Every screening and official diagnostic I’ve taken has me scoring max ADHD points and every time someone describes a symptom I’m left confused that other people don’t have them.
Will my personality change? I feel like being a disorganized disheveled loud interrupter is most of my personality at this point idk.
I’ve never done any stimulants beyond drinking a million coffees per day so i have some anxiety about this
ADHD medication isn’t a magic cure that makes all of your ADHD symptoms vanish, it just makes it easier to deal with them.
Stimulant meds will vary in effect depending on the person. Dr Russell Barkeley, a recognised global expert in ADHD, puts the efficacy of stimulant meds at about 40% for the amphetamine-based meds and about 40% for methylphenidate, so about 80% of ADHDers respond well to stimulant meds. For me, I barely respond to methylphenidate. For others methylphenidate is a game changer. Go into it open-minded but without any particular expectations.
It’s a good idea to go easy on caffeine, especially in the early days of stimulant medication.
Generally ADHDers find that stimulants reduce their anxiety levels.
Starting on stimulant meds usually comes with mild euphoria. Enjoy it while it lasts, don’t go chasing the euphoria though.
If you have a history of significant trauma then often stimulant meds give your brain enough breathing room to start processing that old trauma, like it or not. This can get a bit hectic for people who have a lot of unresolved trauma so if that’s you then make sure that you have the right supports in place.
Stimulant meds will change how you manage things and how aware you are of stuff in general. This is almost certainly going to change your close relationships, sometimes for the better and sometimes for the worse. At its best you’re going to be a better friend and partner because you’ll be able to attend to other people’s needs and be more consistent with coming through for them. At its “worst”, you might come to the realisation that you are being taken advantage of or you are being abused. Just be aware of this.
If you are also autistic, auDHDers find that their autistic traits become much more apparent and that they find it more difficult to mask when taking stimulant meds.
You will have a lifetime of unhelpful habits and beliefs that you have accumulated over your life up until this point which are unsuitable or downright counterproductive for an ADHDer. Meds make the doing side of things easier but the habits and beliefs will have a much longer lag time and you’ll have to work on those, ideally with someone who understands ADHD well.
ADHD meds will give you the ability to focus and sustain that focus, which is wonderful. They don’t instantly provide you with the self-discipline to focus on the most urgent priorities though so you might find yourself furiously researching some historical event or reorganising your kitchen when you really need to be packing your bags for your flight.
Often ADHD symptoms and an individual’s psychological response to them can mimic depression and treatment-resistant depression. You might find that if you’re prone to depression that some of this is alleviated by the meds.
Overall it’s better to stay consistent with taking ADHD meds even on off-days or weekends because it will make it much easier to establish different habits and a new attitude towards things, however it’s also okay to take medication vacations particularly in the early days as you’re adjusting. My general advice would be to avoid taking medication vacations more than once a fortnight, except where there’s good reason (e.g. you’re sick, you’re having difficulty with side effects, you need to sleep in).
You will be able to push through without food, breaks, or sleep. Don’t do that. Schedule in breaks, make sure that you are eating well and getting enough sleep or you will crash and burn.
You may find that you have a significantly reduced appetite. Try to have a good, high-protein breakfast in the morning to carry you through. Protein shakes and smoothies are ideal.
Depending on what you get prescribed, you might benefit from a prescription that is somewhat higher than your baseline level of need - stress, lack of sleep, poor eating, unusually high demands, lack of physical exercise, and similar things can all make the meds feel less effective or ineffective so having some wiggle room to adjust upwards on the meds based on your needs is Ideal.
If you menstruate then you go through a hormonal cycle where you will naturally have less dopamine in your nervous system. ADHDers who menstruate very often suffer from PMDD. ADHD meds can often help relieve symptoms of PMDD however the meds often feel less effective or ineffective so it’s ideal if you are able to increase your medication dosage around your period.
I can talk more about managing insomnia and increased anxiety on ADHD meds as well as second-line ADHD meds if you need the info but that’s likely something for down the track, if you encounter these things.
Edit to mention that I’m also pretty knowledgeable about the less commonly prescribed ADHD meds and all of that stuff as well so if you have any questions about ADHD (not to mention autism, mental health, and medications more generally) then let me know.
This was an excellent writeup.
Lifelong medicated inattentive ADHDer. I would recommend giving the meds a shot; start with a low dose, ramp up a bit, see how it feels. I have had some make me feel suicidal. I have had some make me feel no different at all. I have had some give me involuntary movement disorders. I have had some that caused constant rage. As long as I was able to keep “this is medication, not me” at the front of my mind, I was able to finish the test script and ask to switch to something new.
I would not have a career without them. The script I am on now has been an absolute game changer and I’m putting out the best work I have in my life, with minimal side effects (appetite (I was very overweight anyway, I see this as a bonus), sleeplessness). My depression and anxiety are almost entirely handled by just the ADHD stimulants now, since I’m capable of handling and reacting to things without getting distracted, before they become disasters.
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absolutely goated
I don’t think I’m autistic but I certainly noticed a lot more of my ADHD symptoms when i got my depression under control. I really appreciate the informative post thank you
Great writeup! For me I’m struggling with a situation where I know exactly what helps me but I can’t tell my doctor how I know that 👀
If you have auADHD you might find that you’re especially sensitive to medication, and the starting dose might be a very unpleasant experience. A “normal adult’s” month supply lasts me 4.
I wish I had read your comment before I started medication! 😂🤦 Especially points 6-8.
definitely need to work on 9
thank you for this ❤️
You and me both, comrade.
Stimulant meds thoroughly turned my life upside down. I wish I had a bit of a warning about it but oh well, too late for that now.
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So the neurochemical side of anxiety is a bit tricky to pin down because often, especially for ADHDers, it’s a lack of norepinephrine (adrenaline) that causes it however you may be very sensitive to it or you may have an excess of it which is causing anxiety instead. Because of course it’s not just a simple matter of it being an excess - that would be too simple.
There’s really only one way to find out and that’s via tinkering with your norepinephrine levels. Sorry that I don’t have a clearcut answer for you.
If you’ve ever taken a medication that is an SNRI or that has similar norepinephrinergic effects, e.g. venlafaxine, you’ll be able to get a decent understanding of which side of the norepinephrine equation you find yourself on.
It’s hard to know exactly what would be the right path forward in a general sense because it’s important to understand the causes in order to address them. For example, one person might have disordered eating due to being extremely anxious all of the time and then the fix is “simply” to treat the anxiety and voilà. On the other hand if the disordered eating is rooted in something like body dysmorphia then doing something to increase appetite such as trying mirtazapine may help appetite but it might aggravate the underlying psychological issues and make things worse.
As very general advice, for ADHDers who experience anxiety and insomnia I think one of the best options is trying clonidine. This doesn’t work for every ADHDer but it helps with impulsivity, anxiety and the trauma response, rejection sensitive dysphoria, and insomnia.
I have also had really good success with amantadine for treating anxiety, plus it’s a dopamine reuptake inhibitor which is an added bonus for ADHDers although its usage for mental health and ADHD is still very very much in its infancy and I’ve been trailblazing its use where I live and you’d probably need a prescribing doctor who is comfortable with prescribing off the beaten path. Amantadine has a very low side effect profile and it seems to be very well tolerated.
Fair enough. Don’t go over sharing beyond what you’re comfortable with but if the concern is addiction issues then keep in mind that appropriately medicated ADHDers have a way lower risk of addiction because that need for dopamine is already addressed by prescription meds and so the urge to engage in behaviours that provide that kick are usually dramatically reduced and much more manageable. There are some meds like Vyvanse that are pretty difficult to abuse as well. Stimulant meds will reduce your appetite so this can be a problem for people who are prone to disordered eating like anorexia. It’s a bit of a crapshoot to figure out if stimulant meds will increase or reduce anxiety too.
As for alternatives, I think that guanfacine is a pretty safe bet - the side effects aren’t wild and it can help with anxiety, although I think that clonidine works better in this regard. Dosage for adults is a bit tricky but I’ve heard reports of very high doses working for some people - in the vicinity of 6-8mg. Guanfacine usually works best as an adjunct medication.
There’s a lot of norepinephrine reuptake inhibitors that may help but I won’t go into depth on them. There are a few dopamine reuptake inhibitors, such as atomoxetine, but as these are mostly antidepressants they tend to come with significant side effects (atomoxetine especially) and it takes a while to taper up to the right dose. That being said, for some people a medication like atomoxetine is a complete game changer. Atomoxetine also increases dopamine in specific areas of the brain, which is unique to it, and thus it lacks the broad-spectrum effect that a classic stimulant has so it can work really well for some people but for others who have a more global dopamine issue it may have a limited effect or no notable positive effect.
One medication that I think is grossly underrated by psychiatrists for ADHD is modafinil. While this is technically still a stimulant, it’s not the same as the classic stimulants and it does not have any significant norepinephrinergic effect nor does it have significant addiction potential. The lack of norepinephrinergic effect can make it less useful for certain people but, where classic stimulants are not tolerated, it can be a good option. Just keep in mind that it’s drug that has sulfonamide and thus if you have any allergic reactions to meds this may not be suitable for you and you want to know the symptoms of Steven-Johnson Syndrome just to be aware of it if they start to manifest while taking modafinil. It’s not a huge thing to worry about but there’s a small chance of it happening so it’s always worth mentioning when talking about modafinil.
I can speak to personal experience with a lot of this stuff but tbh my experiences are a bit more uncommon and it’s probably better going into this stuff with the understanding of how these meds generally tend to work than it is understanding my less-usual response. I hope this is helpful!
I have taken Straterra(atomoxetine) before. It made me feel “normal”. I had to stop taking it because of some gnarly physical side effects, and that annoyed me because I felt I was able to integrate into society better while on it.
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The less commonly prescribed ADHD meds that are still common-ish imo are:
Atomoxetine
Guanfacine
Bupropion
Viloxazine
Venlafaxine
The much less commonly prescribed ADHD meds imo are:
Methamphetamine (not a joke btw - Desoxyn is prescribed in the US occasionally)
Clonidine
Modafinil (technically still a stimulant but without most of the issues that may come with stimulations such as potential for addiction)
Tricyclics like desipramine
There’s a few more that are really off the beaten path such as amantadine, which I’m a bit of an evangelist for, as well. It’s worth keeping in mind that non-stimulants aren’t a class in and of themselves so there’s not a huge amount in common between, say, atomoxetine and guanfacine.