I'm always repeating myself about: ADHD

This is the first of a series where I write down all the usual stuff I say when I'm talking about something I talk about a lot. In this entry I talk about ADHD.

"I've tried all sorts of medications, and none of them work"

Most of the time when people say this, they mean they've been put on ritalin, rubifen, concerta... in other words, they've been tried on a bunch of different forms of methylphenidate.

Obviously, everybody responds differently to different medications. But evidence suggests that, in general, adolescents respond better to methylphenidate, and adults respond better to amphetamines (such as dexamphetamine).

If you're ready to give up on medication, please talk to your doctor about trying something with a different active ingredient to the drugs you've already tried. This may be a pain in the ass if your Special Authority only allows for one active ingredient, as you'll have to pay to have it amended, but I highly recommend it–especially if, fingers crossed, the cost of doing so comes down with the increase in supply of professionals permitted to write Special Authorities.

And keep in mind there are non-stimulant medications you can be prescribed without a Special Authority, such as atomoxetine.

This is also a good time to note that if you're being assessed for the first time, make sure they put all the available drugs on your special authority, so you're able to change medications just with the help of your GP.

It's also important to keep in mind that if you don't respond well to dexamphetamine, you may respond well to lisdexamphetamine. And I've talked to people who don't get on with one methylphenidate-based medication, but do with another.

Play around with dosages. Too low a dose can leave you in a weird restless in-between space, and too high can leave you feeling wired and agitated.

Caffeine can interfere with medication as well, and it's worth cutting back or tapering off to see how that affects you.

In general, it's good to look up drug interactions between any drugs you take.

"Calendars don't work for me"

Were you unmedicated when you tried, and now you're medicated? Try again–most non-medication interventions for ADHD become much more effective once you're medicated.

Your medication status hasn't changed? Try again anyway.

Something I've found with ADHD is it's really easy to try something, it doesn't work, and it gets stuck in your head that that thing just doesn't work for you. But ADHD is basically the "things have trouble sticking" disorder. If you give up on things after they don't work the first time, you won't be able to do much of anything.

You don't have to keep grinding at something over and over til it works, but circling back and trying again later is basically the only way to get on in life with ADHD. Maybe your environment has changed, or your mood is different, or you're used to it now from your previous attempts; you'll be surprised at what you're able to pick up–at least for a time–if you try again.

Don't forget to change it up. I thought the idea of a physical diary for appointments was so romantic, but in practice I never stuck with it. Eventually I got into using the calendar on my phone, and the habit eventually stuck–one of the few ADHD accommodations I successfully managed before medication.

I never brought the diary with me places, but my phone is always on me. As soon as there's talk of making plans or booking appointments, my phone is out and I'm looking at the relevant dates to check availability and write plans down right away.

Sure I'm not always on time, and I don't always do all the things I plan to do; but there is no way I could keep up my job without it. I am so much less stressed when it comes to timekeeping than I was when I organised my week by setting alarms for work, and checking the course schedule glued to the inside of a workbook.

Other stuff that helps

I've been taking creatine. It helps with my fatigue, and it sorta meets the meds halfway in terms of executive function. Seems to be helpful for a lot of people with ADHD. Some people experience an upset tummy the first week or so, but it goes away. It might not work for you, but it's safe and cheap to find out.

When I started taking it I would forget to take my meds because I was functional enough to get through the morning without them. I'd only notice I hadn't taken them when I was sitting at my desk wondering why I felt so bleh.

I put a 5 gram scoop in my coffee every morning–tastes like nothing.

Unfortunately, the trite advice people give about sleeping and drinking water and eating enough is all real. Getting those things right won't fix your ADHD, but getting them wrong will make it worse–along with everything else.

Eating more protein is good for ADHD, if you aren't getting enough. Shakes are an easy way to do that.

The main point I'd like to end on is that one about trying things again. Life with ADHD is a series of picking things up then dropping them again, and it's important to keep on picking them up.

Like that blog you keep forgetting to update.