ADHD and me: on mental health.

It’s #BellLetsTalk Day, which here in Canada is the one day of the year that people—for better or worse, and sometimes to just bash Bell—stop to talk about mental health. I’m not getting into the Bell thing—it’s a thing.

http://i0.wp.com/farm1.staticflickr.com/283/32488879416_3f9cd185cf.jpg?resize=500%2C379&ssl=1

What I am getting into is this country has taken the time to pause and reflect. This is awesome. I have seen so many of my friends on Facebook share their struggles and triumphs and stories of living with anxiety and depression; of going to therapy and of choosing to try medication. People who have dealt with these things since childhood, or who are navigating mental health concerns for the first time as adults. To all of you who have shared your stories—today or any other day—I am so proud of all of you. Thank you for being bold, embracing who YOU are, and sharing your journey: I hope that it makes people in your world see “mental illness” differently, and see you just the same, because you are. You are important and your story is important. Every damn day, not just today—the highs, the lows, your story is important. Every. Freaking. Day. 

I am right here with you.

ADHD is a neurodevelopmental disorder, but one that is also considered by some—including the Canadian Mental Health Association—a mental illness. Like depression and anxiety, ADHD is caused by an imbalance of chemicals in the brain, specifically neurotransmitters.

And I’ll be honest, there are days that I can’t believe that. There are days that I see attention deficit disorder as a blessing or a gift or whatever cheesy, cliche thing people say and how could that be a mental illness? How could it be something that isn’t awesome? Days that I am on my A-game, that I have witty remarks that come out the right way, and that words just fly out onto the page in front of me, and days that my energy is exploding out of me in a way that actually feels good.

Except, more often, there’s the flip side to ADHD. The self-doubt, the feeling that I can’t do things right because I have failed to meet expectations so many times, the times I cannot focus enough to figure out the simplest of things—or even when I can focus, there is information my brain simply can’t process. There are the times that not only can I not understand why I am reacting to things the way I am, but also that it is a tidal wave: my feelings just crash over me and I can’t figure out how to just stop this and react how I know is “normal”. It helps—a bit—knowing that this is common for kids and adults with ADHD alike, that we legitimately feel things more intensely and for longer than other people do [1]. But it only helps after the fact. There are the times I hyperfocus and fail to get anything done that I actually need done and only let myself down; others that I again feel like I’ve failed someone else. The words “I forgot,” or “I’m sorry,” are not less true when they come out of my mouth: I mean it. But I get it: it’s hard to accept, again, when you’ve heard it before, because it looks like carelessness. I don’t blame my ADHD—I blame myself, because ADHD and I coexist. I am not my diagnosis, but I cannot separate from it, either. ADHD isn’t just about academics: it’s about life. And it sucks when your failures or shortcomings are not for lack of trying, they are just because my brain is not wired that way.

But here’s the thing. It’s so much better than it was. It’s better knowing that there is a reason why some things are like they are. ADHD is not an excuse, but it is an explanation, if even just for myself sometimes. It’s better knowing how to figure out strategies that work rather than just feeling like I’m stupid. It’s better knowing that this is how I am wired, and that is okay

My first appointment with my psychiatrist back in 2013, she did not say it but she clearly made a note that I appeared anxious. I started medication for ADHD the next day. When I met her again a month later, early in the appointment she commented that I seemed less anxious even just on a very low dose of Concerta, and asked if I had felt anxious before. I told her that I hadn’t, but that things just “felt better” inside me. It was hard to describe—she understood. Every appointment I have seen my psychiatrist she actually asks about side effects. She asks how things are going. She asks how my mood is. Every time. Because she knows the statistics.

Research states people with ADHD are at increased risk for mental health issues: nearly half of people will experience an anxiety disorder, well over a third will deal with a mood disorder like depression, and 15% will develop a substance-use disorder. [2] However, if ADHD is managed correctly, be it through whichever combination of exercise and therapy and medication and eating well-ish, these things can either be caught early and treated early—maybe even be prevented. Maybe.
I am fortunate, I do not currently have any co-existing mental health concerns. That doesn’t mean that it hasn’t, won’t or can’t happen.

ADHD medication doesn’t give a person with ADHD any special ability to concentrate. I probably still focus less well than most non-ADHDers on 72 mg of Concerta a day. I don’t know because I’ve never had a non-ADHD brain. But do I feel better? Yes. Even though all of the above that I still struggle with. Part of it is because of medicine, but part of it is simply knowing what I am working with, knowing that other people experience this, knowing other people get me.

So, Canada.
You spoke.
I spoke.
We “talked”.
Now, don’t shut up just because Bell does.

Because we need this conversation. And we need the conversation to go further: to ensure mental health care is easily accessible—and affordable—for all Canadians. To make therapy with high-quality therapists affordable and accessible*. To ensure that services are available on demand, when people need them—weeks, or months, or years later. As a Canadian, healthcare for your body comes with the package—its a right. But care for your brain? It’s still on the table. (Which is closer than it’s been for a long time.) Stories are important, but so is access to care.

We need this conversation because we need every Canadian to feel confident they can be supported when they choose to share what they are facing.

Because my diagnosis is NOT about whether or not you believe it exists or not. It exists.

And we are living, breathing, singing, dancing proof that WE EXIST.

*Affordable and accessible therapy, to me, means to make therapy that is not income dependent or not something that is dependent on (awesome) charitable organizations like Aulneau, or educational institutions like the University of Manitoba Psych Services Centre. I’m uninsured, and if I can’t afford insurance, I can’t afford a $150 an hour therapist: which doesn’t mean that I should (or in some cases can) just wait longer.

starting concerta

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.

Winnipeg-20130808-00258.jpg

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.

slide043.gif

(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.

DSCF3112.JPG

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.