ADHD Meds

I’ve been taking stimulants for ADHD¹ for nine years.

I was hesitant to go on them. It’s funny, because at the time I was smoking half a pack of cigarettes and a non-zero amount of weed every day. I got drunk on beer and Jameson most weekends. I’d often grab McDonalds for both lunch and dinner, and if there was a 2L of Coca-Cola in the house, I’d down it in a day.

But, “I don’t want any chemicals messing with my brain.”

For years I had tried all the methods of getting organized. I wanted it so bad, but nothing stuck. I wish it were for lack of effort. At least then I would have known the path forward. But things got to the point where “try harder” was no longer a viable strategy.

So I decided, “I’ll try the meds for thirty days. If life is better, I’ll stay on them. If life gets worse, I’ll go off.” (Please, please, please don’t go off your meds without talking to your doctor.)

I went to see my family doctor. He said, “There are two kinds of meds you can try for ADHD. Option A (Straterra) builds up in your system and will take about two weeks to kick in. Option B (Ritalin), you’ll notice in 15 minutes.”

I took Option B.

Fifteen minutes later, I was like “Holy shit! Is this what everyone else feels like?” Then I cleaned my apartment for three hours.

It was like putting blinders on to the distractions of the world. All the stuff in my periphery went quiet. For the first time in my life I could make a list of A, B, and C, and actually do it – and in that order.

Life started getting a lot better after that. Within a few weeks my boss asked me what was going on because I had been noticeably more effective. My sleep schedule got marginally better. I started showing up less late to meetings.

I also have Type 2 Bipolar, but was in denial about it. So while the stimulants helped on some days, on others they caused me to focus a lot on how much life sucked. They also occasionally triggered hypomanic states – one of the reasons doctors are hesitant to prescribe stimulants to bipolar folks.

I’d get depressed, my productivity would drop off, and I’d think, “I must have built up a tolerance.” So my doctor would switch me to something different. I went from Ritalin to Adderrall to Dexedrine, which I still take today.

In retrospect, it’s like I had five screws and twenty nails that needed to go into a board, but I only had a screwdriver and had never held a hammer. So I kept banging away on the bigger problem with the wrong tool. Meanwhile, professional carpenters are going, “You should really try a hammer.” and I’m like, “No! I don’t want to be the kind of person that uses hammers.”

Thankfully, my general practioner finally said, “I’m going to stop these prescriptions until you see a psych. These are powerful meds, and I’m not qualified to diagnose your problem.” Two years after getting on the stimulants, I finally saw a psych who put me on Lamictal for bipolar, which, as far as I’m concerned, is a wonder drug. With my bipolar properly treated, I dropped my Dexedrine from 40mg to 5mg, the lowest dose you can get in the extended release.

The over-simplified theory about brains with ADHD is that they’re optimized for novel and high-pressure situations. During times of stress, they release lots of dopamine which helps you focus and function abnormally well. In more mundane situations, your brain releases less dopamine than the typical person, making it harder to focus. My rudimentary understanding of stimulants is that they trick your brain into thinking “Hey! Some high-speed shit is going down! Let’s get to work!”

There are things about the stimulants I don’t like. First off: they’re stimulants. My heart starts beating faster when they kick in. Coming from a family with history of heart problems, I worry about that. My memory also seems to be worse than it was ten years ago, but I don’t know if that’s the fault of Dexedrine, the Lamictal, the Internet, or just getting older.

I feel more machine-like when I’m on stimulants. Sometimes that’s super useful. It’s easier to start working. It’s easier keep working. It’s harder to get distracted. But I also show less interest in people, act more serious, tell fewer jokes, sing less, and am less likely to embrace serendipty. For seven years, that trade-off was worth it. I had a big hole to climb out of and needed all the help I could get to sit at a desk and bang out work eight hours a day.

I was worried that ADHD meds would make me less creative – but if you measure creativity by one’s ability to create, I’m an order of magnitude more creative today than ten years ago. Today I ship. Today I can work on something a little every day and eventually get there. My runaway train of thoughts always felt creative, but I finally came to realize that – by definition – I wasn’t actually creating so much I was simply thinking. Ideas seemed brilliant because they were never tested against the real word. The meds helped me me bring those ideas out of my head and into existence.

For me, the stimulants were a temporary scaffolding providing external support while I built more permanent structure. They were training wheels keeping me from falling over while I learned to keep a to-do list that sticks, how to not drown in email, how to set realistic expectations.

I also shed a lot of crippling guilt. I came to accept that my brain works differently than most – better in some situations and worse in others. Boredom is bad. Novel situations are good. High pressure situations are good. Creative situations are good. Situations where I have to perform – where there is nothing left to procrastinate, just this moment – those are good. I’ve since tried to shape my life around the way my brain works instead of jamming it into situations it wasn’t built for.

Two years ago, I stopped taking the Dexedrine every day. I had started public speaking and felt less animated and less spontaneous when I was on them. It was a marginal difference – I was still capable of giving compelling talks on stimulants – but it was the first time that it felt like they hurt me professionally, even just a little bit. By that point I had built up enough habits and confidence to try life without them.

I still keep them around and take them as needed. Sometimes it averages out to five times a month – sometimes I’ll go a few months on them and a few months off depending on the season. I’ve got this perfect-for-me job as developer evangelist where every week looks a little different. I get to travel for events. I have incredible freedom over my schedule and the projects I work on. It’s hard to imagine a job better suited for my brain’s strenghts. But, if I notice that my inbox has been sitting at 70+ emails for a while and that my expense reports are six weeks late, then I have no qualms taking a Dexedrine and getting after it.

I used to think of meds as a binary thing. Either you were pro-Western medicine, or you hated the propeganda spread by profit-maximizing pharmaceutical companies and wanted none of that artificial crap in your body. Now I look at all meds – and really, all decisions we make in life – as a cost-benefit analysis. What are you getting? What are you giving up?

One in three people with bipolar will attempt suicide. The others live in agony. My Lamictal prevents both of those outcomes and has no noticeable side effects. That’s a pretty huge ROI.

The Dexedrine makes me somewhere between 1.1X and 3X more productive depending on the work that needs to be done that day. It also causes me to feel 10% to 30% less funny, spontaneous and empathetic.

It’s hard to imagine the math ever changing on the Lamictal. But the Dexedrine calculation happens every day. For seven years the answer was a resounding “Yes” – and I have no regrets about that. Even if they shaved five years off of the functional lifespan of my heart, sacrificing quantity of life for quality of life was probably worth it – for I was finally able to move in the direction of my dreams and close the gap between who I am and who I thought I could be.

These days, the answer is most often “No”, but I’m grateful to still have the stimulants as a tool in the tool belt.

1. The correct clinical term is “ADHD”, which encompasses even the non-hyperactive kind, but I still mostly say “ADD” in conversation. ↩