A New Try

I have four alarm clocks in my room not counting my cell phone. I have a clip with an outdated to-do list. I have a coffee maker. I have three lamps. I have a desk and two other places to sit that are not my bed. I am taking ADD meds (yes, I decided to take this piece of information public, more on that to come). I still do not feel like I am Getting Things Done.

So starting today, I am going to try a new strategy. Forget about the technology. I am going old school.

Today I am buying binders and a white board or two. I am making lists that are easily changeable, and I think the one technology thing I am going to do is set an alarm (maybe on my computer) to go off at bed time. I am going to try to forget about the panic that these goals make me feel and focus on this problem like a scientific experiment. I am going to try to post on this here, costs and all.

The Devil You Know

Part 2 in a series on medicine and the thought processes that go into deciding to take it. Read part one here.

Before I start this post I need to stress: I have no training scientific or medical and I cannot stress enough how important it is to consult with a doctor before making any decisions about medicine or treatment. End disclaimer.

In the year this blog lay dormant, I thought a lot about medicine for mental illness. I have seen my friends-- and, frankly, myself--struggle with a bevvy of diagnosed and undiagnosed problems and then struggle with the question of whether or not to take medicine.

What is it about taking medicine for mental illness that makes people balk? We take medicine for all sorts of things. For allergies, for colds, for muscle aches, for cramps, there's a pill for every ailment and we take them and praise modern medicine.

And then, we face mental illness. For many mental illnesses or disorders there are even physical symptoms. I don't think there are any direct physical manifestations of ADD, but the possibility of anxiety that comes with unchecked ADD certainly has physical effects, as does depression, which also can stem from unchecked ADD.

But its not the physical symptoms--of any mental illness--or not only the physical symptoms. Emotionally and mentally, medicine can be life changing and, in some cases, life saving.

Why the fear? Why the worry about taking medicine that can change a chemical makeup on the brain? That can address the biological basis of something as confusing and often as intangible as mental illness and disorders?

I don't have all the answers. I wouldn't even presume to have a single fully formed answer, and I can't speak for other people's fears; this is a question that plagues even some of the most accomplished psychiatrists and psychologists. But I've been thinking about it a lot and I have a theory.

I think that this idea works best when applied to adult mental disorders, which is the focus of this blog. I think it is particularly applicable to ADD, because unlike some other disorders that are treatable with medicine, ADD is something that doesn't just show up. You might get diagnosed later in life, but once you're diagnosed, you know that you've had it for a while.

Not to resort to cliches, but I think that the question of treating adult ADD is a question of the devil you know versus the devil you don't. Someone who gets an ADD diagnosis in adulthood had already found some coping mechanisms. Even though the coping mechanisms likely will have failed enough to start thinking about treatment in the first place, ADD is the way that you have lived . However effective or ineffective those coping mechanisms were the whole package of struggle and coping become part of your personality; you know what it feels like, you know what it looks like.

Medicine, however, is not known. Additionally, it's the failures of medicine that get more attention that success. Breakthrough technology gets coverage, but the day to day stories of people taking pills and feeling better are not news, are not talked about, and are not fretted about. A brief look at just some of the articles that have caught my attention, indicate how scary the Internet can be when you are looking for guidance.

In recent weeks the Supreme Court ruled that patients could directly sue drug companies, which then lead up to several other cases, where people who committed suicide while taking different antidepressants. It's in the news, and its frightening.

And then, there was a mystery diagnosis that the New York Times Magazine printed which featured some scary stuff about Concerta, one of the ADD meds. (That article, I think deserves its own, nuanced blog post, because Concerta is safe and was used in an extremely unusual situation that became unsafe). And there is news of over-diagnosis and over-medication. And then, this article about Paxil resurfaced on Slate. I suspect that it resurfaced because of the renewed interest in the legal ramifications of misusing, or mis-prescribing drugs, and because of the settlement of a case regarding poorly-made pills.

So there's the news, and the fear that the medicine will change your personality (whether that's the coping mechanisms or something larger), and the fact that at the end of the day, the only way you can tell if medicine is working out is by trying it and seeing how you feel. That trial and error process can be both scary and frustrating. And then there's the stigma, which to be perfectly honest should be lifted, but its not. It's still going strong, which is why this blog was anonymous.

So then you choose.

The devil you know: ADD and everything that comes with it: all the crap that comes with it, all the personality quirks that might be part of it, and all the coping mechanisms that you've sorted out over the years.

And then the devil you don't: medicine, all its uncertainty, and all the frightening stories that float around.

It's hard to get past that fog and see the positives, the possible assets among all the uncertainties.

That's one theory at least.

Adult Manifested ADD

Once I committed to coming back to this, it was hard to actually do so. First, I started this blog while on Spring break in college. And, second even after that, I had more time -- and more personal need -- to write this blog.

But, recently, now that I'm no longer in college and am now in the real world -- whatever that means--I've been thinking a lot about ADD again. Particularly about the warped, incorrect term "adult onset ADD."

The DSM standards mandate that symptoms manifest themselves before the age of seven. That much is clear. But then, there is the fact that this is a blog about adult ADD. As I understand it, there are two types of adult ADD. There are the people who had child ADD which turned into adolescent ADD, which turned into teen ADD, which turned into adult ADD.

And then, there are the people, who were diagnosed with ADD as adults.

In my case, it was the latter, though it came as a surprise to no one, including -- well, hypothetically--my first grade teacher who administered the hearing and listening test I failed.

But I would suggest the term "adult manifested ADD." A psychiatrist I recently spoke to said that for many people, ADD surfaces at different times in different people's lives: for some it's high school, for some it's college, for some it's medical school, and for some it's a first job, or a marriage, or what have you.

Different changes trigger different types of symptoms, different manifestations, and that's when the diagnoses come in, offering help in the wake of changes in a person's life that can be big enough, or different enough to allow the ADD to manifest itself.

News For Thought

This New York Times Magazine article, "Self Non-Medication," is one of the best examples of science journalism I have seen in quite some time. It is a personal story of a man trying to go off of depression medicine, which I should note is not at all necessarily reflective of ADD medicine. What is great is the mix of personal and science. It is an interesting look at the quesiton of taking medicine, though admittedly for a different disorder.

It's a bit long but well worth the read.

Enjoy.

A Preliminary, Personal Decision

Part 1 in a series on medicine and the thought processes that go into deciding to take it.

It's been a while since I wrote a post here and even longer since I wrote a post of substance. So here goes. A lot of the books I have been using are sitting in a box in my parents' house, so I am going to try my best to write about medicine without the books and will write an updated or new post when I unpack that box. Because it seems I have a lot to say, this post will just be about deciding whether or not to take medication and later posts will cover the options. I'm trying out this bolding key sentences style as a way of breaking up huge blocks of text.

First off, there is a lot of bad information on the Internet. By bad I mean either patently false or very biased. There are people who don't believe in taking medication ever, there are those who don't believe that Attention Deficit Disorder is in fact a disorder and therefore don't believe in treating it, and there are people who are paid by drug companies to promote specific drugs. Know that and do not self medicate. It's not worth the risks, and even with the medicine that says there are "no side effects" there can still be side effects because each person reacts to medication differently (I had horrible side effects with a med I tried, even after being assured by a top doctor that side effects with that medicine were extremely rare) and there are ALWAYS risks if you are self-medicating.

I firmly believe that the decision about taking medication for ADD is an extremely personal decision, one that should be made with your doctor and whoever else you choose to consult. No one else, not even if you are still on your parents' health insurance, should be allowed to weigh in without your consent. (Keep in mind, this is a blog directed at adults with ADD, it might be different when the person in question is a small child, but I am not commenting at all here about medicating children. That's a whole different discussion that does not have a place on this blog). For that reason, I will not write here anything about whether or not I am currently taking medicine or which ones, if any, I am taking.

When I first considered whether or not to take medicine, my primary concern was that my personality would change. I didn't want to lose the speed at which I talk, the sharpness of my sarcasm, my ability to be interested in multiple conversations and topics at once, or my creativity. That's not to say that there is any medicine for ADD or ADHD out there that does that, but there were things I was worried about. I had heard descriptions of high-schoolers complaining that their friends were so much more fun -- funny, loud, all around goofy and more active--when they didn't take their medication. And I didn't want that to be me, even though I had been told by more than one doctor that those effects were common in people who have the hyperactive subset and in children, neither of which I was, I was still nervous. But this quote of a mother describing her child on medication : "She's still my dreamer, but now it's on purpose that she dreams" (Hallowell, 40). In short, the medication didn't stop her ability to dream, only let her choose when to do it.

When I considered taking medication, I decided that I would tell a few very close friends, friends who knew me very well and would see me in varying situations. These would be the only people I would tell at first--three or four people total--and I would let them know that I expected them to be honest with me. Did I seem less distracted? Was the change noticeable? Was the change positive? Were there personality differences? Were there things that were missing, and if so were those things that they were glad to see go (like, walking into the middle of the street with out looking, temper bursts, too much anxiety) or quirks that were part of who I am?

Pay attention to things that irk other people. Are those things that you want to change about yourself? Are those things that medicine could help you change?

One more thing to think about: You should be able to tell if the medicine is having an effect, so with people with more mild forms of ADD or ADHD, you might want to take your environment into account. About to leave school and start a job? Switching from one job to another? About to go on vacation? Do you want the extra boost (and I mean this in an entirely positive, way. Taking ADD medicine is not cheating or giving you an unfair leg up. It's leveling the playing field) as you start a new job, or are the demands on your attention so different that you need to be able to see what lack of attention feels like before you can decide if it needs to be remedied? In other words, are you going to be able to tell what changes are caused by medicine and what are caused by a new environment? Is that something that you are concerned about?

This post is full of questions, many of which people might want to bring to the doctor who is prescribing the medicine, but they are also questions to ask yourself, because as I said before and will say again, taking medicine should be an informed, safe, and intensely personal decision.

NEXT: On the different medicines. What is out there? What are the differences?

Some Personal Thoughts

This blog was designed to provide information but I think it's also important to provide personal reactions so that when other people read it it might resonate with people who are dealing with ADD, testing, or diagnosis. So here are some personal thoughts. They are from a longer essay, edited for legnth and identifying features. That's why it sounds disjointed.

I am part of a growing number of students and adults who are diagnosed post-childhood because, growing up, they were the academic super-stars, popular, and more or less well behaved. Their symptoms were overlooked when they were children because they seemed to fare well without medication or therapy.

The first time I remember having a panic attack was in fourth grade. I didn’t call it that. I didn’t call it that until I was a junior in college. But when I was nine, I had the test the next day on the digestive system, and I didn’t feel prepared so I burst into tears, the big back-shaking kind, with liquid coming from everywhere, eyes, nose, mouth. I don’t remember what my mom said. I do remember that she came into my room later that night and took the diagrams of the stomach and intestines and the flashlight from under my blankets. I got an 103 on the test. No one worried, because when the tears dried I was an overachiever....

On the molecular level, Speed—the blanket name given to a group of drugs that produce the stimulant effect—and Adderall are the same drug. Both are Amphetamines—the title that is given collectively to an assortment of drugs with similar molecular structures including Meth, which can be made illegally in secret laboratories. Amphetamines, legal or illegal can be taken orally, or through injection, smoking, or snorting and create the same rush.

When I nervously asked a psychiatrist counseling center what the difference was between Speed and Adderall, he said, “nothing. Molecularly, they are the same. The difference is how you take them. Adderall is prescribed in small, controlled doses.” The illegal counterparts of the drug clearly are not.

It’s of little surprise then, that Adderall is easy to get on college campuses. Students, some joking some not, beg for it when they are faced with pulling an all-nighter. Other students use it as a party drug.

“I snort it sometimes when I'm going out for fun, because it hits you faster if you snort it,” an NYU student identified only as Mary told The Washington Square News.

When I told a friend via an instant message chat that I wasn’t sure if I was going to get a prescription for Adderall, he wrote “WHAT!?!??!...but like, it's speed.”

Which is exactly why I didn’t want to take it. Edward Hallowell, a physiatrist who has ADD himself, treats it and has written multiple books about the subject, listed “[t]endency towards addictive behavior,” as a symptom of adult ADD in his book Driven to Distraction. Later in the book, Hallowell, describing high stimulation ADD, a specific subset of Adult ADD, “he—and it is usually a he—may seek high stimulation through relatively safe avenues [such as] creating tight deadlines to work under.”

I don’t know if I have high-stimulation ADD. I don’t fit all of the descriptors and I am not a risk taker in the most widely accepted form it takes. I am afraid of roller coasters and skiing. But I am addicted to deadlines. Ask the person who sits next to me in the library. I hate the exhaustion that comes with writing on tight deadlines. But I love the rush that comes with them.

I have a tendency to addiction—my dependency of coffee indicates that much. So I am afraid of prescription medication.