ADD Diagnosis

I was diagnosed with ADD in October. In hindsight, there are a lot of red flags, but until recently I was attributing my cognitive difficulties to chronic fatigue. After I was diagnosed with sleep apnea, though, and started using a CPAP machine, it became obvious that even when I was well-rested there was something significant going on. I brought the subject up at my annual physical in June, and after only four months of putting it off finally picked one of the psychiatrists off the list she gave me and made a phone call.

The psychiatrist started me on 10mg of adderall, then bumped it up to 20mg after a couple of weeks. (Basically, the inital dose is usually not enough to help, it’s just to establish that I can tolerate the medicine.) At 20mg, the effects were pretty obvious: I had a big spike to my productivity.

The principal effect is that it’s easier to get multi-part tasks done, even when it’s something as simple as writing an e-mail or figuring out a Hungarian sentence. I think there are two separate cognitive effects involved. First, an inhibition against switching tasks; and second, an enhanced ability to divide a single task into multiple steps while maintaining a mental image of how the parts combine to form the whole.

The inhibition against changing tasks is a really obvious effect. For instance, right now, while I’m not on my ADD meds, I’m getting up half a dozen times in each paragraph, and the interruptions are all productive—tossing out some recycling, making a cup of tea, getting a snack—whereas if I were taking adderall, I would just sit down and write three or four paragraphs and be done with them. (The tea thing is a trivial example, but an interesting one because I don’t see how it could be a placebo effect. I noticed while reading Hungarian that I would think, “I should make a cup of tea” and then not do it and think it two or three times before making an effort of will to stop and go make a cup of tea. And then half the time I’d end up with cold tea because I’m less likely to reach out and take a sip.)

Same thing with Hungarian: it’s easier to sit down and read through a whole page instead of getting through a couple of sentences and deciding to quit and do something easier. Plus, on the ADD meds, it takes less effort to read each Hungarian sentence. I feel like I’m automatically adjusting my focus to the correct level: when I need to look up a word, I’m zooming into that one word, while not losing sight of the context, so that when I get the definition it plugs naturally into the sentence, whereas before I took ADD I would look up all the words I didn’t know in a sentence, and then I would look up some of the words again because I’d forgotten them, and then I’d have to work out how the grammar made them fit together, and it was a constant low-level effort of will not to just zoom out and see the whole page and feel overwhelmed.

Staying on task isn’t entirely beneficial, by the way. If I turn on the TV while I’m eating dinner, it makes it really easy to keep watching a second or a third or a fourth episode. I’m not taking meds to enhance my ability to bingewatch Netflix, but that is an effect.

I also started carrying around a notebook to track my mental state, and this morphed into more of a to-do list, which was helpful as both an organizational and a motivational tool. I tended to get more done when I wrote out explicit goals for each day in advance, and as I got in the habit of writing to-do items down, I became less likely to lose track of stuff. In the last few months I’ve backslid a couple of times, but I have maintained and refined my to-do list a bit and it’s been very useful. (It’s important to note that even after the ADD meds started working, I still remained as prone as I ever was to forgetting about things I didn’t write down. The ADD meds don’t seem to have helped at all with my general scattermindedness. I suspect this is both a direct and indirect effect of the ADD: the fact that ADD made it difficult/impossible for me to stay organized meant I never developed good organizational skills and habits, and fixing the cognitive problem doesn’t also magically fix the skills & habits problem.)

As for side effects, well, I found myself going to bed later and later each night, which was a big problem. The reduction in appetite was also pretty significant. I went from 142 pounds to about 130 over the course of a month. I adjusted my diet some to compensate, but I felt like I didn’t really get the problem under control until around Christmas, when I started taking a two-day drug holiday each week to let my appetite and sleep cycle reset.

Unfortunately, there was another side effect which was more serious. When I went in for my annual rheumatology appointment, the nurse measured my heart rate at 136 bpm. About 20 minutes later they re-measured it and it was a bit over 100, but that was still pretty worrisome, especially since my blood pressure was also up from a year before. I ordered a Fitbit online to monitor my heart rate, and the quick summary: it is way too high. After a week without adderall, I’m averaging 70-80 bpm when I’m sleeping, and 105-115 when I’m awake. By contrast, at my last two physicals my heart rate was 56 and 60.

My psychiatrist discussed some non-stimulant ADD drugs with me, and I’m planning to start one of them this weekend. There are a couple of different options, and they both need to be ramped up from a low initial dose, and could take a month or so before they reach an effective dose. And of course if the first drug doesn’t work out, I have to start all over again. So right now my productivity is practically non-existent, and it could two weeks before I’m back up to snuff, or it could be three months, or I could never find a sustainable solution that worked as well as the unfortunately unsustainable one did.