ADHD medication
November 16, 2024 1:50 AM Subscribe
Long journey of self reflection and diagnosis later: I have ADHD! What now?
I'm so relieved and glad to have some answers. I have ADHD!
And now I need help thinking about medication, what sorts of questions I need to ask my psychiatrist, just, where to start. It feels a bit overwhelming so I'm looking for someone to break it down for me.
I'm in Australia, in case that's relevant.
I'm so relieved and glad to have some answers. I have ADHD!
And now I need help thinking about medication, what sorts of questions I need to ask my psychiatrist, just, where to start. It feels a bit overwhelming so I'm looking for someone to break it down for me.
I'm in Australia, in case that's relevant.
Best answer: Sorry for the many links - here are some more specific ones you might find useful:
ADHD compensation strategies
How to deal with rejection sensitivity
Autistic and ADHD nervous system and stress response: increasing the window of tolerance
Neurodiversity affirming therapy - what that means
posted by Zumbador at 5:12 AM on November 16 [5 favorites]
ADHD compensation strategies
How to deal with rejection sensitivity
Autistic and ADHD nervous system and stress response: increasing the window of tolerance
Neurodiversity affirming therapy - what that means
posted by Zumbador at 5:12 AM on November 16 [5 favorites]
Best answer: The good news is that you don't actually need to figure this out yourself. Your psychiatrist should have a standard protocol for trialing ADHD medication, including a medication type and dose to start with and a plan for escalating dose, and they'll also know when it's best to try a different med.
They're likely to ask you about your medical history (especially any history of heart issues), mental health history (especially anxiety/depression/psychosis), potentially family history of those things, and the ADHD symptoms that are most troubling you, that you hope to see improving with the medication. You may want to write this info down if you have trouble recalling that kind of thing on the spot. The psychiatrist may use this information to choose a medication class to start with, or they may have a med that they prefer to start everyone on. Psychiatrist appointments are typically very short, efficient, and exclusively focused on the medication, so don't expect to discuss more general ADHD strategies with them (unless things are very different in Australia, I suppose).
For your own background knowledge, you may want to look up the typical side effects of stimulants and common non-stimulant meds, and see if any of those are particularly problematic for you. You could request to avoid a certain med based on that if you want, but you're unlikely to be able to directly request a specific med or dose to start with (and it's going to look suspicious if you do) so there's not much point trying to decide a starting point on your own.
posted by randomnity at 6:25 AM on November 16 [1 favorite]
They're likely to ask you about your medical history (especially any history of heart issues), mental health history (especially anxiety/depression/psychosis), potentially family history of those things, and the ADHD symptoms that are most troubling you, that you hope to see improving with the medication. You may want to write this info down if you have trouble recalling that kind of thing on the spot. The psychiatrist may use this information to choose a medication class to start with, or they may have a med that they prefer to start everyone on. Psychiatrist appointments are typically very short, efficient, and exclusively focused on the medication, so don't expect to discuss more general ADHD strategies with them (unless things are very different in Australia, I suppose).
For your own background knowledge, you may want to look up the typical side effects of stimulants and common non-stimulant meds, and see if any of those are particularly problematic for you. You could request to avoid a certain med based on that if you want, but you're unlikely to be able to directly request a specific med or dose to start with (and it's going to look suspicious if you do) so there's not much point trying to decide a starting point on your own.
posted by randomnity at 6:25 AM on November 16 [1 favorite]
Best answer: Also, the psychiatrist may or may not discuss this with you, but if they don't, make sure you look up all possible interactions with drugs and foods before you start taking it (for example, some ADHD meds have interactions with caffeine, alcohol, cannabis, some cold meds, and vitamin C and foods that contain it). They're also likely to ask you about your current and past use of alcohol and other drugs. If you have any red flags for substance abuse, they will typically avoid giving you stimulants.
posted by randomnity at 6:32 AM on November 16 [1 favorite]
posted by randomnity at 6:32 AM on November 16 [1 favorite]
Best answer: Generally, your Psychiatrist will start by giving you a medication, and then you’ll both take it from there.
My suggestion is keep a log. Take note of how the medication affects your thinking, your mood, any noticeable side effects. Keep track of what you’re taking, and how much.
If you do go on stimulant medication, they sometimes can cause panic attacks in some people. Knowing that it’s nothing but the medication (and maybe too high a dose?) can be helpful here.
You might need to trial a few different medications before you find one that works for you. You may even need to try a bunch, and circle back to a previous one. That’s why having a log is so helpful.
posted by jonnay at 7:22 AM on November 16 [1 favorite]
My suggestion is keep a log. Take note of how the medication affects your thinking, your mood, any noticeable side effects. Keep track of what you’re taking, and how much.
If you do go on stimulant medication, they sometimes can cause panic attacks in some people. Knowing that it’s nothing but the medication (and maybe too high a dose?) can be helpful here.
You might need to trial a few different medications before you find one that works for you. You may even need to try a bunch, and circle back to a previous one. That’s why having a log is so helpful.
posted by jonnay at 7:22 AM on November 16 [1 favorite]
Best answer: Work with your prescriber through the standard protocols. You don't have to decide for them. It can help to put together a crib sheet about the available stimulant options in Australia, though, so that if you have concerns about any of them you can discuss that with them.
I think the common mindset is "stimulants are the treatment for ADHD" and therefore that is what you will do. Stimulants are NOT the only treatment for ADHD, which would be better described as a spectrum or a plot-graph rather than a single disorder. Your doctor will pick a regimen to start with based on how it presents for you in your life.
My ADHD is heavy on the executive function deficits with a persistent - but moderate in presentation, I'm not risk-taking I'm just bored easily - distractibility. I don't really have ANY hyperactive-type symptoms: I don't sit still very well but that's the distraction rather than a need to move, I don't have rabbit-brain, at worst I was a restless sleeper (that has entirely gone away with medication, this is my version of "wait, other people just DO this??"). So I don't really have symptoms you expect stimulants to - paradoxically - calm down.
I also wasn't diagnosed, and honestly was only moderately struggling, until perimenopause. I burned completely out and crawled partially out of that crater with an SSRI, later got diagnosed and tried going off the SSRI and just be on vyvanse, whoops turns out the SSRI was my executive function so went back and used the two together. Vyvanse was not effective enough to be worth the hassle of getting it every month so I dropped it but the distractibility was just a constant struggle. I finally discussed this with my SSRI prescriber and she was like honey you're dopamine-seeking, have this bupropion sidecar for your escitalopram and click, everything fell into place there.
But wow does it make some of the internet angry, I think because they feel patronized somehow? to be given antidepressants for their ADHD. But it's not off-label! This is a totally legitimate treatment protocol for some people's ADHD. It's a nervous system disorder that is mostly treated by messing with neurochemicals, and so are depression and anxiety. It's all the same soup, it's just the proportions and presentation that are different.
Anyway, if you need to write up the ways in which your day-to-day is affected so you have your thoughts organized going into the medication discussion, do that.
And plan to log how you're responding as you start on medication. Go back to that list of how your days are affected and see how things are changing.
posted by Lyn Never at 8:23 AM on November 16 [2 favorites]
I think the common mindset is "stimulants are the treatment for ADHD" and therefore that is what you will do. Stimulants are NOT the only treatment for ADHD, which would be better described as a spectrum or a plot-graph rather than a single disorder. Your doctor will pick a regimen to start with based on how it presents for you in your life.
My ADHD is heavy on the executive function deficits with a persistent - but moderate in presentation, I'm not risk-taking I'm just bored easily - distractibility. I don't really have ANY hyperactive-type symptoms: I don't sit still very well but that's the distraction rather than a need to move, I don't have rabbit-brain, at worst I was a restless sleeper (that has entirely gone away with medication, this is my version of "wait, other people just DO this??"). So I don't really have symptoms you expect stimulants to - paradoxically - calm down.
I also wasn't diagnosed, and honestly was only moderately struggling, until perimenopause. I burned completely out and crawled partially out of that crater with an SSRI, later got diagnosed and tried going off the SSRI and just be on vyvanse, whoops turns out the SSRI was my executive function so went back and used the two together. Vyvanse was not effective enough to be worth the hassle of getting it every month so I dropped it but the distractibility was just a constant struggle. I finally discussed this with my SSRI prescriber and she was like honey you're dopamine-seeking, have this bupropion sidecar for your escitalopram and click, everything fell into place there.
But wow does it make some of the internet angry, I think because they feel patronized somehow? to be given antidepressants for their ADHD. But it's not off-label! This is a totally legitimate treatment protocol for some people's ADHD. It's a nervous system disorder that is mostly treated by messing with neurochemicals, and so are depression and anxiety. It's all the same soup, it's just the proportions and presentation that are different.
Anyway, if you need to write up the ways in which your day-to-day is affected so you have your thoughts organized going into the medication discussion, do that.
And plan to log how you're responding as you start on medication. Go back to that list of how your days are affected and see how things are changing.
posted by Lyn Never at 8:23 AM on November 16 [2 favorites]
Best answer: Psych drugs are so weird.
Everyone responds differently to them.
I went to a psych, for my "depression" and the ADD I have had since my parents put me on Ritalin in kindergarten, because I was "hyperactive". Don't remember that much, nor kept taking it.
Agree the logging is a solid idea. Was on Wellbutrin for a few days, which reignited my essential tremor and my insomnia. Switched me to Stretarra which turned me into a zombie for a month. Got prescribed Cymbalta, and looking at those side effects, and anecdotal references here on Ask, declined that. And am too old to be given the stimulant drugs. Went back on the Wellbutrin, which seems to have helped. Psych wont respond to my requests to actually give me refills of that. Time for a new psych I think.
It is a process. Take what your professional suggests. If it seems to be bad, try what else they suggest. Go from there. Or, find a new psycholgist.
posted by Windopaene at 7:25 PM on November 16
Everyone responds differently to them.
I went to a psych, for my "depression" and the ADD I have had since my parents put me on Ritalin in kindergarten, because I was "hyperactive". Don't remember that much, nor kept taking it.
Agree the logging is a solid idea. Was on Wellbutrin for a few days, which reignited my essential tremor and my insomnia. Switched me to Stretarra which turned me into a zombie for a month. Got prescribed Cymbalta, and looking at those side effects, and anecdotal references here on Ask, declined that. And am too old to be given the stimulant drugs. Went back on the Wellbutrin, which seems to have helped. Psych wont respond to my requests to actually give me refills of that. Time for a new psych I think.
It is a process. Take what your professional suggests. If it seems to be bad, try what else they suggest. Go from there. Or, find a new psycholgist.
posted by Windopaene at 7:25 PM on November 16
Best answer: A child psychiatrist pointed me to the AACAP Parents Medication Guide. Not all of the info will apply, but a lot of it does apply to adults too. It's one of the clearest summaries of all the options I've seen. (And there's a little chart at the end to log side effects). It took me about a year to figure out medication that seems to work with minimal side effects.
Another good resource: ADDitude Magazine website, recommended by the doctor who diagnosed me. You can search for info on medication or all sorts of things. Their podcast is helpful as well.
posted by skunk pig at 9:50 PM on November 16
Another good resource: ADDitude Magazine website, recommended by the doctor who diagnosed me. You can search for info on medication or all sorts of things. Their podcast is helpful as well.
posted by skunk pig at 9:50 PM on November 16
Best answer: I don't know if you've read some of the same personal experiences of adults diagnosed with ADHD that I have, but I noticed how many people described their medications as "game-changing" or a "lightbulb" or some other transformative terms. Then, I found that nothing really did that for me. And it turns out that's not really very uncommon: Something like 1 in 5 folks don't really get much response from ADHD meds.
Not trying to be a buzzkill, but just relaying my experience.
posted by secretseasons at 9:52 AM on November 17 [2 favorites]
Not trying to be a buzzkill, but just relaying my experience.
posted by secretseasons at 9:52 AM on November 17 [2 favorites]
Best answer: Agreed, and I think the right place to set expectations is that medication should make it easier to implement the lifestyle changes and mindset changes as you figure out and onboard systems and processes that will actually work for you.
Those lifestyle changes can be done without meds, and they can be done long before diagnosis and any subsequent prescriptions, but what you hope for is that meds help you get out of your own way so it's not so hard to accommodate yourself. If they don't do that, the issue is with the medication or dosage. But if they don't magically fix your life with no effort on your part, that is unlikely to ever happen.
posted by Lyn Never at 5:38 PM on November 17
Those lifestyle changes can be done without meds, and they can be done long before diagnosis and any subsequent prescriptions, but what you hope for is that meds help you get out of your own way so it's not so hard to accommodate yourself. If they don't do that, the issue is with the medication or dosage. But if they don't magically fix your life with no effort on your part, that is unlikely to ever happen.
posted by Lyn Never at 5:38 PM on November 17
Response by poster: Thank you so much everyone, this was exactly what I needed.
posted by freethefeet at 6:43 PM on November 17
posted by freethefeet at 6:43 PM on November 17
The above answers are wonderful, so I'm just going to add a little from my personal experience:
I just did a ctrl+F for "titration" and found 0 hits, so just to add, that's the process by which you taper onto a medication, in case you didn't know the term and run into it elsewhere. (I didn't run into the term in the US, but the UK is obsessed with it when going onto medications. Probably something from the NHS/NICE.) I will add that sustained release medications are not just longer lasting version of the base medication, I have definitely had a different experience on lysdexamphetamine (Elvanse in the UK, Vyvanse in the US, not sure what it is in Australia) than I did on straight amphetamines (Amfexa in the UK, Dexedrine or Adderall in the US, again, not sure about Australia), with the sustained medication being much better for me.
Also, if stimulant medications do not work for you, there are second line non-stimulant medications. They tend to have odd side effects and have not been shown to be as effective, but that is an option in case the stimulants don't work. Talk with your doctor if the stimulants don't work, or work very little, there are other options.
Also, finally, something that I highly recommend, if you do find a medication that works for you and that you need to take daily, get a pill box for your morning dose. Load it up the same time every week, take it when your day starts. It's about the only way I know to make sure that I don't miss a dose or double dose. It may not work for you, but finding a routine around medication has been really good for me. (If you end up with a medication you need to talk multiple times a day, a pill bottle keychain attachment was pretty good for me, although if you carry a purse, you may find alternative means.)
Finally, finally, a great deal of the ADHD literature was written for and by men. Which is great for a cis guy like myself, but is lousy for all others. Feel free to disregard anything that doesn't speak to your experience, including from doctors.
Good luck. It's hard, but having an explanation always helps.
posted by Hactar at 2:26 AM on November 18 [1 favorite]
I just did a ctrl+F for "titration" and found 0 hits, so just to add, that's the process by which you taper onto a medication, in case you didn't know the term and run into it elsewhere. (I didn't run into the term in the US, but the UK is obsessed with it when going onto medications. Probably something from the NHS/NICE.) I will add that sustained release medications are not just longer lasting version of the base medication, I have definitely had a different experience on lysdexamphetamine (Elvanse in the UK, Vyvanse in the US, not sure what it is in Australia) than I did on straight amphetamines (Amfexa in the UK, Dexedrine or Adderall in the US, again, not sure about Australia), with the sustained medication being much better for me.
Also, if stimulant medications do not work for you, there are second line non-stimulant medications. They tend to have odd side effects and have not been shown to be as effective, but that is an option in case the stimulants don't work. Talk with your doctor if the stimulants don't work, or work very little, there are other options.
Also, finally, something that I highly recommend, if you do find a medication that works for you and that you need to take daily, get a pill box for your morning dose. Load it up the same time every week, take it when your day starts. It's about the only way I know to make sure that I don't miss a dose or double dose. It may not work for you, but finding a routine around medication has been really good for me. (If you end up with a medication you need to talk multiple times a day, a pill bottle keychain attachment was pretty good for me, although if you carry a purse, you may find alternative means.)
Finally, finally, a great deal of the ADHD literature was written for and by men. Which is great for a cis guy like myself, but is lousy for all others. Feel free to disregard anything that doesn't speak to your experience, including from doctors.
Good luck. It's hard, but having an explanation always helps.
posted by Hactar at 2:26 AM on November 18 [1 favorite]
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Neurodivergent Insights is also very good - here are their ADHD infographics
posted by Zumbador at 2:52 AM on November 16 [4 favorites]