Resistance was a major thing I felt in regard to the last point in the Recommendations section of the report of my psychoeducational evaluation.
It is important to recognize that though an ADHD diagnosis cannot be made based on the results obtained, the possibility of an ADHD diagnosis has not been ruled out. Considering that [Kerri] does exhibit some ADHD traits, she may consider discussing with her physician the possibility of a pharmaceutical intervention to alleviate her ADHD symptoms.
(Wang, p. 8, 2013)
It wasn’t a decision I had to rush into. However, given the realities of the Canadian medical system, I gave myself time to think on it, but talked to my primary care doctor pretty quickly on the subject of medication. I know of a handful of primary care doctors who are comfortable prescribing ADHD meds–mine wasn’t, which I was more than okay with. Instead she told me she could refer me to a psychiatrist–which for me was a much better solution. Because of the inconclusiveness of my “diagnosis”, I wanted to be sure that somebody with actual expertise in these things was working alongside me in the decision process surrounding medication.
That appointment came on Thursday. Wednesday, I didn’t want to go–the resistance returned when I screwed up dosing times for all but one of my asthma meds which resulted in waking up at 4 AM when the Zenhale and Atrovent simultaneously wore off, and forgot my pill at dinner until the next day at lunch. At this point, I had growing resistance to going on yet another medication. I psyched myself up by reading the treatment chapter from Delivered from Distraction the night before–which helped because it made me realize, unlike my other meds, if I try meds and either a) they don’t help or b) I simply don’t want to be on them . . . I can stop this one. So, I went into the appoitnment a bit more open minded.
Fortunately, the vibe of the appointment was really good, too. I was definitely nervous, which is typical of whenever I see any new doctor, but I had zero idea what to expect from this appointment. I filled out three more pages of assessment questionnaires then waited a long time. Things got better when I walked in to the doctor’s office to neutral colours with the lights off, natural light coming in from the open window, and the doctor’s bike propped up underneath the window. By the time three minutes had passed, she had told me about picking blueberries in her front yard and having “eight thousand mosquito bites”–between that and the bike, I figured things would be good.
After she glossed over my report with a highlighter, we did an hour of story of my life–all the typical intake stuff like I did with assessment. Through that and the new questionnaires she confirmed the ADHD stuff they had uncovered in my original assessment–that I experience significant inattention and impulsivity (but not so much hyperactivity aside from fidgetiness). The impulsivity thing always throws me for a loop–I don’t see myself as particularly impulsive (but maybe that’s part of the problem?). Her final “diagnosis” was that things were still inconclusive, but she was strongly leaning towards ADHD-PI (primarily inattentive). Story of my life not fitting into boxes (not sure I’d want that any other way :]).
Despite the inability to confirm a diagnosis, she concluded that I do have significant symptoms and medication could be a constructive way of dealing with them. Some discussion, explanation and demonstration with a wicked cool model of a tablet later, I walked out feeling a lot more confident about a lot of things . . . and a super intense looking prescription for Concerta tucked amongst some brochures in my backpack.
So, I then exchanged super intense prescription for innocent-seeming bottle of controlled substance [which at the time was totally freaking me out haha]. In reality, the extended release meds [like Concerta] are manufactured in a way that they’re basically impossible to snort/inject.
(Slide 40 – Credit to Medscape)
So, this thing allegedly lasts for 12 hours (which really means from like, 8-14 hours depending on what your body does with it). The outer layer starts working within an hour, then as it hangs out in your stomach, water gets absorbed into the capsule and pushes out the rest of the medication in a controlled-y manner or something. Fancypants. The #1 most well known ADHD med is Ritalin–all Concerta is, is extended release Ritalin (methylphenidate). “Did it on Ritalin, I got me some good grades . . .” / “On a steady diet of / soda pop and Ritalin . . .” / “Cause I’m worth more than this / so stop writing prescriptions for my Ritalin…” [Matthew Good, Green Day and Katy Perry all off the top of my head… there we go!]. Methylphenidate is a stimulant medication–as my doctor explained it, people who have ADHD have brains that don’t know how to “put on the brakes”–stimulate meds “wake up” the part of the brain that helps put those brakes on–focus attention, control impulsivity, and decrease hyperactivity.
It’s all a game of playing with dosing. Day one was like magic–I wasn’t fidgety, I had one thought in my head at a time. Day two wasn’t quite as good, but I also didn’t drink as much water throughout the day, so I’m trying to work at that. I’m at the kick-in point on day three now, and mostly I’m trying to keep really close notes on my symptoms and how the meds are working–after three weeks, I can either increase to a 36 mg dose in the morning, or split it in two [the bonus of splitting is that I get longer coverage from the meds–11.5h doesn’t really cover a productive school/work day if I’m studying until like 10 PM or something.
But it’s good. It’s another step that is hopefully in the right direction. It’s another tool that hopefully helps make things better. Every step, each modification means a bit more work . . . but also hopefully more success, too.
If you’re interested in the day-to-day bits, I’m tweeting on #startingconcerta.