Yup, ADD/ADHD. What now?
April 2, 2010 8:48 AM   Subscribe

Ok. I've read the epic ADD/ADHD thread, and it read like my biography. What do I do now? When I go to a doctor, what should I expect? What is your experience with medication?

(I'm fairly terrified. I hate the thought of being medicated, but the comment "I spent 32 years not living up to my potential and I can't help but think a lot of that time was wasted." is haunting me. I'm just curious about what happens next.)
posted by nevercalm to Health & Fitness (10 answers total) 20 users marked this as a favorite
Here's a question I asked about experiences with ADHD medication. You'll find a lot of good info there.
posted by ocherdraco at 8:58 AM on April 2, 2010

You and me both nevercalm. My experience trying to find a psych in NYC, who specializes in adhd, AND accepts Cigna has been very disheartening so far. Do you have a primary care physician or any doc that you like? Maybe get referrals from them. The pyschs gave me a quiz, to see which symptoms I had. It was one of the same exact quizzes that you can take yourself online.

I was put on Wellbutrin by my GP for depression. On the plus side I was able to experience focus in a way that was a revelation to me. On the down side, it seemed to make me ragey and emotional and I experienced my first and hopefully last panic attack. I stopped taking it.

Several years later I was prescribed Adderal XL and didn't experience anything. So it was switched to regular adderal. I did make things a little more quiet in my head. But the loss of appetite and eventual weight loss was too much especially since there weren't any significant positives. I am still searching.
posted by mokeydraws at 9:21 AM on April 2, 2010

nevercalm, have you read any books about ADHD? Specifically, have you read Delivered from Distraction? If you're the kind of ADDer who can't read long books, at least read Chapter 1. This is the guidebook you need for the first day of the rest of your life.
posted by ocherdraco at 9:26 AM on April 2, 2010

I was leary of drugs too, and it took me a good couple of years deciding I needed the try them out. Two years ago, I was running a side business while working full time somewhere else, and I just wasn't being productive enough for either.

When I went to the doc, they referred me to a specialist (clinical psychologist) for testing. The testing involved a questionnaire and a computer based "reaction test". What they don't tell you is that the "reaction test" actually tests for two kinds of ADD/ADHD: inattentive (typically ADD) and impulsivity (typically ADHD). Interestingly, I showed signs of both, with isn't quite as common as one/the-other.

I'm 27 now, been on Adderal/Vyvanse for about two years now. One thing's for sure, the drugs help, but ultimately you still have a choice regarding what you focus on each day, and starting off on the wrong foot will certainly set you back, because you can focus on the wrong things entirely. That's why it's important for me to plan my blocks of time in advance and use some sort of alert system to know when to switch tasks, as well as have lunch. (Appetite suppression is a side effect, and I lost over 20 pounds because I'd focus too much skipped meals at times.)

Also note, Vyvanse is activated by water (it's a prodrug), so be sure to hydrate plenty if you end up taking this drug. i usually take it with 12-16 oz of water, which works well for me.
posted by purefusion at 9:39 AM on April 2, 2010 [1 favorite]

What ocherdraco said.

My husband and son both have ADHD. We just recently had our son re-evaluated, just to see where we were and if a medication change was necessary. The difference between the results of the first eval and this one was amazing. He's considered to be in partial remission with medication use. That's so huge. It means that his symptoms are managed so well that the ADHD is not negatively affecting his life like it did pre medication. We are considering a medication change, just to get him on a long-acting med (because remembering to take a second or third dose isn't a good strategy for him), but I can tell you as a person living with people who have ADHD, medication has been a godsend for us.

As for what to do now, get a referral to a psychiatrist or an ADHD clinic from your primary care physician. You'll be evaluated in stages, fill out some self-reporting forms and have a talk with a psychologist/psychiatrist. He/she will discuss the results with you and will have some strategies for you to consider next, like behavior modification, talk therapy and/or medication.

Good luck!
posted by cooker girl at 9:40 AM on April 2, 2010

Best answer: I had hit a crisis last summer (June/July '09), and my husband urged me to go see a therapist through my work's EAP program. The night before my first appointment, it suddenly popped into my head - "I wonder if I have ADHD?" (I had struggled for over 10 years with depression). So, I went online and found a short WHO screener for ADHD, and I scored pretty high.

Saw the therapist, mentioned my theory, she said, "Hmm, you sound like another client who was diagnosed with ADD as an adult, seems possible that you have it."

Then I went to my family doctor (I started seeing him at age 26, and had had the depression diagnosis for a long time, so we never discussed my depression in a ton of depth). He asked me some basic diagnostic questions (i.e. whether I was fidgety), and said, "Hmmm. Sounds like a possibility. I'll refer you to a psychiatrist, and we'll start you on Ritalin - if it seems to make a difference, that points to ADHD - if not, we'll look more at anxiety/depression." I've said this elsewhere, but that first day, when I took the Ritalin, it was like I had been living in an impressionist painting without realizing it - it reminded me of the first day I wore glasses when I was a kid, and I noticed individual leaves on trees, and the distinct colours on each side of the leaves.

With the psychiatrist, I had to fill out a bunch of questionnaires before our first appointment, and so did my husband and my parents (theirs was a detailed history form). He took a detailed history from me, and then administered the Brown (?) ADD rating scale. I was diagnosed by him with ADHD-Combined (Inattentive/Hyperactive-Impulsive - having the "combined subtype" is slightly unusual for girls/women, at least according to current thinking). He has been managing my medication since then - initially I saw him once-a-month, and now I'm at once every 3ish months.

I was really lucky in that none of the professionals I encountered expressed skepticism/"shot down" my theory - I've read that some doctors still don't "believe" in Adult ADHD. If you do encounter a negative reaction, I urge you to seek a second opinion. Good luck!
posted by purlgurly at 10:03 AM on April 2, 2010

Best answer: First and foremost, you are treating your ADD. For all the commonality that sufferers have, the important thing is to figure out how it specifically manifests in your life. This is a very subjective thing and crucial to your success.

Some examples:

1) CEOs and entrepreneurs often benefit greatly from ADD, because of the highened creativity and the myraid issues they must attend to quickly; a perfect match for the short attention span. But there are often times that require increased depth of thought or attention and there is where their challenges lie. So these people either delegate such duties or take direct action specifically towards these factors.

2) Some sufferers can have a tendency to operate in both extremes of hypo-attention and hyper-attention: hard to get focused on one task, then once in, very hard to stop focusing on it (at the extreme, some folks even need to be physically touched because they won't hear their names called). They will require methods to alert them to the passage of time, both in order to stop avoiding a task and to come out of a task when it is time for another.

The most important thing about treating ADD is knowing the specifics of how it is reducing your quality of life. Determine the things that you aren't doing but wish you were, or identify those habits or responses you have to everyday things that turn into monumental efforts.

Now, take those specific quality of life factors and turn them into specific goals. Your performance at meeting your goals is how you will determine what works for you. They can be yes/no goals, (e.g. did I get the quarterly project done before the deadline?) or they can be numerical goals (e.g. how many times was I on time to work, how long it it take to get started on a task, how many do-able to-do items were left at the end of the week?) , or they can be qualitative goals (e.g. how satisfied and I with my job, my weekend; what do my friends and family notice in terms of changes?)

Any of your goals will then have measurable criteria to evaluate their effectiveness. Without this, you can be easily overwhelmed or simply in the dark as to what is working. With these, you can not only be in charge of you progress, but easily enlist the help of others in monitoring and supporting your efforts.

Then there is the choice of treatment modality. These basically falls into these categories:

1) physician with meds
2) psychiatrist with meds
3) psychologist/therapist
3) ADD coach
4) ADD support groups
5) DIY through books, web, videos, etc

From this list, you pick the ones that work for you. Usually it is a combination of these. And even within each category there is a trial and error approach to figure out how much (if at all) they are helping. But there is no certainty in effectiveness for any of these before you begin. I believe the best approach is to try what you can based on insurance benefits, available funds and time, personal preference. Then as you are exercising these treatment modalities, keep a month-to-month progress on the criteria set to measure your performance on goals. With this, then you can treat this like a controlled experiment to find out the effective techniques that provide real change. As new challenges arise, alter your experiment to bring in new goals and assessments to track.

Finally, be patient. Some things may help more than others. Like any significant changes in our lives, there will be obstacles and back sliding. Forgive yourself and keep in the fight. Best wishes.
posted by buzzv at 11:12 AM on April 2, 2010 [5 favorites]

I like the answer buzzv gave. Definitely get a professional diagnosis. I'd add that if there are any emotional issues tied in, you are probably going to benefit by talk therapy, though do try to find someone who is well-versed in adult ADD if possible. Talk therapy can be counterproductive if you are working with someone who is unaware of the effects of your disorder, and especially if they disbelieve it exists as a "real" medical condition.

I am doing well with Adderall and Wellbutrin as well as talk therapy, but that's me. I just started some cognitive behavioral therapy with my therapist, though she's sort of new at this. Most of my emotional work has been on my own, but it helps to have someone to talk to, and it's a requirement of the clinic where my psychiatrist works. Very soon I need to find a new job or different way to make a living. That's critical to finding fulfillment. I agree with the recommendation for Driven to Distraction. That book triggered a pretty big breakthrough for me. You might want to pick up the book The Da Vinci Method, sort of ties in with what buzzv was saying about entrepreneurs as well as the hunter-gatherer theory - take it with a grain of salt, because the author is a bit full of himself, but the goal for myself is to do what works for me for a living and in my life and to "exploit" the beneficial effects of my condition, and that's what it's mostly about. You might want to pick it up later on when you feel a bit more grounded - helps with the next phase of life after diagnosis and some therapy, if that's the route you choose.
posted by krinklyfig at 6:07 PM on April 2, 2010

Oh, btw, as you get into this more, you will probably start to notice how nearly every authority on adult ADD strongly recommends daily exercise. This is a very good recommendation, at least 45 minutes or more, preferably in the morning. I invested in an elliptical trainer and use it religiously. Makes a huge difference, if you're not doing it already.
posted by krinklyfig at 6:32 PM on April 2, 2010

Best answer: Something to keep in mind is that there is no one perfect solution for ADD. That's a crucial part I know has already been touched on by some previous posts. My coping mechanisms are totally different from yours, and the next person. Same goes for what helped me.

It's like being part of a secret club, except there's no one single thing that defines why any of us belong there, except some how you know you're fully accepted for who you are.

You are going to be heading down a terrifying path of information, and overwhelming opinions of what to do, and what not to do. This might take some time to figure out. This combination of meds, to that combination of daily changes. Read these ten thousand different books (there are some genuinely important ones, Driven to Distraction is one I strongly recommend), then follow up with this set of daily instructions, exercise too! It's safe to say there is a lot of informational noise out there right now on ADD, some of it good, some of it bad, and you'll sometimes be confused and stuck. Try not to become too frustrated, you just gotta keep on goin' on. There really is that proverbial light at the end of the tunnel. I hate to sound cliche, but it's true.

Medication is also a hugely complex subject. Do your homework, is all I can suggest. Read up on the drugs, it's helpful and should allow you to better explain to your doctor whether or not you are jiving with the stuff. It may take some time to find a good combination of medication(s). Speak up to your doctor, loudly if need be, because (and I hate to say it) some doctors are not listening closely enough. If you need to find a new doctor, do so. Find what works with you, and who works well with you.

You'll have to deal with some of your past, present and future. You'll be forced to admit things you are used to doing aren't good for you. You'll have to forgive yourself at times, and be hard on yourself at other times. You're very truly forging a new path for yourself. You may need to be constantly vigilant towards yourself, and your changes. It's more effort than most people will have to do in a lifetime, but that's OK. Focus on you.

And yet, as scary as it may sound, you'll know when you've found the sweet spot. It'll be like a fog lifting from you, the clarity of a fresh spring morning, or the softening of the thousand voices and ideas in your head to a gentle volume. You'll know it when you can formulate your own analogy for the rest of us. And never forget that you are not alone. There's an army of ADDers out here on the web, all lurking in various places (like here!), and even at local support groups in your area.

Good luck.
posted by bencongdon at 8:17 PM on April 13, 2010

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