That’s how long I’ve been getting treatment for my ADHD. In case this is the first blog entry of mine you’re reading, I’ll recap: At the ripe old age of 32 I finally figured out that I have ADHD. The shrink put me on a low dose of Adderall, and the rest is history. Ok, so it’s only like a month and a couple days worth of history, but you know what I mean.
I got a surprising amount of feedback on the whole ADHD thing, including a few people asking me if it affected my ability to come up with novel ideas. There seems to be a lot of creative types out there who are holding off on getting treatment because they don’t want to turn into a mentally blunted zombie. I get that; I had those fears too. Continuing on the same blundering path would be kind of shitty though, so I read up on all the available meds, edified myself, and took the plunge.
The Good: Adderall is Kind of Awesome
All advice is autobiographical. There are no exceptions to this statement. Keep that in mind when you hear my take on this whole ADHD thing. Everyone has different genetic and epigenetic variations and combinations that affect the levels of neurotransmitters in their brains. Never trust someone who tells you they have ‘the answer’ to anything; they are, without fail, going to be full of shit. Maybe not entirely full of shit, but anyone who can put aside rational doubts and uncertainties is not to be trusted. I could write a whole book on this topic, but that’s a tangent for another time.
What I’m getting at is that this treatment is working for me, but it may not work for everyone. Some of the ‘new and shiny’ aspect has worn off, and my brain has acclimated to a little bit to the stimulants, but they’re still remarkably effective at clearing out the sludge and cobwebs and getting my neurons back in line.
I have a funny habit that my shrink observed, where I’ll stop in the middle of a conversation when I’ve been trying to explain some complex topic and ask ‘does that make sense?’ I no longer need to do that. I never even realized it, but I will lose track of my own topic of discussion if I go on for more than a few minutes. I can also code things now. Since I work in IT, this is incredibly useful. I’m actually not sure how I coded anything prior to this, but seeing the volume of comments I put in my code before I can hazard a guess. It’s like having a damaged short term memory, where you’ve only got so much space to work with. Ever see the movie Memento? It feels a little like that, only without the gaping plot holes or Joe Pantoliano.
Post-it notes are my friends. I need less of them now, but the number of reminders and notes and personal instructions I have to record have been cut in half. This stuff has cut down my stress levels tremendously. There’s a natural sort of uncertainty and anxiety with ADHD, where you can’t tell if you’ve forgotten about something or lost track of something, and you’re always worried you’re going to fuck something up. Keeping on any sort of task is exhausting, and even the thought of certain tasks is panic inducing. Dumb stuff, like scheduling appointments, planning trips, cleaning the house, walking the dogs, etc. These are things that are no longer new and shiny, so your brain knows it’s not going to get the dopamine fix it desperately needs. Somewhere in the back of your mind the spine-crawling anxiety of being trapped doing something un-stimulating for fifteen minutes feels like hell on earth. Some of the animal rescue work my wife and I do requires us to call people and interview them for fostering or adoption; doing that filled me with a level of dread I can’t properly express. It was so damn easy to forget key questions that you need to ask people, and I did it all the time. The constant threat of failure for even simple, mundane tasks like that is awful.
There are a lot of things that I do, and I think a lot of ADHD people do, that make them come across as complete assholes. Obstinate, stubborn, argumentative, difficult, inattentive, etc. It ain’t deliberate. Things that used to make me insane are now tolerable. Sort of… normal. I don’t mind making those calls, or planning stuff that takes more than a few minutes.
ADD/ADHD is kind of a dumb name for this disorder, if I may interject some more random only vaguely related opinions. Something more serious sounding like “Dopamine Deficiency Syndrome” would be better. ADD has such cultural baggage as being a non-condition or an excuse, but this shit will seriously fuck up your life if you’re not aware of it. Ok, tangent over. Well, this tangent. There’ll be more.
But the answer to the big question that people asked me is that this stuff doesn’t mess with your creativity. I still have no problem coming up with ideas. Dextroamphetamines are kind of weird; they’re not like long term meds like anti-depressants; they don’t really cause any major brain rewiring, there are no withdrawal symptoms if you go off of them. The human body is so good at processing them that the problem is actually keeping enough of them in your system to be effective.
I’ve gone a few days or a weekend here and there without the Adderall, and I went back to my normal disoriented self. In theory I think if someone did find that their creativity was impacted by these types of meds, you could just pick a day or two and go off of them and let your scattered brain go berserk. Record your ideas, and then go back on the stuff so you can focus and work on them. I don’t need to do that, personally, but it’s a viable option.
It’s not all unicorns farting rainbows and shitting daisies though.
The Bad: Welcome to the Exciting World of Drug Interactions!
Many years ago I was diagnosed with PTSD and clinical depression. I was put on a very low dose of an SSRI: Zoloft. Tiny dose; only 5mg. That’s a barely therapeutically effective dose.
Recently I bumped up to 10mg, after I really came to the conclusion that my brain was just not working right. This was a few months before the ADHD revelation. No side effects; I felt a little less miserable about failing at all of my life projects and being in a constant state of mild confusion, so that was good.
About a week into taking the Adderall I started getting side effects. These were not fun. Tolerable, but not fun. I was hot all the time, and I was sweaty. My heart would race from time to time, and it felt like it was beating harder than normal. I started flinching at things that startled me way more than I really should. My fight or flight reflex was in complete overdrive, to the point that playing video games would get me so amped up that I’d start to get tremors and muscle spasms.
But then the tremors stayed… and the random muscle twitches were pretty constant. An average person could probably accept a certain degree of trembling hands, but for an artist? That’s really shitty. It got to the point where it did impact my ability to draw, and I was starting to get worried that the side effects would force me off of the stuff.
But I’m a little OCD, so I’d been reading up on all sorts of interesting things about brain biochemistry, the history of pharmaceuticals, neurotransmitters, etc. I’m a nerd, so I get into that kind of stuff. Part of it is probably that it’s novel, so it makes my brain light up and triggers the whole dopamine release thing.
So in my research, I stumbled upon something really interesting: Adderall is really not supposed to be mixed with SSRI’s. SSRI’s are Serotonin Re-uptake Inhibitors. I know how they work, but to put it simple, it keeps the serotonin hanging around longer in your brain to do its job better. Adderall does a similar thing with Dopamine, in addition to making your body produce more.
But Adderall also makes your body make more serotonin too, and that’s the problem.
Serotonin Toxicity: The Fun Never Starts
Too much serotonin is bad. In fact, it causes those exact symptoms I outlined above, among other things. Adderall side effects overlap with a lot of those symptoms, so it’s very easy to overlook. But a few of the symptoms, like the weird muscle spasms and tremors, are nearly unique indicators of Serotonin Syndrome. The severity varies, as with anything, and I believe I had a mild case of it. Severe cases can just outright kill you though, so this is shit to take seriously.
Interestingly, it only took a minor dose of each of these meds to trigger those symptoms. It’s like a combination of menopause hot flashes and roid rage. I mean, I don’t know what either of those things are like, but you know what I mean.
So the obvious solution was to stop the Zoloft, so that my Serotonin levels, which are rather clearly at or near a normal level, could calm down a bit. So I did, and the next day they were gone.
Oh but if only it were that easy…
The Ugly: Brain Zaps.
I’ve never written about this before, but I know these fuckers all too well.
A few years into taking Zoloft I went cold turkey for a bit, to see how it was affecting me, and see if I still needed it. A few days later my head started to explode.
I didn’t register what it was at first, but soon I put two and two together.
When you go cold turkey off of an SSRI, your brain goes a little ape shit. SSRI’s do make long term changes to your brain, unlike plain old stimulants. The human brain is very malleable and adaptive, and it responds and adjusts itself to whatever chemicals are in your body. Food, drugs, etc. The brain undergoes clear changes when you get an SSRI in your system, and it takes some time for your brain to finish the rewiring. Most of these types of things are of a risk for young kids, but there’s some evidence that even an adult brain will have some permanent or at least very long lasting brain changes from it.
So, of course, if you go off of the stuff it takes a while for your brain to un-wire itself.
That’s where the zaps come in. It sounds like a dumb name, but that’s the best term for it. It’s got a whole formal name of SSRI Discontinuation Syndrome. Brain Zaps sounds more interesting though.
It feels like you’ve hit your funny bone; a really bad hit, the kind you feel in your toes and belly button or even under your tongue. Only it starts in your brain. For me it seems to be related to the balance system, as it’s tied in to vision. Turn your head too fast? ZAP! Look left or right with your eyes too quickly? ZAP! Stand up too fast? ZAP!!
Sometimes they just hit you out of the blue for no clear reason too. And boy do they feel shitty. Some of the big ones can hit so hard that your hearing cuts out for a second and your vision closes in a bit, like if you get up too fast after playing a marathon game of Tetris or an average Warcraft raid and go all light headed. It clearly sends some kind of insane signal through all of your nerves, because the really strong ones will make your tongue, belly button, toes, and the head of your wiener go all pins and needles. Pretty much anyplace in your body with a shit load of nerves gets blasted with unfiltered nerve signals.
Yeah, that’s right; I said the head of my wiener. It’s over-sharing day today, didn’t you know?
It takes almost a month for SSRI’s to take effect on most people. And it takes the same amount of time, or longer, to wean yourself off of them. I can only hypothesize that the drugs themselves don’t directly curb depression, but it’s more to do with the neurological changes they induce. I don’t know though, I’m just some random game geek on the internet, so don’t take any of my rambling speculations seriously. My symptoms and side effects are about as accurate as I can report them though.
And After the Ugly: the holding pattern of moderate annoyance:
So that’s where I’m at now. I’m walking an annoyingly fine line between brain zaps and hand tremors, while trying to get a better handle on how long the Adderall lasts in my system.
Take the Zoloft too infrequently or cut the doses back too far, and my brain starts trying to give itself electroshock therapy to punish my poor decision making. Take it too close to the Adderall and I start doing involuntary jazz hands.
I’ll get over it, of course, but it’s going to take some time. Hopefully not too much longer than a month, but we’ll see.
The real crazy thing is that the doses I’m on are pretty small. There are people on ten to twenty times as much Zoloft as I was on. There are people taking five times as much Adderall as me. There are people on both of those drugs, at the same time, along with other shit to control other symptoms or side effects.
I’m scientifically literate, financially stable, and reasonably intelligent and well informed on matters of medical importance. And in spite of that, I can just barely navigate all of this madness to get myself correctly diagnosed after twenty five years of symptoms starting when I was a kid. I can’t even wrap my head around how hard it must be for people with less means and less information to navigate these types of issues.
I don’t mean to end this by going all bleeding-heart-liberal-commie-socialist whatever on you guys, but this is heavy shit. What I’m dealing with is insignificant compared to what others have to deal with, and my issues have half fucked up my entire adult life.
That’s one of the pernicious things about names and labels. I wrote earlier that I thought ADD and ADHD had too much cultural bias attached to them, and I’m dead serious. Screwy levels of one or two chemicals in my brain, cause by one or more dysfunctional and all too common variants of a gene, have caused me to get fired from jobs, nearly fail out of school, screw up one opportunity after another, and lead to depression, self destructive behaviors, and an impressive collection of idiotic decisions over the years.
And I got really lucky. Even with my late diagnosis, I’m doing pretty well, and avoided all of the worst ADHD pitfalls.
I ain’t saying none of this is my fault. It’s all my fault, and I’m ok with that. I don’t like it, but it’s my bullshit and baggage to own. But bloody hell, our system isn’t well suited to help people with mental issues, is it?
A lot of people seem to have the opinion that mental issues like depression or ADD or mood disorders or what have you are moral failings, a character flaw if you will. Just a result of laziness, indifference, weak will, or whatever dismissive term you want to write on a label and slap on someone’s forehead. I’ve met a lot of people like that. They exist; there are a lot of lazy assholes out there, both physically and intellectually. But not everyone with trouble getting by is like that. I doubt that even a majority of people with issues like that are malingering exploiters.
I’ve gone my entire life, except for the last couple of months, assuming that my problems with work and life in general were because of something that was wrong with me. I bought in to the idea that I had motivation issues, or perhaps my screwed up childhood damaged me and made it harder to get shit done. That’s the kind of thing a person should be able to get over. Strong people are able to overcome crap like that, persevere, and be successful. So for my entire adult life I’ve thought I was a lazy shithead. I’m smart, I can figure stuff out, and yet I can’t finish a damn thing and sometimes just holding down a job has been an unbelievable struggle. I’ve never once blamed an outside source for my shortcomings. I’ve always turned it inwards. Try harder, think harder, concentrate, don’t be so scattered, stop wasting time, don’t fixate on useless stuff, don’t be such a failure.
That’s some rough shit. It’s no wonder my previous shrink thought I was depressed; I fucking WAS depressed, but for legitimate reasons. Treating the symptoms wasn’t going to help; the root cause needed to be identified and treated.
But that blame, that accusation that you’re just another lazy fuck who’s blaming their laziness on ADD or depression or bipolar disorder or whatever… that can be some seriously debilitating shit. Even if most of it is coming from you, yourself, it eats at you.
And like I said, I’m one of the lucky ones.
My disorder is simple, if hard to pin down and complicated by other issues at first. It responds well to treatment, and now I can focus my energy on getting my shit together.
But I still think about people with worse problems and less resources. How the hell would anyone expect them to excel in the face of that kind of adversity? Even in countries with medical systems that are less hindered by infantile ideologies than ours it’s tough.
I’ve got no solutions for this. I could think up plenty of stuff, sure, but I doubt any of it would be useful. I don’t know enough about it to come up with a plan that would be worth taking seriously. But I will say this:
Everyone has their demons. Never dismiss someone out of hand, because you never can tell what’s going on in their head.
Hell, even they may not know.