Let’s talk about my relationship with ADHD and ADHD medication. Now, let me tell you. I’m a psychiatrist, and I’m a child psychiatrist, I believe medicines work. I know they work. I’ve seen them work. I have patients who I have put on a stimulant, and their entire life has changed. But some of us are more complicated than that. I have ADHD; I have anxiety, I have depression, I have PTSD. I’m a complicated patient on top of being a complex patient. I’m a patient that has significant side effects with stimulants. They make me fatigued, irritable and cause GI symptoms. They make me so tired, y’all SO TIRED!!!
As a kid, you know there were times that your parents let you drink a little bit of coffee, I would drink coffee at night because it put me to sleep. As a psychiatrist, this makes sense, but at the time I was like, man that’s weird that coffee puts me to sleep. Let me tell you how this works. We (people with ADHD) have lower than average dopamine in our frontal lobe, which is why we have the executive dysfunction that we have. So stimulants (including coffee), increase dopamine, which in turn helps calm us down and help us focus and, you know, not be as impulsive and be able to make better decisions. But for some of us, it also makes us tired.
I have always had issues with fatigue, even as a child, I had to take afternoon naps every single day to be able to accomplish anything after school. I’ve always kind of been a little bit more fatigued than I would think most people are. First revelation and light bulb, I was diagnosed with sleep apnea in medical school. At the time, I was pretty small, so it is likely structural and something I have had my whole life.
I was put on a CPAP but unable to tolerate the masks. So I know my sleep apnea contributes to my fatigue, but things just kept getting worse and worse over the past decade and even more so the past three or four years, I have been miserable . Just miserable. I’ve been on different ADHD medications to try and find one that worked best for me. What I found that works the best for my ADHD and impulsive eating, which probably made me the most fatigued, is Vyvanse.
This past year or so, I was on several meds, one was Adderall XR, and a few months ago, I switched back to Vyvanse (which I had been on previously) because it worked the best for my ADHD and impulsive eating.
Because I already have chronic fatigue, I didn’t realize how much of this was my medication. Every day I was making a choice “do I want to be tired today, or do I want to get things done today”. If I don’t take my medication, I’m still tired, though (though not exhausted), but I can’t focus If I take it. If I take it, I can focus I could get things done, but I am tired . So most days of the week, I was making a choice to take my medication, and, you know, be tired but get things done.
What I mean by getting something done, is work related things, because, by the time I got home, I am too exhausted to do anything but get in my bed. I wasn’t playing with my kids; I wasn’t cleaning, I sit in bed with my kids and be like y’all come get in the bed and cuddle with mama or let’s watch a movie, let me sit on the floor with you guys while you play . but I couldn’t be active because I was exhausted. I was at the point I was crying multiple times a week just thinking “ I cannot live life like this. I just can’t, like I can’t be this tired for the rest of my life”. I was passively suicidal, you know no plans to hurt myself but if I went to sleep and didn’t wake up , it would have been fine. I just could not imagine living my life as tired as I was at this point.
Then things changed. I took an out of town trip for a week and accidentally left my meds. I noticed that I was less tired and less depressed because the fatigue was making me unbelievably depressed. I mean, I have depression, but this was extreme depression. So I was less tired, then a couple of weeks went by, and I was like okay I need to start back up my Vyvanse because I’m falling behind on things at work, but I just couldn’t make myself restart them. I felt so much better except for ADHD related symptoms.
Let’s remember that I still have chronic fatigue. I’m still tired from the moment I wake up to the moment I go to sleep. However, I do not remember the last time I felt refreshed. But without the stimulants, I have not cried because I was fatigued. I have not been so tired; my eyes burned. I have not felt like I wanted to go to sleep and not wake up. My baseline fatigue is sooooo much better than my fatigue + stimulant fatigue.
We need better options!
Now, obviously, this isn’t an anti-medication post. I’m a psychiatrist; I believe in medication. I take other medications for my depression and ADHD that have been helpful. BUT for us ADHDers who have side effects to a stimulant, we need more non-stimulant options. Right now the only non-stimulant options are Wellbutrin, Provigil and Nuvigil (which are not FDA approved to treat ADHD in this country but are approved in most other countries ), Strattera and Alpha Agonist (clonidine and guanfacine ). Some nice studies show amantadine is helpful for ADHD. But none of these come close to the efficacy of stimulants. I’m not sure what my next steps will be, and I am discussing that with my psychiatrist. I most certainly need my ADHD treated. I just wish there were better options, both as a psychiatrist and as a patient.
Anyone for whom stimulants have been life-changing? Share your success story below? Does anyone else have side effects with stimulants? Share your story below? What non-medication tools/ coping skills (regardless if you take medications are not ) are you using to help manage your ADHD? Sound off below?
This isn’t an anti-medication post. I’m a psychiatrist; I believe in medication.