this post was submitted on 23 Oct 2024
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ADHD

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What improved immediately with meds - and what didn't (lemmy.ml)
submitted 1 day ago by [email protected] to c/[email protected]
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I have used Modafinil before occasionally, and it helped quite a bit, but the strong side effects forced me to save it for emergencies.

6 days ago first Elvanse. Within about 30 minutes of the first dose, many problems were gone completely! No mental effort to do what's needed, be it laundry or a subtask at work. It feels like my brain is a little butler whom I can just order around without doing it myself. Many things just happen, e. g. I put garbage in the bin, carry dishes back to the kitchen as I go anyway, without thinking about it. Complete instant fix. Also a constant feeling like a hundred bucks, better than many recreational drugs.

Almost feeling bad when gaming at the end of the day, keeping it brief, doing extra work hours right before bed. The effect has somewhat worn off by then, but the no-effort-to-do-things is still there.

I always did feel better when checking things off my todo-list, even untreated, but now I get a lot more done, since there is no pain to just do it.

I can also work out until the body just physically gives in; there is no mental barrier to fight like "ONE MORE REP!!!". It might have been a mistake to exploit that in the first few days, leading to exhaustion and more difficulty to judge the right dose / side effects. When I saw someone who was very buff, I used to think: He may not look like it, but he has fantastic discipline, focus and willpower. Now I wonder if some of these people are just normal, lol

This is a completely different life, and slightly better than Modafinil! I am a little worried about when the effect wears off and I need a break, but I've been there before: A lot can get done with just about 50 "super-days" per year.

What did not improve one bit is my forgetfulness and other cognitive problems. Just as stupid as before, e. g. packing a suitcase, putting things next to it to stash something else and then forgetting them. Leaving my phone in insane places. Barely able to use the self-checkout at a supermarket. It's always an adventure, looking confused between the card screen and the items screen, often needing an employee, forgetting my card there and not realising before the next day etc. Problems with web UIs & pop-ups. That's what my GP wanted checked out 1 1/2 years ago, but no appointments.

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[–] [email protected] 3 points 11 hours ago

I've taken Adderall for the past year and tried some other stimulants. So far adderall is tolerated better by my body and and wallet compared to other meds.

Improvements: Follow-through with tasks since I can hold an idea or thought to the end. Being okay with good enough, I am not fighting my self to make it perfect and just move on. I can read a book. Math is actually interesting since it doesn't feel like I am looking at a shattered mirror of scattered lessons. I am suprised about how much stuff I have retained from school but couldn't utilize. My handwriting is great and doesnt feel like a chore to make it legible. Conversations feel like I'm actually in the room and participating. I don't know how I did customer service and retail before.

What did not improve: My short term memory still sucks. Playing 20 questions to get a super simple concept out is shorter but still happens. Procratination is just different, now I do some productive stuff while procrastinating so maybe it's an improvement. While doing things is easier, the planning phase of anything is a game of moving deck chairs on the Titanic and I just improvise in the end. Time is still an illusion and holy fuck I'm late for work.

[–] [email protected] 2 points 14 hours ago* (last edited 13 hours ago) (1 children)

Also a constant feeling like a hundred bucks, better than many recreational drugs.

Be aware that the euphoria is a temporary side effect and will only last for a week or two. The "actually being able to do things" part will remain, but feeling like a hundred bucks is due to the drug literally being an amphetamine and will fade as your body becomes tolerant of the dosage level you're taking.

[–] [email protected] 2 points 11 hours ago (1 children)

I was afraid it might be like that. Also quite possible that the euphoria does part of the job, so I actually need more. Low dose opioids have a similar effect on me - I'm euphoric, I get things done. So currently, it might even be like 60 % euphoria, 40 % noradrenalin, explaining that I need only 12 mg when the lowest child dose even is 20 mg. I might end up with something like 30 mg.

The danger I see is that I think I need to up the dose to match the euphoria from the start, while I actually need to get to the point where it's 0 % euphoria, 100 % noradrenalin.

Very much simplified, if not wrong, as noradrenalin might be a main contributor to the euphoria.

[–] [email protected] 2 points 10 hours ago* (last edited 10 hours ago) (1 children)

I found that the initial euphoria helped me get out and do things I normally wouldn't (like catch up with friends and family I'd lost track of over the years), and the satisfaction from that helped keep me naturally happy after the false euphoria faded. Your mileage may vary, but actually getting things done for once helped a ton with my related disorders like anxiety and depression and things weren't nearly as bad even when I started feeling normal again. And remember, the medication's ability to let your brain feel motivation doesn't fade, only the euphoric feeling.

The danger I see is that I think I need to up the dose to match the euphoria from the start, while I actually need to get to the point where it's 0 % euphoria, 100 % noradrenalin.

That's one of the main things my doctor warned me about when I started taking Vyvanse. He said that even though it might feel like your medication isn't working as well, to not to chase that rush because it won't actually help your symptoms and you'll quickly become tolerant of the higher dose as well. All you'll accomplish is paying more for a higher risk of side effects.

Not to mention if you appear to be a drug seeker they might decide to switch to a different, non-controlled medication that doesn't work nearly as well as what you're currently on.

[–] [email protected] 2 points 9 hours ago

This is certainly very helpful as it is. The way I had to live below my potential, I need only like 50 good days in a year. If things don't work out as I hope, I could use Methylphenidate 50 times per year to achieve that.

Overall, I thought there is not such a clear separation between the euphoria and fixing the ADHD symptoms, as both are caused by noradrenalin, among other things. However, after some reading today, I realise that the intended effect of the medication works with such neurotransmitters in the prefrontal cortex and can very well do so over years, while euphoria is caused by the same neurotransmitters, but elsewhere.

[–] [email protected] 6 points 1 day ago* (last edited 15 hours ago)

So. I've kind of had two eye opening moments with meds.

I first started with concerta, and it was like stepping into the light. The problems were certainly not gone, but they were at least manageable. I could break out of mental loops that were not productive, and focus on stuff I actually needed to do. I still had a bit of an obsession with being as near-perfect as I could, but I could focus those efforts into things that were actually useful, instead of my mind going in circles.

It improved my emotional state. I was kind of in a long term funk of "everything is meh", and I found myself smiling so much it hurt my face. A lot of that diminished over time, but it hasn't gone away, it's just less intense.

Recently I started on an NDRI, Wellbutrin, which had more subtle positive effects. Immediately I noticed the negative side effects, dry mouth, some GI issues. I stuck with it for a week and most of that has subsided. I dunno if the negatives made the positives more shrouded, or if the positives are just minor in comparison, but I find my emotional state and attitude is more on the positive side rather than sitting fairly firmly in the middle.

As for my usual ADHD symptoms, with the combination of the concerta and Wellbutrin, I have little or no difficulty doing the little routine things that I always had to push myself to do before. The phrase "super easy, barely an inconvenience" applies to all the little trivial tasks I do daily, when before it was always some level of mental effort to get myself to do things.

I feel more "normal" now than I ever have before.

I must say, if this is how non-ADHD (and/or non-executive function disorder) people are, then I get why they don't understand us. This is an easy, quick, and trivial task, it takes no time or effort to do.... But when you have an executive function disorder, the task might as well be "climb Mount Everest" not "fold laundry".

[–] [email protected] 10 points 1 day ago* (last edited 1 day ago)

Immediate:

  • Focus on a task because I decided to do so
  • Stay focused much longer without becoming exhausted or frustrated
  • More respectful in conversations because I was able to stay focused on what they were saying. I also remembered what they said.
  • Hope that things could improve

Long-term:

  • More confidence in myself
  • Reduced shame that I was rude, disrespectful, or careless about others. Paradoxically, this lead to me setting better boundaries when overwhelmed because I didn't see them as rude.
  • Less reliance on notes
  • Less anxiety that I forgot something important
  • Less vulnerable to manipulation because I was able to see patterns better since I could remember interactions more, and I was more confident that what I remembered was right.
  • I was able to structure my days better. I developed a daily routine, eat healthier, and establish sleep schedule.
  • More awareness as to what were issues I was having because of ADHD
  • Felt more like a person than a problem

What surprised me the most was that all of these are apart from work. I had no idea how much ADHD was affecting my overall life. When the psychiatrist said that treating it would be really impactful to my mood, I thought she was just trying to lift my spirits and get me hopeful. Nope. She knew exactly what she was talking about.

Edit: Whoops. These all were things that improved. What didn't improve was things that were related to other matters, such as anxiety in crowds, lack of trust in others, general sense of doom, etc., but I'm working on it! Being able to plan and follow through is fantastic. Ohhhhh, is this what executive functioning is??

[–] [email protected] 4 points 1 day ago (1 children)

Modafinil and Dexamphetamine sure - but have you tried Methylphenidate then?

(Parent with ADHD kids here)

While Modafinil has support in the literature I don't think it's prescribed officially for ADHD, and due to the different way they work the top choice for ADHD is usually Methylphenidate rather than Amphetamine.

Whatever works for you is the best for you though, I was just a bit surprised :)

[–] [email protected] 3 points 1 day ago

GP and therapist also said that methylphenidate is the way to go, without alternative, even. But the psychiatrist said that for adults, lisdexamfetamine is slightly better, both regarding best effect and lowest side effects. A quick web search seems to support that, as well as what people in this community, who tried both, said.

One disadvantage is the insurance: If I try some day to have it covered, it's quite likely that they insist to pay only for the cheaper methylphenidate, and only switch if there are significant problems.

I found this German source for dosage and finding the right medication very good: https://www.adxs.org/de/page/232/eindosierung-von-medikamenten-bei-adhs#content-241-elvanse-lisdexamfetamin

[–] [email protected] 11 points 1 day ago* (last edited 1 day ago) (1 children)

I can focus longer on tasks I don't want to do, like pointless work tasks and can retain information in the shirt term longer than without meds. Completion of large and complex work doesn't end up being a downward spiral of 'what if' side tracks that aren't relevant, and refraining from speaking up when not needed is way easier. Social interactions are a lot less stressful because i say what I'm actially thinking snd not drifting into random tangents.

What didn't work is long term retention of learned skills. Whole meds helped with doing new things in the short term even when uninterested, I still have to relearn most things I haven't done for a few years. Honestly that is the worst thing for me related to ADHD, repeating all of the same mistakes any time i do something I don't do regularly and instantky remembering how I made that mistake the last two times I relearned it.

[–] [email protected] 6 points 1 day ago (1 children)

I can relate to the paralysing "what ifs".

[–] [email protected] 4 points 1 day ago

Yeah, being able to focus on the important ones is such a huge benefit of meds when doing large and complex processes that can have an endless number of possibilities.

[–] [email protected] 18 points 1 day ago (1 children)

[off topic?]

Any time you start a new treatment it's a good idea to keep a log of how you feel.

[–] [email protected] 2 points 11 hours ago

One of the things that didn't improve for me, keeping records ~~of things.~~

[–] [email protected] 3 points 1 day ago (1 children)

What is your dose?

[–] [email protected] 5 points 1 day ago (1 children)

I started with 5 mg, which had a significant, great effect for 4 hours, then crash. I worked up from there and think that 12 mg is the right one for now.

I followed this guide in German, and agree from experience that starting with 30 mg or even 20 mg is not a good idea: https://www.adxs.org/de/page/232/eindosierung-von-medikamenten-bei-adhs#content-241-elvanse-lisdexamfetamin

Interesting is their take that the right window +/- 5 mg must be hit, otherwise too low of an effect or very unpleasant side effects.

For Modafinil, I also went with 1/8th of a normal dose for a while, working up over months to 1/2.

[–] [email protected] 2 points 15 hours ago

I'm glad it's working for you. I had a similar experience. It's called Vyvanse in the States. Your post caught my eye as I thought maybe there was a different drug for me to look into.

I started on 10mg for a month and worked up to 40 for work days and 30 for non-work days. I took concerta (Ritalin) for a period about 10 years ago. I get some mood swings and headaches when stimulant meds wear off. I don't like taking the meds on weekends so I was stuck in a cycle where Monday evening I would be extra grumpy and have headaches for about 2 hours and then it would disappear. I figured that it was due to the med wearing off. After starting Vyanse I was fine for a couple weeks but then started noticing the same pattern. Headaches and a hatefull mood on Monday evening. My Dr and I came up with a plan to not stop the med on the weekend, instead take a smaller dose. This really works well for me. I'm able to get stuff done on weekends too and it solves my headache and mood issues by getting a bit of a break but maintaining a certain level over the weekend.

My complaints are feeling like it mutes some positive personality traits, weight, and sleep. My wife has more difficulty reading my facial expressions sometimes, which leads to some assumptions that may not be correct. She'll think that I don't care about something we're discussing because I don't appear to react.

I've lost about 30 lbs or 15kg. I really noticed the appetite suppression when I started taking Vyvanse but I think that's leveled off. I really think I eat like normal but my wife tells me that's not true. Truthfully I'm happy about the weight loss but I need to make sure not to let it get out of control.

I've been a night person my entire adult life. It's led to only getting 5 hours a night even when I'm off meds. Now sleep is even harder. It's not so much falling asleep that's the problem, it's that I'll wake up after 5 hours (even if my alarm is off) and not be able to go back to sleep. I've tried melatonin and it seems to help but I have to get the timing and dose right. If my alarm goes off before the melatonin wears off I'll be very foggy for 20 min or so in the morning.