ADHD

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Unsure about my medication (slow-release methylphenidate) (leminal.space)

submitted 8 hours ago by komorebi@leminal.space to c/adhd@lemmy.world

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I've been on slow-release methylphenidate for a while but I feel conflicted about whether or not it's right for me.

I was prescribed 1x10mg for a week and then my dose was increased to 1x20mg. After I noticed that I experience quite a drop in the afternoon, I was prescribed 2x20mg.

On the plus side:

It's so much easier to get started with things and keep going
Responsibilities feel less scary and doing chores or errands becomes almost an activity I enjoy

But then, there are also things that feel good but also weird me out a bit:

In some aspects, I feel almost like a different person. For example, when I'm off my meds I don't really want to have children. I feel no desire to have any and because life already feels like a constant struggle with ADHD I feel that overall I'd rather not have kids. But when I'm on my meds, I suddenly feel like this super chill, "proper adult" who takes care of shit and almost craves responsibility and starts seeing the beautiful side of having kids.
I feel "emotionally fearless", in that I find it a lot easier to face emotionally difficult things or conversations.

I kinda feel like the meds turn me into a better version of myself and it's kinda scary, because (a) I notice that I want to feel like this ALL THE TIME and start craving my meds beyond my daily dose. And (b) it makes me wonder who I really am? Am I really the person that I am on my meds but due to my ADHD brain I can't be that person without my meds? Or are the meds pushing me up on some artificial higher level that feels nice but isn't "real"?

And then, there are some negative effects:

Sometimes, when I want to do or focus on a specific task and can't due it because something else came up, I become irritated because I WANT TO DO THAT TASK NOW.
On some days the meds don't seem to work at all which causes me to feel irritated as well, because I WANT TO FEEL GOOD and why aren't they working.

I've tried talking to my doc about this but he barely has any time, appointments are usually 10 mins and that's it. He's covered by insurance and so has a ton of patients. I've now scheduled an appointment with a private doctor. Much more expensive but I feel like I need someone who takes their time and really listens to what I'm experiencing.

And I just wanted to vent a bit about feeling confused. If anyone has any helpful input, I'd appreciate hearing it <3

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[–] Photonic@lemmy.world 1 points 2 hours ago

First of all: maybe double check whether your doctor actually put you on extended release or on regular. I mean, it is possible that you doctor started this right away, but the most common strategy is to titrate on regular methylphenidate and when you’re on an effective dosage, switch to XR.

If it’s not XR, then maybe there is a gap in between your doses where you get to a subtherapeutic blood level that explains why some days it doesn’t really work. Or maybe your dosage isn’t just there yet – many patients are on 54 - 18mg or 72 - 36mg. Morning and afternoon dosages can also differ, with the morning dose being higher. At what time during the day do you feel that it doesn’t work? Maybe you can find a pattern.

And then to make it even more complicated, your XR pill is not 100% extended release, but rather a part (the outer layer) is released immediately and the inner layer is extended release. The ratio of IR vs XR can differ between manufacturers, for example 50/50 or 25/75, although the overall dose will say the same in mg. So double check whether you always get the same “brand” for the most predictable result.

And then if you really don’t feel like this is it, there may be alternatives – depending on where you live – like dexamphetamine and some other, more atypical meds that may also work better for you.

Second, the side effects you report are common. Some may get milder over time. Like the cranky / irritated feeling. In the meantime, be gentle with yourself. You can still become distracted, just like neurotypical people can still get distracted. And I feel the hyper focus mode doesn’t really go away. Some people (like my brother) stop their medication after a while because they don’t really recognise themselves on medication after living a big part of their lives off meds. People can feel like the symptoms are part of their personality, and maybe there is some truth to that.

I can’t advise you about having kids. That’s your decision and of course there is a chance that your kids will also have ADHD. I just know that my childhood would have been easier with some support. So if you begin to recognise the signs I think early intervention and maybe medication would go a long way. I have decided for myself that I would like to have kids, even with ADHD, a super busy and high-stress job and a girlfriend working in the same field.

As for your doctor: I had the same thing you had before with my own doctor. A few minutes every 6 weeks and you’re done. I now have a nurse practitioner who has much more time, sees me more often and has more time to help me find the right dose. Doctors will always be pressed for time especially with the ever increasing numbers of ADHD patients…

[–] FoxyFerengi@startrek.website 5 points 7 hours ago

I think the bulk of your concerns are better to speak with a therapist about than the doctor prescribing the meds. I've found my adhd is 75% managed by meds and the rest is tools I've learned in therapy.

I am a bit concerned about the feelings of euphoria you're still experiencing and chasing, those usually wear off fairly quickly after a stimulant dose increase and that is worth speaking to your prescriber about. Some people do really well on non-stimulant medications like Strattera, and because that stays in your system much longer you may be more stable and have less questions about who you really are.

As an aside, some things lower the efficacy of stimulants. For example, don't drink orange juice or take vitamin c with your medication. Also, medication breaks on weekends are important to keep you from constantly needing to increase your dose