No insomnia the first night on 40mg. Maybe a little irritable during the first day due to feeling somewhat frazzled. Second day was fine. A bit of trouble getting to sleep last night. Both the frazzled-ness and the sleep delay were well within my non-medicated experience. Third day, today, is good. Feeling energetic, but not too much so. Calm.
One of my big questions about this whole medication process is: When will I know I'm taking enough? I'll know I'm taking too much when I get unmanageable negative side effects. That's clear. I don't want to figure out where too much is and just back off a bit, though. That's not taking enough, that's taking as much as possible. I want just enough to give me the help I need.
So back on Thursday when my doctor called to say it was time to go to 50mg, I asked him. Turns out that taking too much and backing off is pretty much the standard procedure. I told him I already thought the medication was helping me a bit. Wouldn't it be better to figure out how much it was helping before trying a higher dose?
My doctor's opinion is that I would know for sure if it was helping. I have to consider that seriously; what is the point of having a doctor who specializes in ADHD if I don't? My work experience is highly variable, though. I have some very good weeks, some very bad weeks, and plenty of weeks in between. Even with ADHD I'm a pretty competent and successful person, so even on the so-so weeks I would manage to get the critical stuff done (and on the bad weeks I'd manage to make plausible excuses). I can only measure how well I'm doing by how happy I am with what not only what I got done, but how I got it done.
Last week was pretty consistently good, which tells me that the meds are likely helping somewhat. It wasn't perfect, though; I did end up doing some unnecessary surfing and other self-distraction when things got frustrating. What didn't happen was that part where I get caught up in self-distraction for hours. So, I can't be sure. It could be that just knowing I'm on meds making it easier for me to pull myself back from the edge. In other words, placebo effect. I won't really know until I've been on a dose long enough to stop thinking about the meds and just settle back into my life.
I told my doctor all of this. I want to take just enough medication to give me the help I need to be happy. I don't want to end up taking much more than that just because I wasn't yet completely sure, or because a little bit more might make me feel even better. I'm OK with some residual struggle. Heck, I have to expect struggle. If I'm not struggling, then I'm not challenged enough. I want to feel challenged.
He clearly thought I was making too big a deal out of trying higher doses. From his point of view the meds are very safe. If you are going to bother taking them, why not take whatever amount provides the most help? I can see his point. Even though the meds do present some risks, why take on 30mg worth of risk for marginal benefit, when 40mg might provide much more benefit for little additional risk? Moreover, just was one can't figure out what the benefits of a given dose might be beforehand, given one's unique physiology, neither can one figure out what the problems will be.
The short-term problems caused by the meds, the ones you know about right away, are not my biggest concern, though. I'm worried about the long-term risks, with cardiovascular health at the top. Potential long-term neurological changes are just behind that, not because I'd be less concerned if they occurred but because there is not much evidence that they will.
It is reasonable to conclude that the risk of long-term adverse effects increases with the dose. The shape of the curve is not known, though. I'll have to look up what the typical dose/risk curve looks like for these kinds of medications. The bottom line is that taking more meds means more risk, so I only want to take more if I don't think my current dose is helping enough to be worth taking meds at all.
So, I came to a compromise with my doctor. I went to 40mg instead of 50, and I'm planning to stay at 40 for two weeks instead of one. My life is not falling apart; I'm in no great hurry. I understand that the only way to find out how I'd feel on a higher dose is to try, but I'm not interested in seeing how non-ADHD I could possibly be without causing unmanageable side-effects. I'm interested in finding out how little meds I need to feel happy with my life, and I can't figure that out without going a little more slowly.
Sunday, October 31, 2010
Tuesday, October 26, 2010
30mg Vyvanse, Day 6
Slept well last two nights. The insomnia is gone, at least at 30mg. No negative side-effects at all now, that I can observe.
Positive effects? A little harder to say. That clear feeling of constant energy and zero inertia has definitely disappeared along with the insomnia. That's good - it was disconcerting and abnormal - but it makes it a little more difficult to discern whether anything is happening at all.
I think I'm having an easier time starting and continuing difficult tasks. There is still that feeling of dread when contemplating longer periods of hard work. I can't expect all of my bad habits to disappear in 6 days, though. I will likely only feel more positive facing tough challenges when I've pushed through a few of them successfully. My dread is only natural; these kinds of tasks have consistently ended with me being disappointed and angry with myself for how I have handled them. I have to recalibrate my dread-meter.
Positive effects? A little harder to say. That clear feeling of constant energy and zero inertia has definitely disappeared along with the insomnia. That's good - it was disconcerting and abnormal - but it makes it a little more difficult to discern whether anything is happening at all.
I think I'm having an easier time starting and continuing difficult tasks. There is still that feeling of dread when contemplating longer periods of hard work. I can't expect all of my bad habits to disappear in 6 days, though. I will likely only feel more positive facing tough challenges when I've pushed through a few of them successfully. My dread is only natural; these kinds of tasks have consistently ended with me being disappointed and angry with myself for how I have handled them. I have to recalibrate my dread-meter.
Sunday, October 24, 2010
30mg Vyvanse, Day 4
I'm not going to keep up the day numbering for long. It will get old and pointless fast. For now, I think it is still appropriate. It emphasizes how little time has passed, how little experience I have with what medication is going to do for me. Four days, three nights. Not much.
Did I sleep? That night - the second night - only a little. Four and a half hours or so. I handled it a little differently than the first night. I decided I wouldn't try for long right at the start. If I wasn't getting to sleep within half an hour or so, I'd get up and do something simple and relaxing and then try again later.
So after the first half-hour passed, I did a Sudoku. It was a really hard one, made all the harder by me not realizing that each 3x3 group also had all 9 digits. What can I say? I've never bothered to do a Sudoku before. I came up with some good strategies by considering how I would code an algorithm to solve it efficiently, because it seemed like I might have to do some guessing and see if I ended up violating any constraints down the road. I also derived some rules about eliminating possibilities using unique pairs and triplets of possible cell digits in a group of cells. Kind of necessary when you are unaware of one-third of the constraints and thus have no squares that can be narrowed down to just one possible cell digit.
Then I realized it was 1am, and I was tired, and I was able to sleep.
The next day was interesting. Here I was having slept very badly two nights in a row. I should have been dragging myself out of bed and plodding through the day's tasks. But I wasn't. I was alert, I was motivated. There was zero inertia. When it was clear I wasn't going to get any more sleep, I got out of bed and started the day. Just like that.
Now this, I think, is clearly unnatural. This is not just relieving ADHD symptoms. When I pulled all-nighters in university, or stayed out late with friends, it was not ADHD that made me tired the next day. The part of the Vyvanse that is keeping me awake at night is also preventing me from feeling the effects of sleep deprivation. I guess that's good, in a way. Not sustainable, though.
Insomnia or not, I will have to monitor what the stimulants are doing to me. My doctor's opinion is that people with ADHD underestimate the effect of their symptoms on their life, which causes them to be all the more amazed by how much better they feel once treatment starts. If this is what stimulants are going to feel like long-term, though (and I know it likely isn't) - constant, reliable alertness and energy - then it is not just a matter of feeling like normal people for once. Normal people get tired too. Normal people still have to exert some effort to get out of bed in the morning.
That was Day 3. Yesterday. What is going on today?
The big news is that I slept more or less normally last night. Yay! I bought some melatonin with the plan of using it only after half an hour of sleeplessness, and I didn't have to. I made a point of being physically active in the evening with the hope that this would help. Maybe it did, maybe it didn't. I slept, and that's what matters.
Getting out of bed this morning still took much less effort than usual, but it also took more effort than yesterday. This seems odd on the surface, but it makes sense after a little more thought. Being able to sleep means the medication is no longer preventing me from becoming naturally tired. It is natural to be somewhat tired first thing in the morning, even if I did sleep well. This is good.
Other than the insomnia and slightly unnerving lack of tiredness, I have had no negative side effects. A bit of a headache has come on and off, but who wouldn't get a headache after weaning themselves off of caffeine while simultaneously getting crappy sleep?
Irritability? Ha. I feel calmer and more patient than before, and that is saying something. I generally pride myself on being calm and patient. Even with the lack of sleep, I've been able to keep from getting frustrated or angry in several difficult situations over the last 4 days. This effect has now dropped a bit since the start, but it is still there. I think it will last even if it settles to a lower level, because I can connect it back to ADHD symptoms.
One of my major symptoms was work avoidance. Not just my day job work, any work. It was a frustrating struggle just to get the essentials done, so few things bothered me more than someone going and making extra work for me. I would get disproportionately annoyed at people who very much deserved my patience and kindness, just because their mistake happened to be making me work when I didn't want to.
ADHD also (in the opinion of Dr. Russell Barkley, at least) involves an inability to engage our planning faculties in the moments when they are needed. When faced with a challenging situation, I would often fail to remember and use strategies I knew well, and knew I should be applying. Instead, I'd just get frustrated.
Since medication should mitigate these symptoms, it should cause me to respond better to frustrating situations. If I am less concerned by extra work, and if I can engage good strategies, I will be able to be more forgiving and less angry.
I hope the improved calmness and patience endures. I haven't had the chance yet to put it to the best use. I want to reach one of those really tough times first - the times where I failed completely, where I lost whole days or even weeks trapped in a cycle of frustration, furtive self-distraction, and dishonesty to cover it all up. Times filled with a burning shame and self-loathing.
I want to reach one of those times, and I want to push through to the other side.
Did I sleep? That night - the second night - only a little. Four and a half hours or so. I handled it a little differently than the first night. I decided I wouldn't try for long right at the start. If I wasn't getting to sleep within half an hour or so, I'd get up and do something simple and relaxing and then try again later.
So after the first half-hour passed, I did a Sudoku. It was a really hard one, made all the harder by me not realizing that each 3x3 group also had all 9 digits. What can I say? I've never bothered to do a Sudoku before. I came up with some good strategies by considering how I would code an algorithm to solve it efficiently, because it seemed like I might have to do some guessing and see if I ended up violating any constraints down the road. I also derived some rules about eliminating possibilities using unique pairs and triplets of possible cell digits in a group of cells. Kind of necessary when you are unaware of one-third of the constraints and thus have no squares that can be narrowed down to just one possible cell digit.
Then I realized it was 1am, and I was tired, and I was able to sleep.
The next day was interesting. Here I was having slept very badly two nights in a row. I should have been dragging myself out of bed and plodding through the day's tasks. But I wasn't. I was alert, I was motivated. There was zero inertia. When it was clear I wasn't going to get any more sleep, I got out of bed and started the day. Just like that.
Now this, I think, is clearly unnatural. This is not just relieving ADHD symptoms. When I pulled all-nighters in university, or stayed out late with friends, it was not ADHD that made me tired the next day. The part of the Vyvanse that is keeping me awake at night is also preventing me from feeling the effects of sleep deprivation. I guess that's good, in a way. Not sustainable, though.
Insomnia or not, I will have to monitor what the stimulants are doing to me. My doctor's opinion is that people with ADHD underestimate the effect of their symptoms on their life, which causes them to be all the more amazed by how much better they feel once treatment starts. If this is what stimulants are going to feel like long-term, though (and I know it likely isn't) - constant, reliable alertness and energy - then it is not just a matter of feeling like normal people for once. Normal people get tired too. Normal people still have to exert some effort to get out of bed in the morning.
That was Day 3. Yesterday. What is going on today?
The big news is that I slept more or less normally last night. Yay! I bought some melatonin with the plan of using it only after half an hour of sleeplessness, and I didn't have to. I made a point of being physically active in the evening with the hope that this would help. Maybe it did, maybe it didn't. I slept, and that's what matters.
Getting out of bed this morning still took much less effort than usual, but it also took more effort than yesterday. This seems odd on the surface, but it makes sense after a little more thought. Being able to sleep means the medication is no longer preventing me from becoming naturally tired. It is natural to be somewhat tired first thing in the morning, even if I did sleep well. This is good.
Other than the insomnia and slightly unnerving lack of tiredness, I have had no negative side effects. A bit of a headache has come on and off, but who wouldn't get a headache after weaning themselves off of caffeine while simultaneously getting crappy sleep?
Irritability? Ha. I feel calmer and more patient than before, and that is saying something. I generally pride myself on being calm and patient. Even with the lack of sleep, I've been able to keep from getting frustrated or angry in several difficult situations over the last 4 days. This effect has now dropped a bit since the start, but it is still there. I think it will last even if it settles to a lower level, because I can connect it back to ADHD symptoms.
One of my major symptoms was work avoidance. Not just my day job work, any work. It was a frustrating struggle just to get the essentials done, so few things bothered me more than someone going and making extra work for me. I would get disproportionately annoyed at people who very much deserved my patience and kindness, just because their mistake happened to be making me work when I didn't want to.
ADHD also (in the opinion of Dr. Russell Barkley, at least) involves an inability to engage our planning faculties in the moments when they are needed. When faced with a challenging situation, I would often fail to remember and use strategies I knew well, and knew I should be applying. Instead, I'd just get frustrated.
Since medication should mitigate these symptoms, it should cause me to respond better to frustrating situations. If I am less concerned by extra work, and if I can engage good strategies, I will be able to be more forgiving and less angry.
I hope the improved calmness and patience endures. I haven't had the chance yet to put it to the best use. I want to reach one of those really tough times first - the times where I failed completely, where I lost whole days or even weeks trapped in a cycle of frustration, furtive self-distraction, and dishonesty to cover it all up. Times filled with a burning shame and self-loathing.
I want to reach one of those times, and I want to push through to the other side.
Friday, October 22, 2010
The start, almost.
Almost, because yesterday was really the start. 30mg of Vyvanse at 7:15am or so. That was the start.
Yesterday was good. Felt good all day. Ate well. Very well, actually. No headache, no dizziness, no irritability. The insomnia hit at night, though. Trouble getting to sleep, trouble staying asleep.
Could I work? Hard to say. It wasn't a typical day. No sitting down for hours with a challenging problem in front of me. No chance to get frightened by the possibility of my own inadequacy, to get nervous enough that the slightest hint of frustration could send me scurrying to distract myself. No clump of small, important, boring tasks to avoid. No chunk of work stretching in front of me that I can't bear to even start, because my thoughts start to tangle and my stomach tighten at the prospect of having to see it through.
Today I feel the same. Good. Not tired despite last night's tossing and turning. Same dose, same time. The difference is that today I am in front of my screens. Well, that and a little less coffee. I don't really drink that much, but slowly stepping off the caffeine seemed like the best thing to do. I'll have even less tomorrow, and by Monday I'll have nothing.
Is it helping? Maybe. I haven't done anything big, but I have managed to get a whole bunch of little things done. I don't feel like I'm running away from my work. I'm not experiencing that horrible feeling of my brain hitting my task list (or even hitting the task of making a task list) and quickly and completely sliding off.
Can't say anything based on just today, even if today really is better. Could be placebo effect. Could be just a good day. Could be completely fooling myself. Time will tell.
Dammit, I hope I can sleep tonight.
Yesterday was good. Felt good all day. Ate well. Very well, actually. No headache, no dizziness, no irritability. The insomnia hit at night, though. Trouble getting to sleep, trouble staying asleep.
Could I work? Hard to say. It wasn't a typical day. No sitting down for hours with a challenging problem in front of me. No chance to get frightened by the possibility of my own inadequacy, to get nervous enough that the slightest hint of frustration could send me scurrying to distract myself. No clump of small, important, boring tasks to avoid. No chunk of work stretching in front of me that I can't bear to even start, because my thoughts start to tangle and my stomach tighten at the prospect of having to see it through.
Today I feel the same. Good. Not tired despite last night's tossing and turning. Same dose, same time. The difference is that today I am in front of my screens. Well, that and a little less coffee. I don't really drink that much, but slowly stepping off the caffeine seemed like the best thing to do. I'll have even less tomorrow, and by Monday I'll have nothing.
Is it helping? Maybe. I haven't done anything big, but I have managed to get a whole bunch of little things done. I don't feel like I'm running away from my work. I'm not experiencing that horrible feeling of my brain hitting my task list (or even hitting the task of making a task list) and quickly and completely sliding off.
Can't say anything based on just today, even if today really is better. Could be placebo effect. Could be just a good day. Could be completely fooling myself. Time will tell.
Dammit, I hope I can sleep tonight.
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