More thoughts on ADHD medication, specifically amphetamine, after a year.
Like lots of people, I started them and BANG! Neo waking in his pod in The Matrix. Life changing. The scales fell from my eyes. I suddenly understood. It all made sense. The stuff I found so incredibly difficult for half a century and other people could just ... do it?
I wept.
"Don't chase the high", they all warn. What does that mean?
About 4-6 weeks later I had an argument with Zoe. I felt some of the old behaviours creeping back in. What? Why is that happening?
Then I started to go to bed late again, and procrastinate, and some of the other stuff. Not all though, I kept the place clean. The piles of clothes never came back. I was still getting relief from sensory issues.
And each new titration dose brought it all back.
Until titration stopped, and I was on my final dose.
And it slipped, slowly, it slipped.
Why did it slip? "Tolerance! You have become tolerant to amphetamine! Take a meds holiday!", they all chant.
I tried. I got as far as 3pm before I couldn't stand the bullshit.
Thing is, the evidence that drugs tolerance to therapeutic doses of amphetamine in ADHD even develops is ... dubious. There's a great video by Russell Barkly on this, here: youtu.be/RbZjL7czIy0?si=6xHaoY…
It's not though. I worked out what has happened, and it's fine.
Unmedicated, undiagnosed ADHD is marked by horrible disregulated emotions (more severe in the combined (me) and hyperactive forms I believe), non existent executive functioning, difficulty focusing, and yada yada.
It is, in a nutshell, "really bloody awful".
If you think you have ADHD but are undiagnosed, you possibly just read that and felt like a fraud, didn't you? "But I don't feel that awful!"
How do you KNOW? You have never known any different.
Because here's the thing. You grow up with this crap and you start to mask it, because you HAVE to.
But masking and coping strategies are profoundly psychologically expensive. They destroy us with burnout run the long run.
So we mask to the point where we can more or less make it through the day, and no more.
And it's a pretty sodding miserable existence (Yes, it really is, yes, for you, person reading this wth "some traits". Lots of stuff you accept as a normal part of being human simply is not. I know you don't believe me, even if you think you do. I wouldn't have believed me either).
And then we get diagnosed.
And medicated.
It. Goes. Away.
It all goes away.
Annnnnnnnd breathe!
You are suddenly Mr Spock. You are impervious to your emotions. You can just DO STUFF! You CAN clean the house and you DO and you ENJOY IT! What witchcraft is this?
"I'm cured! Why did nobody tell me about this?" (We did. You ignored us)
You also aren't cured. You still have ADHD.
Your emotions are still there.
You still have executive dysfunction,.
You still struggle to focus.
All of it. It didn't go away.
You just can't hear it.
Why? Because ... well, you are outside and it's stupid sodding bright, and loud. Insanely loud.
And you've been out there for hours.
Then you come into a dim room which is quiet. You can't see anything, you can't hear anything. It's all there though, just below your level of sensitivity.
A few month later when stuff starts coming back and you conclude the meds are failing? They aren't. Your eyes are adjusting to the dark.
Here's another metaphor: A shelled of water has been dumped on a landscape, continually, over thousands of years. It carves out a basin. It finds its level. Water always finds its level.
Move it to the side and it will flow back into the basin it carved. And so it is with us. We start meds and the level of effort we have always applied to make it through the day, which was borderline killing us, suddenly makes it STUPIDLY EASY.
Borderline killing us. Still is.
So you start to dismantle your big expensive coping strategies, because they were hurting you.
You dismantle them until ... well, you start to approach the level of functionality, or rather disfunctionality that you are used to. And then you stop.
Because water finds its level.
You conclude they aren't working, so you take a meds break and OH MY GOD IT'S HORRIBLE.
What the hell is going on? You turned the bloody difficulty knob up to max again. That's what the hell is going on.
After a week you start meds again, and they magically work! IT WAS TOLERANCE ALL ALONG!
No it wasn't, you muppet. You just started to match your effort to the difficulty level again.
You can get trapped in this cycle.
Or you can realise that you deserve a rest, you've had a rest, and that's nice. Now get up and do your goddam laundry, which is a thing you can do, and is still far easier than it ever was.
That is all.
