Managing ADHD
A personal account of how ADHD affects me and the overwhelming benefits I found from seeking help
ADHD is under-diagnosed in the UK.1 I'm one of the lucky minority who's actually been diagnosed with it, and I've had a weird relationship with my diagnosis since I got it in my early 20s. I don't think I really accepted that I had it until I tried medication and it had an outlandishly big effect on my life.
ADHD is not a condition that I understood well, even after being diagnosed with it. Only when I started to manage it did I begin to see just how far-reaching its effects are in my life. Off of the back of that, I wanted to write a bit about the effects of ADHD medication and my experience of it with the hope of even enlightening one single person who might be helped by it like I might have been. It's to maybe spread a little bit of awareness about what it can actually look like, and how it might be improved, particularly in today's society where the rhetoric is that we need to be investigating rising levels of demand for ADHD care as if it's a bad thing, not investing more in it to combat the historic under-diagnosis of the condition.
For context, I would say that I have moderate ADHD - it is absolutely not as bad as it could be, but even then, the level of benefit I have achieved from receiving care for it is massive in a way that I can't state. That said, nothing on this page constitutes medical advice. Discuss medication and your care with your own practitioners and do as they say. I am not you, you are not me, what is right for me may not be what is right for you.
Life Before Medication
In retrospect, signs that I had ADHD were present in childhood. In year 3 of primary school, I was put on a behaviour plan because I was disruptive and fidgetey. All throughout primary school I would constantly get told to "stop tapping!!!" on the table; I think that and similar things led me to get moderately good at masking.
In secondary school, I made silly mistakes, I would get distracted so easily and I would struggle to concentrate on anything unless I was really really into it, at which point I would struggle to tear myself away from it. But I got on fine academically, as I always have done, and I believe that might have contributed to nobody ever pointing it out to my parents. That's not to say that the level of effort I had to put into my school work was sustainable or appropriate - but I was motivated enough by the "gifted kid" need to get into a good uni that somehow it got done anyway.
After getting to know someone in 6th form who had ADHD and learning a bit more about this thing that I'd never really heard of before, I started to see parallels in myself, but I never persued diagnosis until the effects became really bad when I started university. At that point, the total loss of day-to-day structure and rigid guidelines and support ruined my ability to get work done. I was constantly behind, stressed, floundering a fair bit, and burning out hard. By the end of each semester, I'd be exhausted and drained and a bit miserable.
While all this was happening, I came to realise that my peers weren't struggling as much as I was. I have perfectionist tendencies, so I was pushing myself harder and harder to do as well as I could, and while that was paying off for some of my friends, it really wasn't for me. I'd keep trying harder and harder and instead of anything happening, I eventually gave in.
It got so bad that, at the end of my third year (of four), I failed two modules because I simply couldn't bring myself to pour the incredible amounts of effort into them that I'd have needed to pass those as well as the other four modules I was taking. Before that point, I don't think I'd ever been in a bad enough state to simply not care at all like I did then. They were modules that I hated, that I found incredibly difficult, that I had to force my brain to think about at incredible expense, that I pretty much found impossible to think about. It's hard to put into words just how viscerally done with them, and learning in general, I was.
At a similar point to all that going on, a friend gave me a stern word and suggested that I maybe look into getting help with my ADHD. So I sought some help, ended up starting medication and, for the first time in my life, I could think in a straight line. That was the point at which I realised ADHD is a disability, one that I have, and it is not something that can just be powered through.
What Medication is Not
It's important to say that ADHD medication will not completely fix one's life. It will probably help, a lot. You'll probably wish you'd sorted it sooner. But ADHD is a complex condition, with very wide-ranging effects, and medication won't touch all of them.
Foremost (I think) is the emotional side of ADHD. ADHD often brings intense rejection sensitivity. It's brutal. It severly undermines all of your relationships. It's often impossible to recognise without being told about it. It changes the way you behave and the things you do, it alters your confidence, it messes with your self-worth and it stops you doing things out of fear. If you have no idea what I'm talking about but you think you have ADHD, look it up.
Rejection sensitivity is not something that medication will touch. It also might not remove all cognitive symptoms that you have completely, and meds will always wear off after a while as well. It also won't heal scars left by a life of coping. You are a sum of your prior experiences, and sometimes that might require professional theraputic help.2
Medication Practicalities
My meds are a pill that I take one or two times a day. I take it with food, usually in the morning with breakfast, and later in the day with a snack if I need it.
There are various different types of ADHD medication, but the one I am on is the most effective one in adults - I was told that it works for about 80% of people. It's called methlyphenidate, and comes in various release profiles and formulations.
In its plainest form, methlyphenidate is an immediate release drug that lasts for about four hours. When I take that, I start to feel the effects within about half an hour. They wear off about 3.5 hours later.
I use that form of methlyphenidate to supplement my main dose that I take each morning. My main dose is of an extended-release formulation that releases the active ingredient in two bursts - one immediately, and one four hours later when the first spurt wears off, giving it a total effective time of about 8 hours. I use the supplemental dose after the second dose if I've got a longer day ahead of me.
There are many, many other drugs and formulations available, and if you do start medication, your practitioner should walk you through these, and will work with you to fine-tune a regiment that works best for you (in a process called titration). For example, my extended-release drug has equal strength doses within it, but some have a weighted dose that, say, releases 70% in the first and 30% second, which suits some people better.
Effects of Medication
My dose of meds are such that I do not feel the meds themselves; I instead notice that the effects have taken effect when I try to do something that I would otherwise struggle with; I begin to be able to focus and some of the mental skittishness that I associate with my ADHD starts to go away. But this is not the case for everyone - this section might differ heavily to anyone else's account.
The really big thing I notice is that boring things become incredibly easy to do. Relatively speaking, anyway, and it's honestly such a thrill. To be able to sit down at a desk, lock in and crank out some work that you just need to get through is exhilarating, at first, and then it becomes normal and useful. When I'm on medication, I can sit and stare at a maths problem and crack it without feeling like I'm losing my mind while being unable to hold all the context in my head and getting very frustrated.
My working memory also improves. Holding small details in my head is effortless, and I don't end up staring into space trying to remember the thing I was just about to use. This also goes for sentences and day-to-day chorest - I don't forget the thing I was saying mid-way through speaking, nor do I forget about the next little task I was going to do around the house.
Executive function also improves massively. Instead of sitting in a involuntary procrastination pit for hours and hours on end at the prospect of doing something "difficult" (read: boring), I can just stand up and get it done. Washing? Sorted. Hoovering? Done. Bed? Changed. You get the gist.
Because of all of these being true, I became less stressed, and less desperate. I feel the need to knuckle down and get stuff done and capitalise on every waking moment so much less, because I know that I can be able to sit down and do things at some other point of my choosing, and it'll get done. It's blissful, and so relieving. It takes an unspeakable weight off of my shoulders, to the extent that I fear that I am not truly communicating how good the above can be. I wonder if it is just something you have to experience to understand, but I can say that I am continually surprised that I survived the first twenty-one years of my life without any support whatsoever.
This is not to say that the above are all gone - some days, your meds will work less well, and some days they will work better. This can be influenced by so many things - other stressors in life, a bad night of sleep, someone sat next to you being an insufferable git... But there are all things that everyone else on the planet has to deal with too. On ADHD medication, you're closer to the level of focus and mental control that is baseline for the rest of the population. And I think that's pretty neat.
Side-Effects and Titration
There are no effects of medication without side-effects.
The big one that happens for me on my drug is a worsened sense of interoception - the awareness of how your body feels. I often find that my medication will wear off to reveal a sense of absolutely ravenous hunger or the bursting urge to go for a wee, simply because these are things that I have not noticed I am feeling while my meds were working. They don't go away entirely, but they definitely wane.
To some extent, that is also a sensation that is stronger the less time you have been on medication. The longer I am on medication, the less these symptoms show - the interoception one is the main one I experience, and I experience it less than I did originally. When I was starting out, however, I also did get things like a slight food aversion when my meds were active, headaches as my meds were wearing off and a heightened sensitivity to caffiene (to this day, however, I still drink coffee and get zero buzz from it or caffiene unless I consume a large amount in one go through something like a can of Monster). These all faded with time, and they are not a problem for me any more.
These are all things that you would be warned about by your practitioner should you start medication, and they are things that will be montiored closely too. I have regular medication reviews where my height, weight and blood pressure is checked, and I'm asked a set of questions to make sure I am in good health. Support and monitoring is there, and is important, but they're ultimately just precautions since these are safe, effective medications. As someone who feared them for a long time, they are really not something to fear.
Making medication as effective as possible is finding the balance of monitoring and controlling side effects and the level alleviation of your symptoms. Practically speaking, this is done through a long-running, open-ended discussion with your practitioner. Mine offered me options, asked if there were any subjective things I wanted to change, if issues I was experiencing, if there were new things I would like to try, and so on and so forth. I mentioned earlier that I do not feel the meds themselves taking hold - that's a conscious decision. I could up my dose and get that feeling if I wanted, and some people do, but I don't. The same goes for release profile, timing and all sorts - each are adjusted as a collaborative effort to get the right regiment for you, so much so that I've described it as Build-a-Bear for medication before now.
To Conclude
I hope this has given a little taste of what post-medication ADHD is like, and how it might help you should you have ADHD.
At first, I was very skeptical of meds. I wanted nothing to do with them, because I thought I was better than needing to drug myself up on these spooky, scary controlled drugs just do so anything. Looking back, that was not a healthy mindset, because ADHD is not something I could possibly will away or control in the way I thought I could. It's a mindset that's influenced by the likes of articles such as the one linked at the top of this post.
I very much have not described the full scope of my ADHD, or the things it does to me, or the ways I experience it with and without medication. Hyperfixatons, for example, didn't even come close to being included. The effects are truly so far-reaching that I have trouble recalling them all and describing how they work. I'm willing to bet that I don't even realise some bits of it, even now.
If anything above resonates with you, please, do some research and take long, hard, hopefully-objective-ish think about the way you interact with the world, and consider seeking help and support if you think there's even the slightest chance of it helping you. <3
Thoughts? Corrections? Questions?
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