mostly isn't very fun. The person or people you're talking to may not be bored with the topic or the direction it's going, and may not appreciate the change.

Good luck.
posted by rtha at 3:01 PM on June 14, 2009 [1 favorite]

I was diagnosed as a child back in the days when it was called hyperactivity and considered a behavior problem. I was very briefly on Ritalin at age 8 but it made me into a zombie. That was probably due to an over prescribed dosage which was common in those days - so don't be overly fearful of that happening to you if you decide to try meds.

My parents thought that they were dealing with a behavior problem. They told me that I had the potential to be the worst behaved child in the room, but I wasn't going to be. (In writing that sounds mean, in practice it was quite lovingly delivered.) Starting very, very young we worked together on coping techniques. Many of these are the cornerstones of my control over my ADD today.

Admittedly, mine was a fairly difficult case of ADD to manage. For reference, I got diagnosed in the 70's which was well before diagnosis was common. I made steady improvement in focusing , but didn't fully get my act together until my mid 20's. Now it's a nuisance, but I can control it. If I'm frittering away the hours, sometimes that's okay and sometimes it's awesome.

I would not consider medication now. Not because it's a bad choice, but I feel that I have the tools to manage it. When I struggle with managing my ADD I look for the environmental or emotion causes and address those. In many ways, it's an important feedback loop for me.

Good luck whatever you decide to do.
posted by 26.2 at 3:02 PM on June 14, 2009

How is "willpower" working out for you?

This is well said. I think it's ironic that people with ADD are seen as lacking willpower. Actually, we have extraordinary willpower. That we're able to accomplish much of anything at all despite our minds pulling us in a million different directions all the time requires a shitload of self-discipline. Other people can sit down and work more easily because IT REALLY IS EASIER for them. They don't spend hours pulling themselves together to struggle through ten minutes of productivity, because they don't have to! That's why you have ADD and they don't.

There's this idea in our culture that when treating psychological disorders, we must take the absolute longest, most arduous route possible, or it somehow doesn't count. If someone chooses to try medication, it's a "quick fix," like you said - it's like cheating. So not only are you burdened with the disorder itself, you've forbidden yourself from the most effective means of treating it. Coping mechanisms help, yes, but after a certain point they're not enough. I see this in my mom and it drives me crazy. Her house is a mess, she can't concentrate on conversations we have, and she still does that thing where she devotes an entire day to "cleaning" or "getting things done" and by the end has nothing to show for it. She has been doing this for SIXTY YEARS.

Especially since, according to Wikipedia, Ritalin is pretty similar to Cocaine, and has a list of side-effects a mile long.

Wait till you look up Adderall, which I'm on. It's not "pretty similar" to speed - it is speed. Specifically, it's a mixture of amphetamine salts. Extreme cases of ADD are actually sometimes treated with a drug called Desoxyn - aka methamphetamine.

I work in a research lab that runs studies on potential treatments for methamphetamine addiction. I've talked to hundreds of meth addicts since I started working there. There is so little similarity between my Adderall use and their meth use that it's like comparing aspirin to heroin. Suffice it to say that the main distinction between me and our research subjects is that my amphetamine use improves my life; their amphetamine use ruins their lives. You know what ruins my life, or at least brings me untold misery? My untreated ADD.

If you go on meds, life won't suddenly be a sunny day and a field of wildflowers. You'll still need willpower, you'll need to unlearn old coping mechanisms and learn new ones, you'll need to come up with ways to outsmart your scatterbrained self. It's not a cure. Let me put it this way: for me, without meds, I was like Sisyphus: I'd use all my strength to push a stone up a mountain, but no matter what, it'd roll back down. I'd spend all my time pushing that same effing stone up the same mountain, over and over again, because I didn't know how else to do it, or what else to do. With meds, when I push the stone up the mountain, it still requires all my strength - but, amazingly, most of the time, it stays there. It doesn't roll back down. That doesn't mean I'm done. It just means I can finally move on to another stone and another mountain.
posted by granted at 8:39 PM on June 14, 2009 [2 favorites]

granted: "You'll still need willpower..."

Yup. On ADD medication it's possible to use all your new skills of concentration and laser-like focus to spend the morning reading AskMe really well.
posted by The corpse in the library at 6:53 AM on June 15, 2009 [6 favorites]

I used to take Ritalin but hated the way it sped me up. I tried Strattera for awhile and I really think that it helped me focus. It also did not have any side effects (for me) other than some nausea when I first started. Ultimately I have decided to handle my ADD drug free. I've learned some meditation techniques to help and bought noise-reduction headphones to shut the world out when I need to focus. It's not perfect but ADD drugs are expensive and my insurance won't cover the good ones.
posted by Raichle at 10:21 AM on June 15, 2009

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