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.
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