“Methylphenidate Hydrochloride is the hydrochloride salt of the synthetic central nervous system stimulant methylphenidate. Methylphenidate appears to activate the brain stem arousal system and cortex to produce its stimulant effect and, in some clinical settings, may improve cognitive function.” (source)
Also known as Ritalin, my ADHD medication. I get a few questions every other day about medication, it’s hot topic, because it is heavily stigmatized but also because they can be difficult to get, expensive and there are always questions of “what is best for me”.
There are many questions I cannot answer about medications. I am not qualified to advice anyone about them, but what I can share is my personal experience.
When I was diagnosed almost 10 years ago, I started trialing medication immediately. My diagnosis experience was actually good compared to many I hear about and my psychiatrist was the one who led everything, “I want to see how you respond to this” as he writes out a script for 20mg Ritalin.
Personally I was apprehensive at first, because of stigma, and all I could think of was how my ‘friends’ in the past would had made jokes about abusing them. So in my head, I thought if I told people I was ADHD and taking stimulant meds they would see me as someone who is abusing them for fun and ADHD is just some big joke. For context, I am not really friends with these people anymore for obvious reasons and they were people who I did party a lot with previously, so, I really went into this whole journey taking medication for my new disorder with this mindset, and very ignorant about it all actually.
It was almost immediately apparent to me as someone who had experimented with substances in my youth that it was very much a stimulant, I recognized the dehydration and jaw clenching as side effects, so I wasn’t worried about those things as side effects. But there was definitely a few days during my adjustment period that felt like I was “quite wired”. And that’s about the only comparison I would draw between illicit street drugs and ADHD medication. It is so stigmatized in this way, especially in media. I often see jokes in movies about taking Adderall. But actually the way it is portrayed really isn’t the experience for an actually ADHD person.
The improvements were subtle at first. I was taking instant release so it didn’t take long to come on or wear off. 10mg in the morning (1 pill) and 10mg at lunch. This was sufficient for sometime. I would get irritable however when my meds wore off at least for the first wee while, maybe a month or two. As my consistency at taking pills was never good so it did take a wee while to be good at taking them, every day, at the right times and getting a feel for it. This is completely normal response also.
I went for my first medication review and we just stuck with what I was taking. The first changes I noticed really was my mood over all improved, I wasn’t as dysregulated in regards to reacting emotionally to certain triggers or stimuli as intensely as I previously did. But the biggest improvement for this was actually my anxiety. I was almost practically gone. It was apparent to me that my ADHD was actually the source of my anxiety and that treating the ADHD was treating my anxiety. And depression too, I think it makes perfect sense to draw correlation that living with an untreated psychiatric disorder might have consequences like depression and anxiety. I had tried to treat those things all my life to no avail and then suddenly! It was gone! So that was a big improvement on my life quality.
The other thing that improved quickly was my energy and ability to follow through more frequently. And to hold my focus and thoughts. I was better at conversations and listening. And I was in general getting more done.
But I did notice the difference when I had no meds to when I did. It’s like putting on a pair of goggles to look through a fog cloud. The fog cloud is always there, and when the meds wear off or I forget them I am back to seeing only the fog.
Even though this was working for awhile, there was a point where I felt I needed more. So I had another review and we trialed upping my dose to 40mg a day. So that is 20 in the morning and 20 at lunch. This was the real game changer. And I have been taking this dose now for at least 6 years. And the rebound period during come down was not as tiring as a lower dose. My understanding is that some people feel tired on a lower dose, or too high of a dose so it’s really important to make note of. And though I didn’t feel “tired” per say, I just thought I should have more energy and increasing my dose definitely changed that.
So because this has worked so well for me, I have never needed to try anything else. However I have had Rubifen which is the off-brand version and noticed nothing different, only reason I had that was accessibility issues. I have also had SSRI meds twice at different stages in the last decade for depression and they go quite well together but I do clench my jaw much more with SSRI and it did give me more light sensitivity for awhile until I got used to it. But otherwise they go quite well together for me.
The other thing that comes with taking ADHD medications is that process of getting them isn’t the most ADHD friendly either. If you are like me, forms and phone calls are quite difficult to do, so actually making the call to renew my script isn’t something I have ever been good at no matter how many years go by. And in my country (and probably others) it’s a restricted substance, so I actually have a special authority number associated with my medical files to allow me to have access to my medication. This means any time I go to a new pharmacist, it’s been a bit of a headache. I’ve also got to have conversations with every new person in my current pharmacy and let them know “My meds are in the safe” which is a kind of embarrassing thing to say, like it really makes me feel like “my medication is a bad thing”, luckily my chemist’s haven’t ever given me “looks” about it, or mad me feel bad, but I have had looks from people also standing in line at the store.
But there is always something, every year, that is a hassle because my script didn’t get sent through or my special authority number had expired. And this number get’s renewed every 2 years. I personally cannot understand this, I get that maybe I might stop taking them and then therefore no longer need that authority, situations could change. But as someone who lives with a chronic mental health condition you would think that I would just have that number for life, it’s not like it is going away every 2 years.
I realize also what I am sharing here comes with a lot of privilege, I am very lucky in my country that medication is also subsidized. So I pay less than $25NZD including script cost to access my medication every month. I don’t need insurance. And really the process has been pretty easy. But this is definitely not the normal experience even though it should be.
My thoughts on medication in general is that if you are apprehensive about it, you should still try it, you will have no idea how it could help unless you do try it. It’s not powerful substance with a big adjustment period like anti-depressants are (SSRI etc), just having one pill with instant release should give you a very quick understanding to how you will respond and the rebound from only 1 pill is nothing as serious as suddenly stopping most types of medication – HOWEVER, that is based on my experience and again, everyone reacts differently to medication. My experience is just 1 experience.
Other information I have read about ADHD medication is not every ADHD person responds to it, so that means there will need to be alternatives to medication used either way. Medication is not a fix, but it certainly improved my life quality in general and makes things so much easier. Environment and basic pillar care is still paramount in order for your medication to be most effective too.
I have read a bit that medication didn’t work well or stopped working. But another thing to be aware of is that during PMS medication doesn’t work well, if you are not eating and sleeping properly it will not work well, if you take too much VIT C around your meds it will not work well, and depression and other conditions can also impact it’s efficacy. So there are many factors that need measuring against also to keep in mind.
There’s not much more I can say about my experience with medication except for food. I have lived with disordered eating most of my life, I also attribute this to my ADHD. Dopamine and Serotonin can be found in food, so it can be seen as another type of self medication. One of the only side effects I have with my medication is actually feeling the need to “binge” during rebound, or when I have no medication. It is as if my body is trying to compensate. So it has impacted my physical health in that way, but again, is easy enough to measure or note from trial and error. Making sure I have healthy snack foods and a steady supply of medication has generally helped me with this.
Again, I highly recommend trying medication. I understand apprehension towards it but it really changed my life for the better. Everything is just easier. ADHD will always be there, but being able to impliment other improvements to help with my ADHD were easier to do also because I have my meds. Even on a down day, when even my meds don’t get me going, overall, my focus and attentiveness is always there which has benefits in many aspects of my life not related to productivity (productivity is totally over rated anyways!)
I hope this helps with any questions, medication really is different for everyone but in general it’s not what media makes it out to be, you aren’t going to become overnight someone who is now addicted to stimulants. It really isn’t like that at all, YES, it can be abused, but there are non-stimulant versions out there too if that is really a concern based on your personal experience, and so there is ways to be medication effectively for ADHD without worry about potential substance abuse. And substance abuse is a common self medicating issue for many ADHDers, actually treating your ADHD with the correct medication could help with this too! You won’ know unless you try.
Any tips for advocacy around medication is that a psychiatrist (at least in my country) is the only person who has the authority to prescribe ADHD medication and then your DR/GP can renew the script for you without having to go through them again. But a good psychiatrist will try to treat it with medication, anyone who says you don’t need it, isn’t looking after your well being unless they believe there is some other medical reason why you can’t (like blood pressure etc) so for some people stimulants aren’t a possibility. But other than that they shouldn’t have any personal bias about what is good for you. It’s really important that you request investigation and enforce your entitlements because having access to medication is about autonomy and denying you that is denying you your human rights. It is denying you to reasonable medical treatment. I highly recommend looking into local support groups or similar to find the best person in your area. There is stigma with ADHD medication in medical professions, so it may be something some people encounter. Please don’t give up on yourself if you aren’t feeling heard, try educate or mediate with this person. If you have the option, also try someone else who will help you. You deserve it.