If I can’t do my job without meds, should I find another job?

[Portia_pine]

I have been dealing recently with the adderall shortage again and my work has been seriously suffering. It has been two months since I have been able to get a refill on my medication, and I am so overwhelmed at work and stuck in a constant state of task paralysis and procrastination. I feel constantly fatigued, and my supervisors are very frustrated with me as I have been turning in late work and asking for a lot of extensions. They know I have ADHD but not that I have been off medication due to the shortage.

All this has led me to wonder whether I am in the wrong career or position. If I can barely function in my job when I am unmedicated, is it really the right position?

I know that you all don’t have the answer for me specifically, but I wonder what other people think about this. Is it better to be in a job where you don’t need medication to function and be proactive, as opposed to a job where you struggle daily if you don’t have access to medication?

Would love to hear about experiences from anyone who has been able to find such a job that fuels their need for stimulation and interest to the extent that they don’t need medication just to get through the day. At this point I am not even sure how to imagine what a career like this would look like.

Also, some of my issues likely stem from using medication as my main tool and failing to focus on other things that make my ADHD better or worse, like sleep, exercise, good diet, environment, stress management, etc. I know this is also an issue. However, if I am unable to function at work without meds, then I am also unlikely to function well in these other areas too, since work is taking up so much mental energy. I realize that these things are very connected, so it’s not a one-size fits all solution. But I am curious if anyone has found the sweet spot.

Sincerely, Fighting for my life in my inbox,

Portia Pine

[STEM_Dad]

Yes, I did have a job for several years that seemed a perfect fit for me. It was engaging. It matched my skills, interests, expertise. I was part of a great team, and felt like my work was important. The only downside was that it didn't pay very well.

Then, management made big changes to my department. It was never the same after that. It was actually the effects of the changes (and the anxiety that I developed) which led to my ADHD diagnosis.

I am now trying to find a job that will be more like that than the one I have now.

I am lucky that my medication isn't in short supply. Over a year before the shortage started, I had switched to a non-stimulant (generic Strattera) that works better for me than Adderall did. But most people with ADHD are treated more effectively by Adderall or Ritalin, or other related stimulant medications. So, I feel bad for you all.

[Laviedamocha]

I’m curious as to why you haven’t told them you can’t get medication. Presumably you were doing ok when you were able to have the medication? They know you have ADHD. Genuine question, why not tell them? At least it would explain why you are so off your game. Would it not be better if they knew so they could cut you some (hopefully short term) slack? I also think you’re being quite hard on yourself. Yes you perform better when you have your prescribed medication. So does an asthmatic, a diabetic etc etc. If we withheld medication from other illnesses / afflictions would we expect them to be able to perform to the same level or change jobs? I don’t know how supportive your company is, but at the moment they (perhaps) just think you’ve lost interest in your job and aren’t bothered. Personally, if they already know you have ADHD I’d tell them. Let them know, you know, you’ve been off your game and you are really hoping the medication shortage ends soon and you will be back to your usual self. Go to them and acknowledge the situation before they do and it looks like you are making excuses. It would be better to leave with a good reference, based on how you work normally, from a compassionate boss than a reference from a boss who doesn’t know why you’re not so great these days. Good luck whatever you decide to do.

[Mamamichl]

I use counseling and was not able to get medicated until last week. It does help my rsd, but I can use the counseling strategies and “be here in the now” because of the meds. Have you asked your doctor about a different med? Have you taken a genesight test to make sure you know the meds that work best with you? There are alternatives to adderall.

Also, I just got ADA paperwork turned in to HR and it turned things around immensely. I’ve lost many jobs with my conditions and it will be harder to fire me now that I have that in. My supervisor went from berating and eye rolling at me to constructive criticism.

[Slmndrs]

It never hurts to look for a better job, but I don’t think needing meds for a particular job means it’s not right for you. It does make you more vulnerable to a situation like this, but if you otherwise love your work, I don’t think you should feel like you’re aiming for something inappropriate.

I think that there are very few jobs that I could really do well without meds, and maybe not any. Almost all the jobs that both interest me and pay well with to live on will have at least some components that don’t click easily.

[LisethHIS]

Hello Portia_pine,

Thank you for contacting CHADD National Resource Center on ADHD. I am sorry to hear that you are struggling to find your medication and with your job situation. I am not sure if you have disclosed your diagnosed to your employer. Here are two resources you can reach out to, JAN askjan.org/ and EARN askearn.org/ Perhaps you can also try an app called Focusmate adhdcoaches.org/or consider working with an ADHD coach. Here is the link. chadd.org/professional-dire... or adhdcoaches.org/

If you have further questions, please let us know. We are here to help!

Best Regards,

Liseth

Health Information Specialist

CHADD’s National Resource Center on ADHD

chadd.org

[Jozlynn]

I started my own business - which I am insanely passionate about and actually genuinely love working on - and yet I can still REALLY struggle when I'm not medicated. I'm with Slmndrs - I think there are very few jobs many of us could do without meds (for those of us who depend on them). Sometimes it's just the way our brains are that day and nothing we do changes that.

We tend to think of ADHD meds as optional, unlike a diabetic or asthmatic, but I disagree with that (often) unconscious perspective. If you've been prescribed a medication that works for you, there's a reason it works for you. The caveat being that I know not everyone chooses to go with meds, but all the strategies like exercise/cold showers/meditation/etc., don't help me, personally, for long.

I too was hit by the Adderall shortage, so my doctor had me call around to find out if any of the pharmacies carried the equivalent dosage of Vyvanse - which I've been able to find a little more readily. I have to do some calling around almost every month, but so far I've always managed to find it somewhere. Has your doctor suggested something like that? If not, I would recommend asking them if there is an equivalent med you can try to look for. I was actually just reading about a new med that recently came out for ADHD - Azstarys - that might be worth asking about. I've read good things about it, and one of their plugs is "having a hard time finding Adderall?" - there's no shortage of this new stuff. Just a suggestion!

[HCStymie in reply to Jozlynn]

Azstarys is just the next in a long list of Ritalin derived medications. Which in the U.S. means it will be ridiculously expensive and most insurance companies won't want to touch it. Also, it might be useless depending on what dose of Adderall someone is taking. If on a high dose of Adderall, methylphenidate based meds won't do anything useful due to how they work in the body. On low dose Adderall the rule of thumb is double the dose for methylphenidate. That being said, if one could obtain it for a reasonable price, might be better than nothing.

Your doctor should look into Vyvanse more. An equivalent dose of Adderall and Vyvanse are much different. Vyvanse converts to less than half its dose as dextro-amphetamine. i.e. a 70mg dose of Vyvanse converts to about 32mg of amphetamine. Then it has a long slow release all day long vs an immediate dump of medication. Meaning, the peak blood concentration of amphetamine from Vyvanse won't feel like it is working compared to an equivalent dose of Adderall. Need to adjust for the differences in dosage that may have a chance of working.

There has been some seesaw effects between what people can get. Between Adderall and Adderall XR. Or Adderall and Zenzedi or Adderall XR and Dexedrine spansules. Can see if you can find a pharmacist that is forthcoming on what they may or may not be able to get. Many don't like to disclose that kind of info due to fear of being robbed by addicts. Zenzedi and Dexedrine spansules are 100% dextroamphetamine and most people find them to be a little stronger than adderall, although have a sharper onset and come down. There are other amphetamine derivatives like mydayis you can also look into.

[HCStymie]

" If I can barely function in my job when I am unmedicated, is it really the right position?"

Medication should not be a factor as far as what job you should be in, aside from a few specific cases. Medication is a medical issue, not an employment one. Granted the crap pharma industry and incompetent DEA raw materials allocations have screwed so many people throughout the shortage,

Neither you nor society benefit from people taking jobs just because they can do them unmedicated. The jobs that people get the benefit the most from their ADHD meds are more likely to be higher paying ones. Higher paying jobs means larger economy, less need for government support, Larger tax base, more diversity in goods and service options and innovation. Plus unfulfilled people can develop other issues that weigh on family and society. Mental health issues requiring support and resources, economic and social services support, at the extreme end turning to crime to get by or just lashing out.

I have ADHD, SCT, and probably narcolepsy. Research shows these combinations impair people more together than the individual disorders alone. I'm a software engineer with 4 college degrees. My job is literally 8 hours of math, logic, and problem solving all day utilizing different languages, paradigms, design patterns, software packages, operating systems and hardware, work together, interface with 3rd parties and not have any bugs in the million lines of code. Not to mention all the project and release management and QA paradigms. I was often assigned the difficult tasks others struggled with. I always say "all brain all day". I enjoy being a software engineer who is fulfilled and engaged by the work I do for a 6 figure salary. I was clinically depressed, low self esteem, hopelessness, unfulfilled, unable to support myself, not engaged in society, etc. working as a dishwasher and line cook for $6 an hour before the midlife crisis at 23 that made me go a new direction. Rising water lifts all ships they say. Someone content with their job is more content with their life and better able to contribute to society whether it be monetarily, better attitudes, reduced incidents of crime or other disruption, less need for support from the government etc.

People are not required to disclose that they have ADHD unless it would interfere with them being able to do a job to a reasonable level. In your case, I am guessing it may not just be ADHD but also effects of stopping the medication compounding every thing else.? Or are you back to your natural baseline off the meds?

Your company does have to make reasonable accommodations if it would relieve some challenges you face due to the unmedicated ADHD situation. Like maybe being able to work in a room by yourself to remove distractions or flexibility in your work schedule allowing you to come in and leave a little later to allow for more sleep. Mixed days where you work half in the office and half at home where you may be able to pace yourself and not have the stress of feeling like everyone is judging you. Which often happens with ADHD people. If you constantly have people walking by you that you feel you are letting down, then that takes focus away from the task and stress decreases performance. Definitely do some kind of ADA disclosure with HR to protect yourself from being let go. This is a rising medical issue that needs to be managed, not a bad attitude or general poor performance issue etc.

Why are you sitting around waiting for Adderall? Have you not tried to find a different option with your therapist? If your pharmacist is forthcoming, they may be able to tell you something they have been able to order. Zenzedi and Dexedrine spansules are direct replacements for Adderall and Adderall XR. For most, slightyl stronger at equivalent dose but not as smooth coming off it. Vyvanse is an option if on low maybe moderate dose of Adderall. Due to Vyvanse conversation rate to amphetamine and long slow release it has less than half the amphetamine as its dose is, and the peak blood concentration is a fraction of Adderall or Adderall XR meaning you need to triple or quadruple the dose of Vyvanse compared to your first dose of Adderall IR in a day. Starting adult dose for Adderall is 5mg twice a day. Starting dose for Vyvanse is 30mg.

Ritalin and Concerta are methylphenidate based and in my opinion, better to try before Adderall and stay with it if it works. On low dose Adderall the rule of thumb is double the dose for methylphenidate. 5mg adderall, take 10 ritalin. 10mg Adderall XR, take 20 concerta. Doesn't work so well for moderate doses and methylphenidate becomes a placebo for people on high doses of Adderall do to how they work in the body.

Wellbutrin -Think its for depression or anxiety. Can help with ADHD, often given to people who stop taking Adderall to help with the crash and provide some therapeutic effect. Can enhance low or maybe moderate doses of Adderall. Useless when on high doses of Adderall.

Modafinil / armodafinil. Wakefulness promoting drugs which you may benefit from. Say your fatigued? If a large component of that is due to lack of sleep each night, these drugs are the right ones for the job. Prescribed off label for ADHD. Approved for shift work disorder, sleep apnea, and narcolepsy. Often more therapeutic combined with Adderall, but at reduced doses of both as both are stimulants. Also at lower doses affords a decrease in side effects and can actually help protect against some of the way s Adderall downregulates and damages our brains. Modafinil is actually 50% modafinil and 50% armodafinil. The drug armodafinil is 100%. Difference is modafinil may be slightly weaker for some. But it also wears off in half or less the time than armodafinil. I change my combination daily as needed based on what I need to get done how much sleep I got, how much sleep I need to get etc. Modafinil doesn't last as long as armodafinil. But May last 10 to 15 hours for some people. I only get 5 hours out of it give or take. Modafinil has a half life about 3 hours and that of armodafinil is about 15. So while the modafinil wears off, you still have the other half of which is armodafinil working.

Can't get something from the pharmacy. Plan B. Can get modafinil, armodafinil, and Strattera from here. Modalert and Waklert are from Sun Pharma and accepted as the best of the online ones. Haven't tried the sites strattera though. Let your therapist know if you get these backup options and work on dosage strategy. See if armodafinil lasts too long or modafinil not enough.

modafinia.com/home/

Combining stimulants makes most therapists panic due to lack of education on the subject. I cut my Adderall dose by more than half, added strattera, modafinil, armodafinil, and caffeine. More therapeutic and blood pressure dropped over 10 points from Adderall alone. 5 stimulants. Don't recommend others do what I did. Didn't just wake up and take all that. It was a process.