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In my early twenties, I came to rely heavily on caffeine to get me through the day. I wasn’t sleeping enough and would chug three cups of coffee in the morning. I’d have a few more throughout the day to help me ride through the inevitable energy crashes. The predictable result was that I was jittery, moody and headachey. I would have short windows after ingesting caffeine where I felt lucid and could get a lot done, then the jitters would set in and I’d be unable to focus and finally it would start to wear off and I’d be overcome with exhaustion but too keyed up to sleep. Not a fun cycle to be in but I felt like I couldn’t cope without caffeine. (I recognise that not everyone has this experience with caffeine - it puts some people to sleep!)
At one point, I decided caffeine wasn’t enough and tried an anti-narcolepsy drug (modafinil) that a friend recommended. He raved about how he was able to go a whole night without sleeping and completed a difficult research experiment in a lucid state. The effects were similar for me: I took the tablet and felt my brain shift into a state of effortless focus. I wrote a 3000 word essay in four hours. I’d been putting it off for weeks and suddenly it felt easy. The essay ended up winning me a trip to Switzerland. Just think of what I’d achieve if I kept taking it!
If it weren’t for the side effects, I’d have continued taking that drug daily. The first time I took it, I started getting heart palpitations. Clearly the dosage was too high so I backed off the next time. However, even on a lower dose, my body didn’t seem to like it. I felt a metallic taste in my mouth, my urine smelled really bad and I became super irritable. Obviously I was taking it without medical supervision and a lot of those effects were probably because I was not sleeping very much. Nonetheless, the experience really put me off. Once I finished the pack my friend gave me, I didn’t seek it out again.
I am not anti-medication. ADHD meds seem to help a lot of people and there’s a world of difference between self medicating and working with a clinician. I have been prescribed stimulant medication for my ADHD by my psychiatrist on an “as needed” basis. At the moment, that means I rarely take them (it’s been a few weeks since I last took them) and when I do, I take low doses (quarter to a half of a 5mg dex tablet). Currently I’m coping well through the other strategies I employ (exercise, sleep, meditation, various meta cognitive strategies, working with an ADHD coach) because most days don’t have excessive executive functioning demands for me. When I’m in unfamiliar environments that have high stakes (travelling, job interviews, pitches to investors), I take the meds. Because I take them infrequently and don’t consume other stimulants, a low dose makes a big difference.
The reasons I try to avoid taking medication the rest of the time are:
- My history of addiction: I am concerned about relying excessively on exogenous substances to get me through the day.
- Short term side effects: I experience sleep disturbances (wake up at 3am the next day) when I take long acting forms of stimulants (even at the lowest possible dose) and dysphoria when short acting meds wear off. These types of side effects are quite common for AuDHDers according to research.
- Concern about tolerance: I want to avoid ending up on high doses of stimulants because there’s pretty strong evidence about dose dependent impacts on blood pressure that get worse the longer you take them. Although it doesn’t happen to everyone, many people end up on progressively higher doses of stimulants as their body gets used to the meds (tolerance effect).
Once again, I’m not saying my approach is right for everyone. Medication makes sense in many cases when you consider the overall risk reward profile of living with ADHD. When thinking about the safety of medication, clinicians also have to consider the risk of someone not being on medication. There’s ample evidence that unmedicated ADHDers are more likely to die due to accidents and suicide and are more prone to overall mental and physical ill health. If there is a small risk of long term side effects, they are likely outweighed by the benefits.
I am in a privileged position right now with overall low demands on my executive functioning but can see that I would have really benefited from medication at the start of my career. I probably wouldn’t have been fired from all five jobs (more on this later) if I’d had some assistance. I’m also certain that when I become a father in a few months that I’ll have much greater demands and will likely require medication most days to cope.
An analogy that might be helpful is thinking about life like riding a bike. Neurotypical people have a bike with its tyres pumped up, chain lubricated and gears tuned. ADHDers have the tyres nearly flat and the chain is so worn that it skips every time you change gears. Plus we often get lost along the way and end up going the hilly route. In this analogy, taking meds is equivalent to swapping out the front wheel for an ebike motorised hub. You can go up the hills a lot faster. You can probably actually go the same pace as the neurotypical cyclist for a while if you have the motor going top speed and pedal really fast. But if you don’t pump up the tyres and grease the chain (i.e. learn metacognitive strategies), you’re going to end up having a mechanical issue (i.e. ADHD burnout) halfway up a challenging hill. It’s helpful being able to switch on the motor when there’s a headwind but when the road is flat and it’s a sunny day, it’s enjoyable to just pedal along. If the hill isn’t too steep, it’s satisfying to ride up under your own steam and important to build up the (focus) strength so that if you forget to charge the battery for the motor, you can still get around.
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Hi I'm Jeremy, and I understand the challenges of living with ASD and ADHD.
