Finally starting medication--what now?

[Nleor623]

Skip a couple paragraphs if you dont need background info, lol. After years of people writing off adhd as a possibility and a bad last psychiatrist, I had my first appointment with a new one and it went as well as possible.

Now she prescribed me focalin (dexmethylphenidate). My last year of highschool I was on Concerta xr (methylphenidate). It helped, but took a high dose to do so, which sometimes ended up too much. I asked for the short release for this so it could be more controllable and wouldn't ruin a day if it acted weird. Starting at 2.5 twice a day, and she said I could message after 2 weeks about upping it, or if there were bad side effects.

Thus far--I'm sure I'll need to go up a dose, but I was wondering if other people have had rebound fatigue? I'm heavily on the inattentive side and have always had a limit of physical and mental energy, and having to push through to get through school burnt me out so bad.

At first I noticed nothing, then realized when it wore off, I get even fmore heavily fatigued than usual. I do think now that it's been a week or so I am having an easier time when on it though. I can't tell if the fatigue is in comparison to the med helping me more than I think i (don't think so)or vice versa (also don't think so). I also thought possibly my body and mind need exercised to get used to doing more when I'm on it. Anyone have any similar experiences to weigh in?

Also, it's been so long of barely functioning that I really think I need support to organize my life even if medication helps to the point I feel capable of such. I haven't had luck with therapists who specialize in adhd, and I've not found much use for having everything attributed to anxiety (which is usually a secondary symptom). Does anyone know of any online possibilities maybe, especially that take insurance? Otherwise if anyone has advice for this point in treatment of how to make the best of it.

Thanks so much!

[Gettingittogether]

Yes, it can be hard to find a good ADHD therapist. The good news is that lots of therapists who do not specialize in ADHD can help you. Maybe "lots" is the wrong word. But if you make it a point to try out various therapists--give them two sessions--and then move on if they aren't really helpful.

My former therapist had been an ADHD specialist up until the time I met him, when he changed his approach. But with him, I reduced my anxiety hugely. I was shocked because I didn't think I had anxiety. I had depression, but not anxiety.

Well as my anxiety plunged, it was like I had more freedom, more acceptance, more patience, more confidence, more ability to relax and not panic about my ADHD symptoms. So I wouldn't discount a therapist who is good with anxiety. Anxiety, like ADHD, undermines everything, turns everything into a near crisis.

There are also ADHD coaches out there. I had an ADHD coach shortly after I got diagnosed. She was extremely helpful and in fact, she helped me make my job easier and thus more satisfying, less exhausting. You can google ADHD coach and you'll find lots of folks. You can do this work online, virtually. I actually used to meet with my coach on the phone. In some ways less distracting than meeting in person and easier for me to get to on time!

As for your ADHD meds, the process is this. You try out a med. And take detailed mental notes of the effects and you report the effects--good and bad--to the provider at the next meeting. A good provider will hear you and if necessary, make an adjustment in the medication. It's a process. The trick is to remain optimistic as you try out a variety of ADHD meds. There are many of them. Short term and long term. You will typically "know" when a medication is working. If you don't feel it's clearly working, assume it isn't working and report that. But focus on specifics, specific problems you're still having. It's not unusual for it to take a year or more to get the best medication or medication combination ... one that reduces ADHD problems with the lowest amount of side effects.

Good luck.

[Nleor623 in reply to Gettingittogether]

Yeah, I'm sure I've still got anxiety, although to me it seems at this point it's mostly reactive to adhd problems, and even social anxiety is relieved or worsened similar to other things. But I think you're right, a good therapist is probably more important than the type.

I've always wondered about coaches--I think that might be more what I'm looking for, but honestly probably need a therapist too. Guess cost and insurance can help make that decision.

Glad to hear (and hopeful) that you've had positive meaningful changes. Everything can be so hit and miss, I've given up a couple times with therapy.

[sharkticon]

For me running in the mornings has really helped, drinking water, and therapy. Personally I think Adults with ADHD need more therapy than they think. I feel like there is a lot of emotional dysregulation that goes on and often hidden trauma that needs to be dealt with. A lot of black and white thinking. We think we are all good one week and have everything sorted out, and then the next is like wheres my therapist, my life is a wreck.

[Gettingittogether in reply to sharkticon]

Great post sharkticon. The "emotional dysregulation" piece is key.

For newcomers, emotional regulation is basically the ability to manage your emotions through the ups and down and knocks of life. People with ADHD have a hard time managing their feelings. Note; managing does not mean suppressing. It's more along the lines of not letting one bad moment in a day hijack your brain for the entire day ... and next day ...

Emotional regulation also involves the ability to comfort yourself, soothe yourself when a boss is cold or says a tough word at us ... a spouse gives us a mean look ... Avoiding impulsiveness out of a flash of anger and so on ... Being able to keep yourself in emotional balance is fundamental to thriving. And ADHD impairs this ability. And inability to regulate is part of the concentration/focus problem.

[Hidden]

The advise others have given is all excellent. I have a therapist in addition to being medicated and he helps me focus on me instead of putting all my energy into work and home. We all need time for ourselves too.

When it comes to meds, it really is trial and error. It took me 2 years to find the right med, dose, type, and combo. Methylphenidate didn’t work for me either. I felt tired and was very irritable. I take Adderall now in long acting and instant release and that works perfect.