I can't really take my 3 weeks of sick leave at once...can I?
October 22, 2009 7:19 AM   Subscribe

The trial-and-error method of ADHD drugs: I am already afraid of screwing up my job and I am concerned about all these side effects I read about people having. I can't spend 3 months spaced out or whatever until I find the right drug cause then I'll REALLY screw up at work. Can you help allay my fears or tell me how you and your psychiatrist and/or therapist worked this out?

I can't believe I'm not posting this anonymously, but I wanted to be able to reply more easily than I can with an anon post.

Anyways, after working on my anxiety/depression issues for almost a year, I am SO MUCH better now, without any medication. It was just a lot of things falling into place. My most recent questions had to do with moving and life direction and I see now that it was just more of the same flittiness I've had my entire life and is probably the ADHD. But that's not really what I want to ask here.

I am in a decent job. It is ok, my hatred of the mundane aspects aside. However, I know that my problem with follow-through is a big issue. I never really cared at any other job, because it was either customer service, or I was in college and changed jobs almost every year due to needing to schedule classes. But I need to have A job and we know how the job market is right now.

When I go back and read the posts on here tagged with ADHD, people are often saying "straterra/vyanase/adderall/ritalin made me so spacey/tired/crazy/whatever". I CANNOT go through months of being worse than I am now. My position requires me to be here during the open hours of the office, so working PT or from home is not an option, it's already been discussed in a different circumstance. I'm here or I have no job.

I am meeting with a psychiatrist pretty soon. He and I worked together almost a year ago before we decided to take me off meds entirely but I wanted some personal experiences here. My GP at the time (I no longer see her), over two years ago, had put me on adderrall because she thought I was ADHD, but it made me feel crazy after a little while. I think maybe the dosage was wrong and I was having some severe severe depression at the time. She also had me on Lexapro and maybe that didn't act well with the Adderral. Anyways, I figured I couldn't be ADHD because of the effect Adderrall had on me.

Wow, this is long. I guess I'm trying to answer why this hasn't come up before as a diagnosis until now with my psychiatrist and therapist. Basically, they didn't konw what was wrong with me and were trying to help me manage anxiety/depression, which we did a really good job at. But the other ADHD stuff remains, and I meet all the criteria for it in the DSM according to my therapist.

tl;dr: How can I deal with trial-and-error drug testing that may make me worse at work than I already am? I am afraid to tell my boss. How have you adult-diagnosed ADHD folks dealt with this?
posted by sio42 to Health & Fitness (26 answers total) 8 users marked this as a favorite
I told my boss that I was in the process of changing medications, and asked for his patience as I made the transition. Then, once I had gotten to a medication that worked, I let him know that the transition was over.

(He knows about my ADD however, so though I didn't specifically say, "I'm changing my ADD meds," he probably knew that's what I was talking about.)
posted by ocherdraco at 7:24 AM on October 22, 2009

Not the question but the meta-issue: ask to have this post anonymized tomorrow, or the next day, or whenever you are done replying.
posted by rokusan at 7:32 AM on October 22, 2009

I'm going to cut and paste my usual response:
Absolutely insist on the use of a CPT (Continuous Performance Test) or a TOVA (Test Of Variables of Attention) in titrating your medication to an appropriate level. Basically, these computerized tests (rather than personal inventories, questionnaires, etc.) test your attention (which has multiple dimensions to it) in an abstract manner.

By adjusting the type, amount, and release pattern of your medication in conjunction with these tests, you can find the best bang for your buck. Too little medication and you're not helped. Too much and you have side effects. These tests can help you find the top of that inverted-U curve and stay there.
posted by adipocere at 7:39 AM on October 22, 2009 [7 favorites]

The great thing about speed is that it works pretty quickly and it wears off pretty quickly. If you're not mixing it with anything, chances are you'll know pretty quickly if it's working or if it's making you sleepy or spacey or whatever. Having a psychiatrist instead of a GP and feeling better in general will help you find the right medicine with a lot less guesswork and confusion.

Also, your experience of being on adderall while on lexapro and really depressed sounds really sucky and scary. Sorry.
posted by kathrineg at 7:46 AM on October 22, 2009

Also, I had a total of about two bad weeks while I was changing dosages, but it wasn't all attributable to the drugs. Things you should do that I wish I had done while I was working to find the right ADHD meds:
  • If you're taking a stimulant and moving to a higher dose, don't drink caffeine. Since caffeine is also a stimulant, ingesting it with a stimulant medication will just keep you up all night. (Even if you're the kind of person who used to drink 4-5 sodas a day.)
  • Get enough sleep. This doesn't mean eight hours. It means sleep enough that you don't need an alarm to get you out of bed. That might be nine hours, or even ten.
  • Have someone you can confide in about your work with on a daily basis. Tell them about all your anxieties: what's not getting done, what's stressing you out. The idea is that talking to someone outside work gives you a chance to vent, and can help you plan how to tackle the follow-through, but they don't add stress since they aren't a co-worker, and your unloading to them doesn't add to your vulnerability at work.
  • If you ever think you need to change how you're taking your medicine, tell your doctor right away. If the current dose seems like too much, don't return to a lower dose or stop taking your meds. Call your doctor.
I didn't do any of these things, and those first two weeks were absolutely horrible (both in terms of how I felt and what I was getting done at work), but once I realized that you have to make other changes in your life besides just the medication in order for the medication to be effective, things got way better very fast.
posted by ocherdraco at 7:47 AM on October 22, 2009

And yeah, if you can get those tests they're awesome, but a lot of people do okay without them, so even if you can't get them you can still find a med that works.
posted by kathrineg at 7:47 AM on October 22, 2009

Oh God yes don't take caffeine. I was a 4-cup-a-day coffee addict and drinking it in combination with my meds made me feel like I was crawling out of my skin. Even one cup, brrrr. Awful. So avoid it.

And remember to eat, if you forget, that will make you cranky too.
posted by kathrineg at 7:49 AM on October 22, 2009

A couple of things that may allay your fears:

1. Assuming you're prescribed something like Adderall or Ritalin, you will first be given the immediate release tablets which exit your system faster (my psych said they last about 4 hours, but YMMV). A good doctor will start you at a low dose and gradually move you up. If there seems to be side effects that won't go away once your body adjusts, then they will adjust or discontinue that drug altogether rather quickly.

2. Start on a weekend, or even better a long weekend. That way, if you are having an adverse reaction, you will be home and not dealing with co-workers or bosses.

3. I'm actually on Adderall for depresson not ADD or ADHD, so my experience on it probably differs a lot from what yours might be. I had similar concerns about it affecting me professionally, however, so this may help. I was worried about coming across like I was sped up, high as a kite, manic, or something along those lines, and no one wants to be suspected of illegal drug use or a severe mental health issue at work. Because we did things gradually, I didn't have any of these reactions. At most, it was like I had a strong cup of coffee. I had moments where I felt I was processing a bit quicker than normal, but that passed as my body adjusted, and no one noticed them. It was all internal and calibrated properly pretty quickly (over a course of days, not months).

Similarly, when I was prescribed Zoloft, that did turn me into a spaced out, totally stoned, incapable of doing much of anything individual. People noticed my spaceyness, but chalked it up to me being tired. So, my side effects were manifesting both internally and externally. They also seemed to be getting worse, not better. I knew after a couple of days that this was most definitely not the drug for me, and went off it after 8 days or so. From a medical perspective, ideally, I would have stayed on it longer, but I know my body pretty well and am usually pretty accurate in my assessment about medications and me. If something isn't working and the side effects are that pronounced, then there is no reason why you can't (gradually) stop taking that medication and try something else.

4. Perhaps most importantly, psychs are highly trained, extremely knowledgeable people. They also understand that some side effects people might be willing to live with (dry mouth, decreased appetite for example), while others people do not think the benefit outweighs the negative side effects of the med (drastic changes in personality, losing hair, gaining weight, for example). Be candid with your psych, don't be afraid to ask questions, and listen to what your body is telling you. As long as you are working with a professional, you'll be able to work it out without losing your job or compromising your health.

Best of luck, and please feel free to email me with questions or if any of this didn't make sense.
posted by katemcd at 8:05 AM on October 22, 2009 [1 favorite]

Nthing not to mix your stimulants. Adderall + caffeine = recipe for freak-out.

The great thing about Adderall is you can break the 10mg tablets in half and ramp up very slowly, adding 5mg a day to your dose until you feel focused, and can drop back by 5mg if you start feeling uncomfortably "speedy."

My biggest tip: Always eat something right before you take a dose. The drug will release into your system at a more regular pace than if you took it on an empty stomach. Also, it's an appetite suppressant, so you might forget to eat if you take it without food, then feel like crap later not because of the Adderall but because you forgot to eat.
posted by Jacqueline at 8:13 AM on October 22, 2009

The great thing about Adderall is you can break the 10mg tablets in half and ramp up very slowly (Jacqueline)

Keep in mind that this does not apply to Adderall XR, the extended-release version of the drug, which comes in capsules, not tablets.
posted by ocherdraco at 8:29 AM on October 22, 2009

I actually got 5mg tablets! Which isn't that much.

Also, the short dose is good but when it wears off you may get heart palpitations, which freaked me out the first time I experienced them. The extended release gave me fewer problems with that. The palpitations also went away after a week or so, and after I cut out caffeine.
posted by kathrineg at 8:30 AM on October 22, 2009

Yeah, you can get 5mg xr capsules too, by the way. Seems from this thread that a lot of shrinks don't bother with them but I found them effective for a while; once I got used to them I moved up to 10mgs just by taking 2.
posted by kathrineg at 8:32 AM on October 22, 2009

everyone: thank you.

i definitely feel much calmer about the whole thing now.

as it turns out, the psychiatrist i used to see cannot take any new patients right now, so i'm trying to get into other places, but probably won't get to see someone for a while.

my family doctor is going to have me try the adderall and i have an appt tomorrow with him.

thank you so much for all the helpful advice about eating with it and cutting out all caffiene. i don't drink tons of coffee, but i do sip throughout the day. i probably drink only 1/2 to 1 cup per day total and I don't very often drink soda, only a couple times a month if that.

katherineg - i think i will ask about the extended release. when i was on adderall originally, i did end up getting weird heart things which didn't help my anxiety at all (heh). even tho i'm nowhere near as anxious/depressed as i used to be, keeping any worries like that a minimum sounds awesome.

and in regards to the dealing with work question - i'm guessing from responses it wasn't much of an issue? like maybe it just took some getting used to but mostly, you just found that you were able actually focus on things other than mefi and do work? (haha, but seriously) maybe i'm piggybacking on this...it's just so weird and releiving and overwhelming all at once from many different aspects. i know meds don't "fix" things, but i guess from what i've read, once i'm on the meds, they might make it easier for me to fix the things i want to fix.
posted by sio42 at 8:48 AM on October 22, 2009

Yes! The palpitations freaked me out, I was really really upset by those, especially because I used to get panic attacks.

If you take the XR take it really early in the AM--I have a friend who wakes up at 7am, takes her adderall, goes back to sleep, wakes up for real at 8am. It helps her do her morning routine, too. I have another friend who won't take it if he wakes up after 9 because it lasts too long.
posted by kathrineg at 8:50 AM on October 22, 2009

Work wise, I do a job that probably isn't similar to yours at all (I'm a nanny), but it did help at work because I am able to do a lot more, much more efficiently. I also have a lot more patience because I can focus on the present moment. I almost got fired from my job for losing things and, one time, leaving the keys in my employer's apartment door. So I worry about that a lot less.

I think I said in another thread that I used to always feel like I was in a dream where I would be trying to run somewhere and it wouldn't work because for some reason I couldn't run...now I feel like I can accomplish things that I want to accomplish, if I work hard, because I'm not going to forget something little and stupid.

Of course I still lose things and I'm generally not organized, but now it feels like if I work on that I have a much better chance of doing what I need to do.

Oh, and I made appointments and went to the dentist! Multiple times! And I was only late once! Having the medical help is slowly taking away the stress of having so many little things undone that just build up and add up over months and years to a million little anxieties and disappointments.

I feel like I have more hours in the day.

People understand my MetaFilter comments much more easily when I'm on my meds. It's a little funny, really, how much better I am at writing and making coherent paragraphs.
posted by kathrineg at 8:58 AM on October 22, 2009

And please don't worry about not being anonymous, metafilter seems to be full of people with the ADD and it's good to know people who can talk to each other about this stuff. I've never had any negative reactions from any mefites and, really, even in real life I haven't had experienced any negative feedback from friends. Three of my good friends told me they had ADD too! What a surprise. I think we tend to cluster together.
posted by kathrineg at 9:02 AM on October 22, 2009

Regarding your work situation, I would let your boss (and HR) know that you have some medical issues going on. You do not have to tell them anything specific - you can just just tell them that you have a medical issues and you are starting a new medication, and that it might make you a little spacey for the first week or two, or you might have to leave early / call out sick, but you expect to be back at full working capacity within the next couple weeks.

Then, hopefully you won't need to call out / leave early, and you won't end up spacing out or whatever (I've never taken ADD meds), but if you do, your boss will be much more likely to be understanding. I have [entirely different] medical issues of my own, and my employers / professors have generally been very understanding and have not asked me questions when I have been vague. They have all appreciated a heads-up in advance, so they know that what is going on is legitimate, not an excuse after the fact.
posted by insectosaurus at 10:00 AM on October 22, 2009

Regarding work, I told my boss all about my ADHD stuff. I'm lucky to work in a very supportive environment - they're really trying to help me do my best work (i.e. accommodating my requests about the type of work I do each day - giving me a "break" after an attention-intensive task with one that is slightly less demanding).

I started on Ritalin this summer, the SR type. I'm a student (class ~11 hrs/week, work ~24hrs/week - yaay for hyperactive energy!) and I found that the Ritalin effects weren't lasting as long as I needed them to, taking it 2x/day. So, my psych tried me on Biphentin (a new-ish sustained release methyphenidate - I don't think it's marketed in the States). The day that I took it was...interesting, to say the least. I was seeing the Disabilities Counsellor at my school, and I turned into a bad caricature of an ADHD person - going off on wacky tangents, and having a really hard time reining myself back in. I did not space out, though I did crash hard that afternoon (in lecture, could hardly keep my eyes open). Called psych - he figures that, for whatever reason, my body doesn't metabolize Biphentin the way the makers intend it to. So, I've been taking Ritalin SR 3x/day, and I'm seeing him again tomorrow - maybe trying Concerta? Trying to remember 3 pills/day is a pain in the behind.

On the caffeine note, I don't have issues with sleep when I drink diet cola and take Ritalin. But, I can take a Ritalin at 7:00pm, and still fall asleep by 11:00/12:00 (I personally subscribe to the nervous system under-arousal theory of ADHD, at least for myself ;).

I would suggest getting samples if you can - the amount of Biphentin that was prescribed to me cost ~$150, I think - I'm lucky that I have a drug plan. If I had been out that much for a medication that did not work at all, *and* that wasn't covered, I would have been really really annoyed.
posted by purlgurly at 10:35 AM on October 22, 2009

thanks for idea about samples. i have pretty good coverage through my job, so i shouldn't really be out much money for meds.

i'll probably just start with the adderall until i can get into see the psychiatrist and get those tests adipocere mentioned. at least i know how that makes me feel and that i can kinda know what to expect for now.

i'm hesitant to say anything about having a medical situation etc because i don't want them to find a reason to let me go. i'm not doing THAT badly and i know that don't want to train someone else to do this stuff. but i just feel like i've not been giving 100% and having a conversation where someone actually tells me they feel like that too will only make me feel worse right now.

posted by sio42 at 12:19 PM on October 22, 2009

Just a data point, I would rather call in with a fake flu than tell my work that I have ADD. YMMV.
posted by kathrineg at 1:02 PM on October 22, 2009

I know how you feel about having your fears confirmed. As long as you feel like your situation is generally supportive, however, I think it has the potential to actually strengthen your position.

My bosses have seen me at some real high and low points, including a particularly bad spell when my medications were really going haywire. I HAD to sit them down and talk about it. They wanted to take some of the burden off of me, but as someone with ADD, that's the absolute worst thing they could do; I function much better when busy. When we've sat down and talked since then, they've mentioned how pleased they've been to see me respond to the challenges I've faced. I think it's a big reason that they've given me additional opportunities: they know I'm more likely to take them seriously and be honest than just blow them off or hide my difficulties.

Self-awareness is an underrated but extreeeeemely valuable trait in an employee. It's made life around here a lot easier.
posted by Madamina at 1:11 PM on October 22, 2009

i'm hesitant to say anything about having a medical situation etc because i don't want them to find a reason to let me go. i'm not doing THAT badly and i know that don't want to train someone else to do this stuff. but i just feel like i've not been giving 100% and having a conversation where someone actually tells me they feel like that too will only make me feel worse right now. (sio42)

You do know that this kind of attitude is textbook ADD, right? Feeling that you aren't giving 100% (even if you want to) and that if others find out, you'll be in trouble, I mean. Have you read Delivered from Distraction by Dr. Edward Hallowell? If you haven't, do.
posted by ocherdraco at 8:08 PM on October 22, 2009

haha! i just picked up Drive to Distraction last evening at the library.

that list of adult adhd symptoms reads like my diary, if i could manage to keep one.

just reading through all those stories, about kids and adults alike, i saw SO much of myself.

i can't believe this just hasn't come up before. ugh.
posted by sio42 at 5:48 AM on October 23, 2009

and thanks madamina - i think i'm probably doing better than i think i am. your comment makes a lot of sense. i might wait until after i seem to be doing better to have a talk tho. hearing back that i've been seen slacking or whatever would just kill me right now.

i am glad to hear from the general tone of the thread that bosses/work environments seem to be pretty aware/sensitive etc of the adhd thing. i guess it's more prevalent these days so it's not looked at as such a "crazy" thing.
posted by sio42 at 5:50 AM on October 23, 2009

FYI Driven to Distraction and Delivered from Distraction are two different books. The latter has a lot more information about actually dealing with ADD—the first one was more about the existence of ADD, as not many people knew about it in 1994.
posted by ocherdraco at 12:38 PM on October 23, 2009

ha! that was the ADD at work i guess :-)

i'll check out the Delivered as well.

i got started on some Adderall XR 20 mg over the weekend and it seems to be working very well. my boyfriend was looking thru Driven to Distraction and had looked up about ADHD online and also thought that exactly me. so we're both pretty happy i'm not just a lazy procrastinator :)
posted by sio42 at 5:41 AM on October 26, 2009

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