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Post by cassandro on Sept 24, 2020 12:11:45 GMT
Hello everyone
It's my first time here, and I hope you can help me with your experience.
ADHD is only a recent way of looking at my problems. My life hasn't been a great success in terms of career or relationships and it's hard not to see my innate personality as a factor, although I'm sure some is luck, life events and social position too. I've suffered from depression (recurrent depressive disorder / dysthymia) since childhood. No conventional treatment helped with that. Exercise and other well-chosen activity and techniques and self-help groups has moderated it. Five years ago, in my late 40s, I received an NHS diagnosis of autism (autistic spectrum condition). As I learned about what autism actually means (contrasted with either the popular or clinical views) by meeting other autistic people, I realised there is a 'difference' that does match my social backwardness and behavioural oddities, and that aren't entirely due to things like an isolated upbringing. It's more fundamentally about the way you think and where your attention goes (monotropism), and that can affect how you relate to people. So then someone helping with navigating autism suggested my executive function problems might be thought of as ADHD instead, and I duly get assessed by a psychiatrist. The summary of that is 'yes, probably, but it overlaps a lot with autism anyway'. Apparently no follow-up or practical help follows from the ADHD diagnosis, so not really sure why I bothered.
So at the moment I'm seeing if I can improve in terms of motivation, tiredness and distractibility. I can experience hyperfocus and find it hard to tear myself away from something that's caught my attention, and occasionally work through the night, but it's more the stationary kind of inertia that I'd like to do something about. I'm usually full of ideas and hopeless at putting them into practice, made worse by not having people around me to provide structure. I can relate to the 'universe stuffed into a shoebox' metaphor. My mind can become a torture chamber, but it's also a funfair. I build up lists of things I really want to do but never get around to.
Anyway I tried atomoxetine 40 mg & 80 mg for a few months, having reservations about dependence with dexamphetamine and methylphenidate. Pretty useless in terms of any of the above (motivation, tiredness or distractibility). It's a stimulant for the sympathetic (peripheral) nervous system, but from the few online tests I could find doesn't have any effect on attention. (DASS showed an increase in anxiety, but that's from the physical effects.) Diuretic, disturbed sleep, some nausea, once or twice a tremor, sweating and obvious horripilation (goose bumps) after about two hours. I'd also taken reboxetine for depression in the past and they work and feel very similar except that atomoxetine has a shorter half-life (that is, atomoxetine wears off in about 12 hours). So subjectively feeling a bit more on edge, but no improvement in motivation or focus.
So atomoxetine affects the norepinephrine system while other ADHD drugs affects dopamine. I'm wondering if anyone can explain what dexamphetamine and methylphenidate feel like or how they help in everyday life. Medical texts are usually useless for deciding if a drug is really helping: they tend to just show a correlation based on scoring lists for ADHD 'symptoms' with no 'phenomenological' analysis. What's the positive effect to look out for to judge if it's 'working'?
I can be referred back to the psychiatrist, and if so not sure whether to express an opinion between dexamphetamine and methylphenidate. From fairly limited reading, amphetamines produce dopamine release, while methylphenidate inhibits reuptake. How does that difference feel or manifest itself? It might be that methylphenidate produces stronger rewards ('positive reinforcement') for things that would release dopamine anyway and so encourage focus and motivation on those; while dexamphetamine simulates a reward in itself. The former would sound more constructive (I have the opposite of an addictive personality). However, simply moving the mood and energy baseline up a bit might stimulate more sensitivity to useful work when one is flagging, particularly if one could take a dose only when consciously chosen. All speculation on my part, and I don't know how to confirm without trying both drugs myself. The EPA also seems to favour amphetamines (particularly the new expensive ones, oddly) over methlyphenidate for adults.
So those are my questions: has anyone tried both methylphenidate and another medication and how do they compare in terms of subjective feelings, productivity and mood? Or any other relevant personal experience? Thanks.
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Post by vagueandrandom on Sept 24, 2020 18:52:18 GMT
The thing with ADHD meds is that they affect everyone differently, so asking for people's experiences
may not be very helpful. I also found Atomoxetine's side-effects awful, with no apparent improvement
in anything. However, I know people who take it and find it lifechanging! The same can be said for stimulants -
they can increase or decrease anxiety, make people irritable or calm . . . and this is for both methylphenidate
and (lis)dexamfetamine, IR or XL. The only way you'll know how they work for you is to try them
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tristana
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Post by tristana on Oct 11, 2020 19:32:48 GMT
Hello everyone ................................................. Hello cassandro I have been using ADHD meds for just under a year, when I was first diagnosed aged 49. My initial experience on methlyphenidate (Medikinet XR, 20 -40 mg) was positive - it improved my focus and I could get things done in the early part of the day. However, particularly when the dosage was increased to 40 mg, I would experience terrible 'slumps' in energy levels in the mid-afternoon, to the point where I would need to be careful when crossing the road or walking down the stairs. I was quickly switched to lisdexamphetamine Elvanse, which worked ok-ish on lower (10-20mg) doses, especially in terms of motivation - I was ready to engage with many things early in the day. The higher dose (40 mg), however, made me very irritable and argumentative. After trying some other forms of methylphenidate, my doctor put me back to Medikinet XR 20 mg, but added 5-10 mg Tranquiline (short release methylphenidate) to 'top it up' when my energy levels start fading in the afternoon. My impression of this short-release drugs is that they don't contribute to anything important. My favoured option would be combining low doses of Medikinet XR with low doses of Elvanse, or alternating between the two every couple of months. This way I would benefit from increased focus as well as motivation, but I don't know if this is possible. vagueandrandom I wonder if you could comment on this? Thanks.
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Post by vagueandrandom on Oct 13, 2020 17:52:01 GMT
Hmmm . . . most psychs don't like mixing stimulants, although it's not unheard of - your psych would have to be very experienced
and confident in order to do so, and not all are. It's something you should discuss with them.
Have you tried dex IR? It's technically the same drug as elvanse, but it can have a slightly different effect, for example;
elvanse made my BP shoot up and dex doesn't.
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tristana
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Post by tristana on Oct 18, 2020 17:35:32 GMT
Hello vagueandrandom, and thank you for your reply.
Does what you call "dex IR" have its specific name in UK pharmacies? It sounds like dexampthetamine, yet I only have experience with lisdexamphetamines.
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Post by vagueandrandom on Nov 3, 2020 18:39:19 GMT
tristana IR is instant release dex short for dexamfetamine.
XL is extended release and lisdexamfetamine is like an extended release dexamfetamine (except it's technically a pro-drug which converts to dexamfetamine and lysine when broken down by an enzyme in red blood cells)
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Post by cassandro on Feb 26, 2021 13:51:20 GMT
Thanks tristana and vagueandrandom. That gave me some clues, to go with my little online reading about dopamine. I've now got an appointment in a few weeks and am pinning some hope on getting low-dose short-release methylphenidate. A few hours of improved focus in the morning might well be worth it. I'd anticipate a rebound energy 'slump' later in the day as a penalty, but the advantage of working at home at the moment is the possibility of a nap. Although the trend is to more expensive extended-release versions, having some drug with a short half-life within the body appeals to me, because it might feel more under my control, the effects would be clearer, and you could be more precise about timing the effect. I might not need it at all at the weekends, but will discuss that with the psychiatrist when I finally get to them. Has anyone had longer-term withdrawal problems? As for everyone having different experiences, you can't gainsay someone else's own story, but there must be at least some commonalities or the drugs would never be prescribed. Richard Bentall as on BBC's 'Life Scientific' this week, and his concentration on symptoms rather than diagnoses makes sense to me. It's a bit like categorising and diagnosing a problem as spending too much time on the loo: person A finds a medication helpful, while person B says it makes them worse. Yet the drug really has the same simple effect and A and B can agree within the privacy of their own toilet that it's a laxative! People with executive function problems may differ: a stimulant can have a positive effect if your problem is lack of energy (at the right time), but a bad effect if your problem is to do with anxiety inhibiting action. You can still agree that within the privacy of your own mind what the effect is, even if you have different experiences on whether it is beneficial or not. So I will also try to measure effects on attention (WCST), mood (DASS) and well as longer-term screening tools (CAARS). By the way, I came across a 'target detection' test at gbit.cognitron.co.uk/ in which I underperform. Does anyone know anything similar that measures short-term distraction and sensitivity? I can feel a bit like a car with a failing clutch. The engine is revving way up but the wheels aren't moving. I wonder whether the drug would help the stimulate activity that my grey matter id demanding as 'rational', or alternatively train my errant cortex to concentrate on more rewarding things. I may be having drug cravings without having even tried the drug yet.
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Post by cassandro on Feb 26, 2021 16:13:14 GMT
Actually, what the subjective experience of anything is may be a difficult question to answer, particularly for someone like me who is autistic and 'alexithymic' (don't know what I'm feeling), so it could be unfair to ask. I mentioned I got goosebumps from atomoxetine, but that's not really an internal experience. It could be an exercise to ask what is the subjective experience of something most people know, like tea? Or of alcohol?
Are those simple? Alcohol makes me slightly more talkative, more silly and a lot more stupid. Can I feel the 'buzz', tingly, light-headed or any other feeling? Maybe those feelings exist but you get desensitised to them. Atomoxetine had a 'tingle' to begin with, a sensitivity in limbs.
Tea is more relevant to stimulants than alcohol and harder to describe. I do use tea when needing to get through something or settle down to work, and though it may make me more likely to stare at a screen or something for hours, I still find those hours go past very fast, and maybe I'm not aware of anxiety but it makes me want to be sure of something so I may become over-thorough. It doesn't seem to affect my irritability (I'm irritable anyway). So I could say it triggers hyperfocus, but I'm not particularly attentive to my decisions about how to use time or what to focus on.
I've heard criticisms when someone says they want to be more 'productive', because productivity is a kind of value imposed by profit-seeking society and it may not be good for the individual. But not only does my paid work want me to be more productive, but I want to be able to achieve things for myself. Maybe a dopaminergic drug will help bridge the gap between intent and action. As you say, I might as well try them, but I'd like to understand the kind of effect to know how to make best use of it and also what treatment I should try first as it sounds most likely to help.
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Post by cassandro on Mar 2, 2021 11:40:29 GMT
Trying to be a bit clearer in my questions. Things like: * How (if at all) does medication affect your awareness of what's happening at the moment? * How does medication affect your motivation? (It's not that I'm not motivated exactly, more that I find it really hard to get started, keep going and finish what I want to do.) * How does medication affect your determination or ability to finish tasks? * How does medication affect your feeling of self-control? Of self-discipline? * How does medication affect your curiosity? Your creativity? I'm reading (or trying to) _Focus_ by Daniel Goleman. As I understand it, he associates the brain's 'default' mode, mind-wandering and open awareness, which has its place, with ADHD. I seem to be 'inattentive-type' so my mind is wandering (maybe even creatively) more than it should but isn't focussed on anything directly productive; executive PFC is busy but not concentrating where it 'should'. Dopamine is involved in the 'mesocorticolimbic circuit' that is like a harness placed on the higher functions. It feels like you're lacking top-down control, but what's really missing is the bottom-up loop. Sorry I digress but wonder if any of that resonates with your actual experience of methylphenidate or whatever.
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Post by Deleted on Sept 15, 2021 13:45:33 GMT
How did you get on?
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Post by cassandro on Sept 17, 2021 8:57:09 GMT
Thanks for asking, boost. Do you mean how did I get on with the methylphenidate (MPH) or with the book? I'm on 30mg short-release MPH (Medikinet) at the moment. I finished reading the book. As regards the book (Focus by Daniel Goleman), it's readable enough and evidence-based, but itself rather meanders. The recurrent idea is that there are three classes of attention, 'inner', 'outer' and 'other' each with their own skill-set and one needs a balance between them. I'm pretty bad at the inner focus, and it has some suggestions including learning from others, an internal conception of 'stoplight' traffic lights to be aware of impulsiveness, plus developing awareness of emotions generally. These are distinct neurological processes. The link between attention and reward systems is clearly there, but not definitively explained. As for the MPH, well, to try to answer my own questions, it's more of a mental stimulant whereas atomoxetine was a bodily stimulant, so MPH seems likely to be most relevant to my problems and my frustration at lack of self-control. (Of course there are bodily effects from the MPH and the psychiatrist asks me to monitor pulse as well as weight: I think heart rate does increase by about 10 bpm.) The relevance is probably most clearly seen in the rebound, about four hours after taking the final dose of the day, where the tiredness it produces is very similar in character to the fatigue I feel most of the time, the kind that makes you want to go to sleep under the desk. Without medication, I actually normally get that about an hour after I get up, the feeling of being really, really tired. I don't know what's happening within my own brain that causes that so regularly, whether it's a feature of ADHD or depression or my brain has been racing so much that it's used up its oxygen supply. One way of countering it can be morning physical exercise, preferably away from polluted air. Or I can take my first 10 mg MPH with breakfast and try to keep going. Returning to my questions, how does MPH affect awareness of the moment? I'd actually say it reduces it. I now get very frustrated come 4pm when I realise I have done hardly any of my set tasks and time has flown by. Atomoxetine maybe increased 'outer' focus, whereas MPH is more 'inner' focus and it's hard to resist (or even notice) putting energy into distractions. I still feel that on the journey from A to B, I should visit C first, and on the way to C, I notice D. At the end of the day, I'm not only nowhere near B, but C seems a long way of and I'm really struggling to get to D. On the other hand, it probably works the way you might expect a stimulant to as regards motivation and endurance. So I don't pause for a break and reflect how best to use my limited resources, which at least tiredness can force me to. And that means less sense of self-control and self-discipline. After a dose, I find myself doing slightly more physically before the tiredness lifts. It's slightly 'tingly', which can be unsettling or leave me on edge when my brain still feels foggy. Does it affect 'determination' and task completion? A bit early to say perhaps. I was hoping the drug would increase my 'reward responsiveness' so I'd feel pleasure and satisfaction in doing something (which I rarely experience) and so help develop good habits. If it does have this effect I've not noticed it; unlike 'impulsive type' ADHD I don't have particularly volatile emotions, and as I say am rarely aware of what I'm feeling. Curiosity is still there I think, creativity not so sure. The continued distractibility, and the energy I can now put into the distractions even when I'm really trying not to procrastinate, means MPH is not helping me get back to work. One of the first things on the Medikinet (short release) patient information leaflet is 'You need to have other treatments for ADHD as well as this medication'. The NICE and BMJ guidelines for adult ADHD also mention need for other support, but this wouldn't have been mentioned by the psychiatrist if I hadn't raised it. I am hoping for access to an occupational therapy (OT) group and that the OT will have relevant skills. It sounds like that is some months off. There's also usual access to primary care CBT (IAPT). Interventions I've read might help include psychoeducation and mindfulness. A friend suggested to me that I need to learn new self-management skills for when the medication is activating me or giving energy. I have a timer on my laptop to bring my attention back to my to-do list, and I must get into the habit of reacting to it. I should also try to prioritise moment-to-moment and avoid the strong impulses to satisfy my curiosity when they aren't relevant. As for negative effects, possibly a bit of constipation (need that hypothetical laxative I mentioned), nausea and anxiety. I don't think I feel any drug cravings or look forward to the drug experience. An autistic & ADHD acquaintance described developing a problem around MPH so I was wary of that, but actually prefer to reduce the number of days in the week I take it, for the aforementioned self-control reasons. MPH is less useless than most psychoactive drugs I've been prescribed, but still not particularly pleasant. The biggest problem is almost certainly insomnia, finding it hard to get to sleep or waking 2-5 am, and the consequent lack of sleep which balances out the drug effect itself. This is listed in the 'affects more than 1 in 10' category in the leaflet. It seems to come on as a rebound-from-the-rebound, maybe 10 hours after the final dose, which I now try to take before 5pm. It probably means that if there's a day I want to perform well, I should refrain from the drug the day before. As regards the irritability Tristana mentions, for me that could be from the stimulant or the tiredness when it's wearing off; the drug may help 'externalise' and express such feelings more. I don't think I'd want to combine stimulants, except MPH, tea and chocolate (not in the same mug, you understand). All in all, pretty frustrating. My ADHD diagnosis is now confirmed by a separate professional and tests I've done myself. It seems to be inattentive type. Maybe the diagnosis helps me forgive myself a bit for the failures in my adolescent and adult life, on the other hand it can be thought of as a 'fault', and a real shame I haven't been able to 'apply' the considerable talents and virtues people I often remind me I have. In middle age, still really in entry-level jobs despite amassing heaps of knowledge and understanding and novel ideas (maybe everyone has that illusion?). Little faith in my own decisions, and I don't really have an intimate partner to buttress such faith. If there is an answer, a way to 'change' those things I can, conventional ADHD medication is a small part of it. It's relevant to tiredness, but seems to have exposed deeper problems with motivation and particularly distractibility. I intend to watch more Jess McCabe videos. Does that answer your question? How are you doing? (The web page button says 'post quick reply' and I don't think 45 minutes or so, maybe an hour, is 'quick'.)
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Post by Deleted on Sept 19, 2021 18:08:28 GMT
Thank you for your very detailed response and your posts in general. Very interesting to read. When I pose your questions to myself I realise I don't have simple answers which suggests to me I still don't really know much about anything!
I think there's two sides to this one:
1. I *think* my awareness of what's happening in any given moment is higher but my awareness of my future, in these moments, is still not particularly high on my priority list. I suppose this might make it difficult to realise any lasting benefit?
2. Amphetamines and their analogues can have an anti-depressant effect and being 'happy' fundamentally makes us less critical or less attentive at any given moment.
There is definitely an increase in motivation. Specifically, there's a small window where I experience a bias for action that I can occasionally use to my advantage.
It seems to stop me from getting sacked so it's doing something. I suppose it makes it easier to start things I don't immediately want to do?
For the briefest of moments, I see all my mistakes, what caused them and how it could be different... then it's gone.
I would say it's never positively affected either. Curiosity and creativity are fundamentally stressors - something the ADHD mind delights in but the medicated mind recognises for what they are. Elaborate distractions masquerading as affirmative social constructs.
As an aside, I relate to fatigue. It's always taken me ages to get going in the morning and I struggle to fall asleep at a sensible time every night. You've mentioned a few times that you don't relate to impulsivity. You've also said you seldom understand what you're currently feeling.
To what degree does fatigue attenuate impulsivity, I wonder? Can we be inherently impulsive but not know it?
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Post by cassandro on Sept 21, 2021 11:30:08 GMT
Thank you for your very detailed response and your posts in general. Very interesting to read. When I pose your questions to myself I realise I don't have simple answers which suggests to me I still don't really know much about anything Thanks for the reply. I'm not sure how to do selective quoting on this board without going into the BBCode, but here goes. I generally don't have strong long-term goals, which some people seem to have. Ambition has been thwarted too often. I have some things I want to do in the week, do the washing, talk to a friend, whatever. And then there is the really short-term stuff like what to get out of the fridge for breakfast. The short-term is sometimes a problem because of memory. I don't find MPH helps with the long-term drive, and I'm not sure about the medium-term either. Probably goal-direction and persistence take some additional skill besides the energy from a stimulant. I agree to both parts of that. I'm monitoring my mental state partly with www.depression-anxiety-stress-test.org/ I score high on the depression and low on the other two and think it's picking up some ADHD characteristics as depression and the medication hasn't made much difference although my perception is that MPH has a greater antidepressant effect than SSRI antidepressants (for me). Yesterday after my second dose I found myself doing something rather pointless sorting out photos, was aware I meant to be doing something else, but couldn't drag myself away. So the 'outer' attention was boosted, but I actually felt a loss of control plus irritation at myself. It may almost be like 'depersonalisation' which I haven't otherwise experienced, or maybe I was just more conscious of the conflict between what I was doing and what I meant to. I'm also wondering if after using it a few more months it will have helped develop long-term motivations by embedding rewards into my limbic system. Aha. That was what I was hoping to get from it. Yes, I find myself more active, but not necessarily doing what I wanted to be active on. It's found a bit more fuel for the outboard motor, but there's still no rudder because it was eaten by a shark. I wonder how you use it to you advantage? What works and what doesn't? Useful. I _did_ at some point want to sort my photos, but it wasn't a priority and probably what happened was my 'autistic inertia' autisticinertia.com/2020/12/first-autistic-inertia-article/ kicked in and I kept at it for an hour or more even though I'd only allowed about 5 minutes for it. Very interesting. The medicated mind feels the stress and the distraction and the _superfluity_ of curious and creative impulses? I wouldn't want to make a value judgement on such things, as I don't know where society would be without curiosity and creativity. But it certainly would help to park new ideas so one can continue on a main, purposive task. [/quote] Good point. It may be that I'm experiencing two forces pulling in opposite directions and without the fatigue am impulsive. People would describe me as 'spontaneous', which is a slightly more positive way of saying impulsive and scattered, so I look for new ways to do things, for example. However I won't normally act on each impulse because it's more trouble than it's worth. I don't relate to hyperactivity really and it wasn't highlighted as part of my diagnosis. All this is part of a 'personal narrative' that is an interpretation of the neurology, but I hope is helping me understand and so improve myself and my life.
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Post by ADHD in Denial on Sept 22, 2021 20:57:01 GMT
Wow you guys have such amazing self reflection! I didn’t even realise I did the majority of ADHD behaviours until I started observing myself following a very tentative diagnosis as I was so borderline! Have little understanding if the drugs work or not. I’ve got serious hormonal issues going on which makes it impossible to know. Just As I think things are improving I get horrific PMT which ends in depression then fatigue. I tried coming off the pills which ended badly, insomnia, mood swings and depression. I have no idea what to do as my Pyschs private and don’t want to spend any more of my hard earned savings. I’ve managed to stay in a part time job for the last 4 months….. big achievement for me, first time had money in the account in ages. I’m trying to complete the contract which ends next May, don’t normally take on office jobs that last more than 3 months, even though I get to work from home. Already found myself gravitating towards job pages. 😂.
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Post by Deleted on Sept 23, 2021 12:14:56 GMT
Wow you guys have such amazing self reflection... ...and it only took 9 years of being medicated! Unfortunately, KNOWING stuff isn't the problem. DOING stuff is the problem Brilliantly articulated by this chap here:
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Post by ADHD in denial on Sept 23, 2021 22:10:48 GMT
Good vid thanks. I’ve always known I’ve had problems with working memory as I was diagnosed with dyslexia in my teens. It always shows up on the assessments which I’ve done 3 times now. Every time, Yep still dyslexic 😉. Microsoft teams introduced me to how much I talk over people. Nothing like seeing yourself talk over others. …Clueless I was even doing this. I always new organisation was not my strong suit, although is possible with some effort. Never thought I had a problem with procrastination, just thought it was because I’m always tired. Think I have something akin to chronic fatigue/fibromyalgia for the past nearly twenty years. Now realise on my good days I’m putting off the boring stuff and in the bad days I can often still muster enthusiasm for something I want to do. Had no idea I was impulsive, although I remember once disagreeing with my mother many years ago when she mentioned she thought I was quite impulsive. 9 years eh boost on medication to gain self awareness 😂. I feel like I’ve reinvented myself so many time now, still looking for the authentic self. Hmmmm
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Post by cassandro on Sept 27, 2021 9:28:06 GMT
...and it only took 9 years of being medicated! I hope I can skip ahead... Unfortunately, KNOWING stuff isn't the problem. DOING stuff is the problem Exactly how it seems. Is Russell Barkley saying we need to know and keep trying but it needs other people's knowing and doing to make any difference? Does it take a mixture of encouragement and accountability? He's very convinced he's right. Several interesting ideas about replenishing and not depleting self-regulatory capacity. I'd like to see his references and probably should read one of his books. I hadn't heard the glucose idea, but I do find a rest then hot chocolate somewhat fortifying. I thought fruit sugar was fructose but there is also glucose in things like bananas: en.wikipedia.org/wiki/Fructose
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Post by cassandro on Sept 30, 2021 15:44:40 GMT
Been thinking a bit more about 'bias for action'. I recognise it as a business term, apparently used by Amazon, as well as something not particularly desirable personally. My innate character is actually to think twice before saying nothing, but I felt I overcame that. 'Bias for action' and 'impulsivity' actually sound related, paradoxically.
Tristana mentioned crossing the road when in a slump. I'm more worried about crossing the road when I have a bias to action, being impatient and taking greater risks. (And the psychiatrist is rightly concerned about possibility of suicidality in her patients: what if I am so impulsive I do something drastic? This is one reason I wanted a short-acting version in case things went wrong.) And the bias to action means I'm responding to emails that I usually might ignore. That experience of undirected overactivity rather than undirected struggle leaves me thinking I need to learn more self-control still.
By the way, I shared the video with a professional in the neurodiversity field of 15 years, and they described it as the best and most informative short briefing on ADHD they'd seen.
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Post by Deleted on Oct 4, 2021 18:14:10 GMT
Good points. I always consider ADHD as being a lack of functional anxiety. I consider impulsivity to be completely 'amusement' related. Bias for action (yes, I nicked this from Amazon's leadership principles nonsense) is more when I'm engaged in something meaningful, constructive and future oriented and there is a definite bias for action in this direction, for me, once I've swallowed one of those tablets. I would liken it to the functional anxiety everybody else appears to have by default. My life is still hilariously upside down by any standard measure so WTF do I know?
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Post by cassandro on Oct 18, 2021 13:24:00 GMT
Again, thanks for the useful insight. 'Lack of functional anxiety'. What makes anxiety 'functional'? I used to get vaguely uneasy about approaching deadlines, but not enough to trigger action, possibly anxious about lack of anxiety. I think I found 3x5 mg MPH IR if anything slightly relaxing. 3x10 mg seems to create a generalised anxiety, and the restlessness and impulsivity are possibly worse - part of this is my consciousness of the drug effect: hey, I'm doing something! Scary! Now I'm going to have to take responsibility and decide what I should be doing. Hilariously upside-down? At least you see the funny side.
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stonesfan
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Post by stonesfan on Oct 24, 2021 10:44:19 GMT
The supplements I take as alternative to pharmaceutical stimulants
Omega 3 oil (brain function) Rhodiola Rosea - (Stress) 200mg before breakfast , 200mg after lunch Vitamin B complex - (Stress) with breakfast Ginseng extract tea - (attention) 1 in morning & 1 in afternoon Mindlab Pro - (attention) 1 in morning, 1 in afternoon Espresso 2 x per day - attention Black tea 2 x per day - attention Green tea 1 x in afternoon - attention Ginkgo tincture (memory) - when I can remember! Vitamin D spray (Anti Covid) with breakfast & at night Zinc (anti Covid) with breakfast & at night Multivitamin - (general health) with breakfast CBD @ bedtime
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stonesfan
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Post by stonesfan on Oct 24, 2021 11:14:16 GMT
Also starting 12 weeks of CBT next week.
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Post by Jimmy on Nov 7, 2021 10:52:02 GMT
Also starting 12 weeks of CBT next week. I have web on elvanse for 3 years my diagnosis came late in life and made me realise how many mistakes I’d made. When I went to school it was not recognised and it was often said I couldn’t focus and was badly handled. It’s ruined many relationships and 3 marriages . Things are a bit better now as at least I’m aware of the problem which makes me stop and assess what I’m doing and should I be doing it !
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Post by cassandro on Feb 8, 2022 15:01:39 GMT
I don't think it's worth starting a new thread for this given all my context is above. My question this time is:
How do you know when you've found the right dose of a stimulant?
I'm now prescribed 3x15 mg methylphenidate (standard release) and getting the nausea and anxiety above and getting a bit 'hypomanic' at times, talking non-stop. Really, it's like I'm still getting all the impulsiveness to do things, without any inhibition, so just as hard if not harder to get any useful work done. I'm feeling very tired in one way but not in another. Yes, I start stuff, but am I starting the right stuff? I also think the medication can trigger hyperfocus, but not usually on the right stuff; then I wonder where the day has gone.
Can anyone please share experience of being on the right drug, but too high a dose? Or too low a dose?
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Post by Deleted on Feb 8, 2022 21:55:31 GMT
My brain used to work quite well on 120 elvanse. Clarity. Objectivity. No fatigue. No compulsion to give everyone advice they didn't want to hear or relay endless personal anecdotes after hearing their first syllable. Now on 70 elvanse. Lost two jobs already and clarity feels like a dream I once had. All these things you describe I can't really relate to. I dunno if I'm 'lucky' or what but I've never felt anxious, jittery or high on elvanse. Barely feel anything at all. I think I maybe felt a bit odd on concerta once but even that was ultra subtle in general. What's your job / circumstances? Do you feel you need to have immediate results? Titration can be infuriating. It's not like we have ultra granular options backed up by excretion analysis for the perfect therapeutic / physiological dose. It's a needle in a haystack but the hay isn't actually hay, it's shit. Meanwhile, time marches on, opportunities evaporate and everyone still thinks you're a twat
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Post by cassandro on Feb 11, 2022 15:12:08 GMT
I'm not that used to feeling things either, particularly not anxiety. I'm more noticing differences in my behaviour that might be constructive in the right circumstances, but my activity is just expressing what's on my mind or reacting to stimuli, not really relating to what I want to do, whether work or otherwise. My work is in IT, with a variety of problem-solving tasks. That makes prioritisation difficult; difficult to know where to start may be why it's difficult to start, particularly when left to my own devices. Also often difficult to stop. It's taken more 6 months to titrate this far. 'Immediate' to me would mean getting it right in a week or two. It doesn't need to be that immediate, but psychiatrist appointment has been cancelled owing to an administrative mistake, and the nausea is very offputting. Nausea may be worse if I start again after a few days' break, but it's there as soon as I've taken more than 15 mg in the day.
'No fatigue' is a dream that still taunts me. Fortunately as far as I know people don't think I'm a twat: I am surrounded by kind people and they can see I'm struggling. It's possible the side effects for me kick in at a lower dose than the beneficial effects and I could maybe try dexamphetamine instead. The fatigue may be something other than lack of stimulation or stimulants, eg I'm wondering about poor supply of glucose and/or oxygen to my frontal lobes.
Thanks for the reply anyway.
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