From SimplyWellbeing Newsletter, December 2010
In the last Newsletter I outlined how some years ago I was privately diagnosed ADHD and tried medication but ending up stopping with some heart problems. In June I was re-diagnosed ADHD at the NHS Maudsley Hospital in London, after a year long wait. My PCT had failed in their obligation to properly fund my treatment and had only paid for the diagnosis and no follow up, titration visits.
I was uncertain whether my new GP would be able or prepared to help but thankfully although he was not familiar with ADHD, he proved happy to follow the suggested titration guidelines given by the Maudsley psychiatrist and started me on 18mg Concerta, a slow release version of methylphenidate.
First days are the best
The first few days I was pretty happy, day two I was significantly more productive than usual and able to push through “boring” tasks. I was pleased but this effect did not last. It is very hard to personally assess how a psycho-active drug is helping you. As a drugs changes our mind we quickly adjust to any changes, so I persevered and decided to relax and monitor any changes, to look back at what I accomplished. I also asked for feedback from my close friends and family.
Two months later I reluctantly gave up on Concerta, not sure whether I would continue with ADHD medications.
Two quite negative effects had occurred over the Summer break. Firstly I stopped talking! My girlfriend and I were on holiday driving around the heel of Italy and I had nothing to say. My mind was empty, devoid of thought, so rather than being subjected to my fairly constant usual natter, explanations, stories, debates and humour, she heard only silence. Fortunately she agreed that this was not an improvement! I tried titrating up to 72mg but this did not help. Secondly I become quite grumpy and angry initially, then my mood dropped and I started to become depressed.
Moving from Concerta to Ritalin
I stopped my Concerta at the end of a month trial. My GP felt unable to change my medication type but was agreeable to change to Ritalin as this is the same active substance – Methylphenidate – just in a simpler quick release pill. Extraordinarily, Ritalin immediately brightened my mood and gave me more energy.
This should not make sense, but I have subsequently talked to many, read numerous report and stories of people who have had very different reactions between the different formulations of the ADHD medications. Several ADHD psychiatrists that I know have agreed, that somewhere in the mix of fillers, pill type and digestive system varied results can occur even with “exactly” the same base medication. Strange indeed.
So I tried Ritalin, up to 30mg for the next two months but again was finally disappointed and decided that the benefits did not out-weigh the speedy body effects I that experienced. My moods became less stable and it really did little for me in focus or procrastination. But I am tenacious and I would recommend anyone else trying ADHD medications to be tenacious too. It may be that at the end of my journey I will decide to live unmedicated but I plan to have properly explored the options first.
My GP wrote to the Maudsley requesting a return visit, after several months and some heavy persuasion by me, I was offered a cancellation and now have a prescription for Strattera, Atomoxetine, a nor-adrenaline re-uptake inhibitor. Success with Strattera is not as likely as Methylphenidate, it takes up to six weeks to see if it will help and can give stomach pain and other undesirable side-effects.
But it might work, I will let you know how I fare.