Something Shiny: ADHD! - A Conversation About ADHD Medications - Part II

A Conversation About ADHD Medications - Part II

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03/30/22 • 31 min

Something Shiny: ADHD!

The importance of having a therapist or someone who can help you monitor medications if you are on them. Isabelle describes what it’s like to be off of her ADHD medications while she’s been pregnant/breastfeeding children the last couple of years (stimulant medications, see below, are often not recommended during pregnancy/breastfeeding, though other forms of meds are safe for pregnancy/breastfeeding—another reason why it’s so important to have empowered conversations with your doctors, prescribers, and therapists!) It’s hard when part of your accommodations is medication and that leg of your scaffold is not available. Non-medical or pharmaceutical interventions for ADHD are effective and include: diet, working out, getting adequate sleep, mindfulness activities (not all the time) but a practice during the day can help with frustration tolerance, fidget toys, finding ways to get the energy out, finding more existential interventions to get yourself excited about things instead of anxious or angry about things. David using the idea of guessing the color of the tie of the annoying dinner companions he was previously angry about having to go to—switching an annoying task to an exciting one (those meddling mendelson’s with their zebra zingers!) David also mentions there are some ideas around microdosing with mushrooms, cannibis, ketamine, etc. and he’s never seen them work, not that they don’t, but that he doesn’t even know how to begin talking about them working and is not comfortable talking about it as an expert (if you are one, email us at [email protected]! We’d love to have you on the show to talk more!). Also those microdosing interventions would clearly not work (and be illegal!) with kids. There are really different kinds of ADHD medications, including antidepressants like Wellbutrin (buproprion), which works on inhibiting the uptake (or increasing the quantity of) dopamine, serotonin, and norepinephrine in the brain (which works with the neurotransmitters affected by the brain difference that is ADHD). While a number of other medications can be prescribed for ADHD, David and Isabelle drill down into specifics about the stimulant meds most often prescribed for it: Ritalin and Adderall. Each of these meds have a line of meds that come from them (each med is more related to one or the other). Ritalin is more of a stimulant while Adderall is a stimulant with a mild anti-anxiety component to it. People will have sometimes have side effects to Adderall that makes them feel like there are ants running under their skin or a cold sensation, it’s typically a reaction to the anti-anxiety part of the med; those folks can take the Ritalin or Wellbutrin route sometimes. David shares the story of how he was lucky and Ritalin worked for him; however, his curiosity and studies wanted him to try a newer class of meds like Focalin. He noticed 3 weeks later that it was working; he noticed it was working because he picked up a piece of paper on the floor to throw it away—on the first try! Yet three weeks later he couldn’t remember his partner’s face when she wasn’t in the room and having intense intrusive thoughts of feeling awful and very depressed. He didn’t realize it was the medication right away, but his partner helped him connect the dots and it felt better as soon as he got off of the meds. Even though he tried a different med in the Ritalin family and it should’ve worked for him but it didn’t. David honors how if he was a kid, they would talk about how his behavior was improving, and how he was performing better on tasks, but he might not be able to vocalize his depressive thoughts and changes in recall—so important to not make someone take medication. If medication works, people with ADHD will take it (because it works). They often don’t want to take it when it doesn’t work. People can sometimes feel that people feel really zombie-like, or off, or not like a person—but then you see all these neurotypical-world gold stars for performance but they miss that there’s a person underneath it who is experiencing it working or not working, too. It can take so much patience and tenacity to find a good fit. David and Isabelle reveal that they also specialize in working with trauma, and even specific to survivors with ADHD, it can impact what type of ADHD medication they can tolerate. Medications that come in and out...

Previous Episode

A Conversation About ADHD Medications - Part I

Big Ol’ Disclaimer: We are not doctors or prescribers, but two therapists who have a lot of experience working with folx on/off, loving/hating, trying/not trying all types of medications and accommodations for ADHD. Please seek medical advice for all your medication questions! Continuation of disclaimers galore: we are not giving medical advice, just our opinions. There are a lot of doctors in the world who know what medical terms actually mean and what they mean long term, we very much are aware that psychopharmacology is not our specialty, but we have a lot of experience with people trying medication. Nobody really talks about medication without being hyperbolic: it’s talked about as something that saved your life or that is awful. Most people who find something really effective medication or accommodation don’t talk about it everywhere. They just take the win and talk about it with their therapist. People often get the pop-psych version of what antidepressants, antipsychotics, anticonvulsants, stimulant, etc. meds are, v. How often we talk about something like insulin or blood pressure medications: they carry more shame, stigma, myths and misperceptions. ADHD is a medical condition that can have psychiatric consequences. This is something that is medically warranted but not psychiatrically warranted at all times. People think you can’t go to a regular doctor and get ADHD medication, but you can: it is a neurological difference and a medical condition. Not every person with ADHD needs medication AND it’s not a deficit if you have to take medication. A dilemma David experiences as a therapist is that he is hired by his clients to help wean them off of a medication; we have these thoughts around dependency and what it means to be on meds. What’s strange is how differently we view medication as opposed to other accommodations; for example, no one suggests you work a program to improve your vision to remove your need for eyeglasses (if such a thing exists, barring LASIK), but it’s something we do with medications. David just accepts he’s wearing glasses because they’re super effective. We don’t talk about how effective ADHD medication is for those who want to take it. Isabelle pauses to do a real-time look up of the numbers on efficacy, it is so much more effective than it is for other psychiatric conditions because it is a medical condition (70% of adults and 70-80% of children shortly after starting treatment, per the Cleveland Clinic—see the link below; this is contrasted to a 50% efficacy for antidepressants per the National Health Service—also see link below.). Also a way to think about how quickly you find a med that works for you, versus an antidepressant. It’s important that an ADHD med can help you and not be the right medication for you. Individuals with ADHD require more stimulation to do boring, nonstimulating, low-novelty tasks, so they’ll self-medicate with their own emotions, using anger, excitement, anxiety or fear—all of those make your heart beat faster, arouse your nervous system. Those emotional states are stimulants. David describes gamifying pairing his socks to make his self-stimulant through excitement rather than anger. For people who find anger or anxiety shutting them down in life, when those things get in your way, you might want to think about ADHD medication—it’s not just about impacting focus, it’s about the emotional consequences that come with ADHD. David reviews how non-stimulant medication (eg. Like Strattera) works like small chemical restraints, slows you down. More effective for anxiety-heavy ADHD. Stimulant medications (eg. Like Adderall and Ritalin) are more a way to stimulate your nervous system so you don’t need to self-stimulate to reach that condition. David describes that he didn’t get medication until he was in undergrad or college, the before moment was: “someday I’ll read a book.” And the after was “I could read a book,” this is why he’s such an advocate for people finding what works for them, medication nor not, medication for David was the difference between being a C/D student to becoming an A student. The closest he ever got to as focused as he was on meds was when David convinced himself he would be homeless if he didn’t finish a book in 8th grade, aside from that he didn’t read. To name the abuse of stimulant meds: people can abuse any substance: you can abuse food, for example. It’s important that these drugs are prescribed with therapy, so that a person starts to learn what a medication works for and what it doesn’t work for. The medication doesn’t change your life, you take the medication so you can change your behavior, to fix your life. It’s not speed and doesn’t make everyone do a lot of work...

Next Episode

All About ADHD - Part VII

Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-6th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV; episode 15, All About ADHD Part V; episode 18, All About ADHD Part VI). Gabe starts by asking about bedtime, or really any time when you have unstructured time or less to do/less responsibilities (for example, during the weekends). How can you get yourself to go to bed early, for example, when you don’t have as many boundaries and commitments already? How do you deal with variability in a routine or unstructured time? David names that you cannot make use of your time if you don’t know what you want to do it with. You can outsource choice through routine—practice going to bed/waking up at the same time, having the same bedtime routine—you don’t want your commitments to be punishing, you want them to be your commitments. David’s example is he’s not a great therapist before 10am, and knowing how he spends his mornings and how he spends his time. On his days off, he’s up at the same time, because it doesn’t make his days working a punishment—he calls them “luxury mornings,” he gets to have a coffee, and listen to this playlist, and cook a dish he gets to have for lunch. He’s not just waiting to do something else, there’s a bonus time fill. Isabelle gives an example if you get a last-minute cancellation or you get an unexpected chunk of free time: you give yourself a treat that’s only for that time, like a show you only get to watch if that happens. Isabelle saves her super weird indie films that no one else wants to watch, and it’s in five minute increments, now when someone cancels on her, she enjoys it—it’s about how to enjoy things, not giving yourself ‘free time.’ If you’re doing free time, you’re effed. When kids say they want free time, they want you to leave them alone, they don’t actually want free time, there’s always structure, like the games they want to play or who they want to play with. What about the chaos and drive within being connected to our productivity-focused Western culture? Gabe describes he behaves as he does because of the party he’s in—is it our culture as well? ADHD exists everywhere and we have different political understandings of what we call this diagnosis; ADHD is a medical issue, we can see how it processes information differently, it’s an objective difference in the development of a human, it’s not ‘caused by America’ or people being reinforced for inattentiveness. David names that he thinks ADHD is linked to a survival of the species (see below-Orchid Children article or “The Science of Success”). Referencing allele cells and epigenetic (see below)—in a nutshell, your grandmother’s environment influenced which of your genes are turned on/off—we pass on survival traits. David uses an example of humans abusing rats, where rats were abused and taught to associate a neutral smell (cherry blossom, see article below) with getting hit on the tail and eventually their tails were cut off—they later went on to have children, and those children were introduced to this new neutral smell (cherry blossom) and showed the same stress/fear response their mother’s did. For folx with ADHD, it’s similar in that there are some environments where we are distracted, scared, in our heads, etc., and other environments where we have mastery and feel less distracted, more in our zones. So you have to think about the environmental variables that help us do a task. AJ describes his ‘dough island,’ his place of working in the kitchen where he is noticing he has less distractions (no photos, no tv, etc.). You can then figure out which environments you are more successful in or less successful in. A lot of people have a stereotype of what studying should look like, like how Norman Rockwell invented a lot of associations with what Christmas looks like—now what does studying look like? Churning, grinding, giant books, painful, quiet library, crumpling up paper. Some people may study well just studying in a group never taking notes or writing anything, and if they succeed in school, they’re going to believe they’re cheating, which makes their self esteem take a hit. But wait a minute, the person may feel safer in these environments (allele cells are being activated) and the accommodation is working, it’s not so random. First question: where does the behavior NOT happen? If every time you transition you get anxious, think about if there’s ever a time when it doesn’t happen, and if you’re alwa...