Same med (Concerta), same dose (54mg). Things have been going pretty well. Sleep is reliable with melatonin. Recently it seems that taking it a little earlier in the evening helps; say, 9pm instead of 10pm when I'm going to go to sleep around 10:30-11pm.
Concentration/focus is a little more difficult to assess (as always). I think I am building better habits every day, which helps. There is no doubt that my overall ability to focus, concentrate, and/or sustain effort has improved greatly. A consistent level of strong focus is still elusive, though; I still have days when I have a lot of trouble getting settled down to work.
On the other hand, I am always aware of the dangers of expecting meds to remove any and all difficulties. Normal people struggle with their work sometimes. Normal people have days when they just don't feel like they're able to get much done. If the population of sites like Reddit is anything to go by, a great many normal people have days when they spend large chunks of their time browsing addictive websites (here I am assuming that these popluations may be accurately characterized as "normal"). Meds simply cannot make everything perfect, at least not for long. The dosages required to do so imply other risks and side-effects that will simply shift the problem elsewhere. We all know where this goes: a chain of meds, each of which was started to alleviate the side-effects of the one before.
Normalizing persistent, pervasive use of medications just won't lead to happiness. So I reject that route. I want just enough meds to let me make some consistent forward progress on my work habits. I think I'm getting that now. I have to figure out how to evaluate where my weaknesses are and craft routines to build strength in those areas.
One thing I noticed a couple of weeks ago was that I'd gotten back in the habit of drinking a fair amount of caffeine. When I was on the Dexedrine variants, this was never necessary since they always made me feel very awake. Methyphenidate doesn't have the same effect. I think it improves my focus more, but it does not wake me up. After a few late nights I started drinking coffee & tea to help me get through the following days, like anyone would, and I didn't really get myself pulled back to minimal consumption.
This is something that I now think I have to be very careful of on methylphenidate. It seems like the relative effects of sleep loss on my concentration are greater now than they were before medication. Before meds I guess I was always kind of half-asleep, so being a little more tired didn't really matter that much. Now it matters much more. I should consider getting good sleep to be a fundamental part of my ADHD treatment, and I should expect that if I am not getting good sleep that I will have more trouble focussing during the day.
I am also wondering whether physiological caffeine dependency can change how the methylphenidate effects my concentration. Habitual caffeine use modifies the balance in the dopamine pathways in the brain in a way that counteracts the stimulant effects of caffeine. Methylphenidate modifies some of the same pathways. It is entirely possible that caffeine dependency reduces the effectiveness of my medication.
So, it's good sleep and much less caffeine for me. I've tried it that way for the past week and I think it's working well.
Showing posts with label ADHD. Show all posts
Showing posts with label ADHD. Show all posts
Sunday, April 10, 2011
Sunday, January 9, 2011
"...maybe amphetamine is just not your drug."
Prophetic words. Last weekend, just after posting about feeling like the Dexedrine wasn't working out very well, I started to have sleep problems. Same problem I had on 50mg Vyvanse: not too difficult to get to sleep initially, but then I wake up around 1:30am and barely get back to sleep at all after that. Really, really light, fitful sleep.
This actually started on the Sunday, when I was only taking Vyvanse. Didn't think too much of it, though. Only one night, right? I start off on only 2.5 Dexedrine on Monday, though.
On Monday night, same thing. Hmmm...now I notice the trend. So on Tuesday I take just the Vyvanse. At this point I'm completely sure that the problem will go away. After all, I've never had a single issue on 30mg Vyvanse.
Same problem Tuesday night.
Now I'm worried. On Wednesday, I don't take anything, not even any caffeine. I expect to feel completely bagged, but I'm oddly OK. Call my doctor, tell him what's going on. We agree I should stop the amphetamine-based meds and try Concerta. "At least," I think, "I'll get a good night's sleep tonight."
Nope. Wednesday night is the same as the others.
On Thursday I again take nothing, though I have some tea to get me through the day since I'm now really tired. Can't tell if this is some amphetamine withdrawal or just the effects of not sleeping well for several nights in a row. Despite having picked up my new prescription, I decide to stay off all meds until I've had a good night's sleep. Concerta has a 12% reported occurrence of insomnia; how am I going to know if I'm affected if I have sleep issues before I take the first pill?
Thursday night I take 6mg melatonin. Never had to take it before since my previous sleep problems have gone away as soon as I reduced the meds. Friday I try 3 mg, and last night I tried 6 again.
I think last night I finally saw some improvement. I still woke up around 1:30am, but I had to pee and unlike the previous nights I felt pretty sleepy. Don't remember having a ton of trouble getting back to sleep. I did wake up a couple more times, but my memories of the night are of brief periods of wakefulness. I'll take 6mg melatonin again tonight and we'll see how things go.
One very interesting part of this experience has been doing my job through it. I have definitely had more trouble with alertness (not shocking given the lack of sleep), but I haven't had a ton of trouble getting things done. I feel much more relaxed. I don't know why, but it seems like over the last month the amphetamines stopped making me feel motivated and energetic, and started just making me jittery.
Hopefully my sleep will settle down and I can try the Concerta. Will post when I do.
This actually started on the Sunday, when I was only taking Vyvanse. Didn't think too much of it, though. Only one night, right? I start off on only 2.5 Dexedrine on Monday, though.
On Monday night, same thing. Hmmm...now I notice the trend. So on Tuesday I take just the Vyvanse. At this point I'm completely sure that the problem will go away. After all, I've never had a single issue on 30mg Vyvanse.
Same problem Tuesday night.
Now I'm worried. On Wednesday, I don't take anything, not even any caffeine. I expect to feel completely bagged, but I'm oddly OK. Call my doctor, tell him what's going on. We agree I should stop the amphetamine-based meds and try Concerta. "At least," I think, "I'll get a good night's sleep tonight."
Nope. Wednesday night is the same as the others.
On Thursday I again take nothing, though I have some tea to get me through the day since I'm now really tired. Can't tell if this is some amphetamine withdrawal or just the effects of not sleeping well for several nights in a row. Despite having picked up my new prescription, I decide to stay off all meds until I've had a good night's sleep. Concerta has a 12% reported occurrence of insomnia; how am I going to know if I'm affected if I have sleep issues before I take the first pill?
Thursday night I take 6mg melatonin. Never had to take it before since my previous sleep problems have gone away as soon as I reduced the meds. Friday I try 3 mg, and last night I tried 6 again.
I think last night I finally saw some improvement. I still woke up around 1:30am, but I had to pee and unlike the previous nights I felt pretty sleepy. Don't remember having a ton of trouble getting back to sleep. I did wake up a couple more times, but my memories of the night are of brief periods of wakefulness. I'll take 6mg melatonin again tonight and we'll see how things go.
One very interesting part of this experience has been doing my job through it. I have definitely had more trouble with alertness (not shocking given the lack of sleep), but I haven't had a ton of trouble getting things done. I feel much more relaxed. I don't know why, but it seems like over the last month the amphetamines stopped making me feel motivated and energetic, and started just making me jittery.
Hopefully my sleep will settle down and I can try the Concerta. Will post when I do.
Tuesday, December 21, 2010
30mg Vyvanse + 5mg Dexedrine
7.5mg Dexedrine messes with my sleep. At least, it does if I take three 2.5mg doses around 9, 11:15, and 2:30. The result felt very similar to 50mg Vyvanse; I could get to sleep without too much difficulty, but I would wake up several times from 1am to 5am and never really feel like I got solidly back to sleep.
7.5mg Dexedrine is ~17.5mg Vyvanse, so from a total dosage point of view this is not so surprising. The Dexedrine is only supposed to last ~4 hours per dose, though, unlike the Vyvanse. The point of using them together was to have the Vyvanse provide a smooth base dose over the entire day, while using Dexedrine for a short-term boost just during work hours. Emphasis on short-term. There is absolutely no reason why the extra Dex should still be hanging around at 1am. Thanks, crazy metabolism.
Still, I didn't really feel like the extra Dex was giving me a big boost during the day. If anything, I felt a little jittery. Combine that with the sleep problems and it was time to drop back down a little.
What I am trying now is actually to do the first two doses in the 7.5mg schedule, and just leave off the third. If the amphetamines really are sticking around for longer than they should, then dosing early should be the way to go. I've tried this for a couple of days now, and it feels good.
As always, the highly variable nature of my work (particularly the fact that is is often quite challenging) makes it difficult to assess how much help the meds are giving me. One thing is very clear though: I do not need caffeine anymore.
I used to really need to use caffeine to stop getting drowsy at my desk, even when I had plenty of sleep. It wasn't a caffeine withdrawal problem just mistaken for drowsiness either; I have plenty of experience with caffeine and I always used it very, well, technically. I know how much to take, when to take it, and I know when I'm getting withdrawal symptoms. I didn't take that much (1 Starbucks "grande" brewed coffee sipped over the entire day), since the research shows that chronic high caffeine use will quickly cause significant tolerance and dependence. I even cut my dose back on weekends by enough to kill any built-up dependence while avoiding significant withdrawal symptoms. I was a caffeine boss.
Regardless, I could be clean of caffeine for well over a week, have gotten 8+ hours of sleep a night for several nights, and I'd still have trouble keeping my eyes open at more that just a couple of points during the day. I know now that this was likely an ADHD symptom. My brain was getting worn out from focusing and couldn't keep up the effort. I used caffeine as an over-the-espresso-bar-counter medication for it. I don't have to do that now, at all, so the meds are helping, and they are helping in a more consistent way. Heck, I've been grumpy and/or jittery many, many more times due to bad caffeine dose choices than I've experienced during all this messing around stimulant medication.
Maybe part of the reason I didn't notice as much of a huge change as I'd expected on the meds is I was doing a good job self-medicating with caffeine? I don't know.
What I am sure of, though, is that 30mg of Vyvanse alone is more than sufficient for my weekends. That's one thing I really like about using Vyvanse and Dexedrine tabs together. On the weekends I don't have to worry about carrying around the Dex and dosing at the right time. There are no worries about feeling grumpy or losing sleep. 30mg of Vyvanse is absolutely fabulous from that point of view. I've never felt even a twinge of extra grumpiness when using it, and most of the time I feel calmer, more relaxed, and more patient.
So hats off to Vyvanse for that, I guess, even if it does crazily stick around in my system for 12 hours longer than it is supposed to. Silly Vyvanse, I can't stay mad at you.
7.5mg Dexedrine is ~17.5mg Vyvanse, so from a total dosage point of view this is not so surprising. The Dexedrine is only supposed to last ~4 hours per dose, though, unlike the Vyvanse. The point of using them together was to have the Vyvanse provide a smooth base dose over the entire day, while using Dexedrine for a short-term boost just during work hours. Emphasis on short-term. There is absolutely no reason why the extra Dex should still be hanging around at 1am. Thanks, crazy metabolism.
Still, I didn't really feel like the extra Dex was giving me a big boost during the day. If anything, I felt a little jittery. Combine that with the sleep problems and it was time to drop back down a little.
What I am trying now is actually to do the first two doses in the 7.5mg schedule, and just leave off the third. If the amphetamines really are sticking around for longer than they should, then dosing early should be the way to go. I've tried this for a couple of days now, and it feels good.
As always, the highly variable nature of my work (particularly the fact that is is often quite challenging) makes it difficult to assess how much help the meds are giving me. One thing is very clear though: I do not need caffeine anymore.
I used to really need to use caffeine to stop getting drowsy at my desk, even when I had plenty of sleep. It wasn't a caffeine withdrawal problem just mistaken for drowsiness either; I have plenty of experience with caffeine and I always used it very, well, technically. I know how much to take, when to take it, and I know when I'm getting withdrawal symptoms. I didn't take that much (1 Starbucks "grande" brewed coffee sipped over the entire day), since the research shows that chronic high caffeine use will quickly cause significant tolerance and dependence. I even cut my dose back on weekends by enough to kill any built-up dependence while avoiding significant withdrawal symptoms. I was a caffeine boss.
Regardless, I could be clean of caffeine for well over a week, have gotten 8+ hours of sleep a night for several nights, and I'd still have trouble keeping my eyes open at more that just a couple of points during the day. I know now that this was likely an ADHD symptom. My brain was getting worn out from focusing and couldn't keep up the effort. I used caffeine as an over-the-espresso-bar-counter medication for it. I don't have to do that now, at all, so the meds are helping, and they are helping in a more consistent way. Heck, I've been grumpy and/or jittery many, many more times due to bad caffeine dose choices than I've experienced during all this messing around stimulant medication.
Maybe part of the reason I didn't notice as much of a huge change as I'd expected on the meds is I was doing a good job self-medicating with caffeine? I don't know.
What I am sure of, though, is that 30mg of Vyvanse alone is more than sufficient for my weekends. That's one thing I really like about using Vyvanse and Dexedrine tabs together. On the weekends I don't have to worry about carrying around the Dex and dosing at the right time. There are no worries about feeling grumpy or losing sleep. 30mg of Vyvanse is absolutely fabulous from that point of view. I've never felt even a twinge of extra grumpiness when using it, and most of the time I feel calmer, more relaxed, and more patient.
So hats off to Vyvanse for that, I guess, even if it does crazily stick around in my system for 12 hours longer than it is supposed to. Silly Vyvanse, I can't stay mad at you.
Wednesday, December 8, 2010
30mg Vyvanse, again
Ugh. What a difference a few days makes. A few hours, actually, since things kind of fell apart on Sunday night, less than 12 hours after the last post.
I'd noticed a bit of irritability in the evenings on the Spansules during the week. I didn't take it too seriously, as short-term side effects are not unusual after changing doses or medications. I'd also noticed, with a little more alarm, some difficulty maintaining an erection around the same time. Again, I was willing to wait it out and see if there was really a long-term pattern.
Well, those things came together to make one big unacceptable problem on Sunday. Suffice it to say that my grumpy, anxious self made a nice wreck out of the end of the day. I had a horrible night, and I spent the morning lying in bed contemplating my own worthlessness until I couldn't delay getting up any longer.
Luckily, I did manage to get up and take my dose. An hour later, back in my right mind, I called my doctor and said I had to back off to 30mg of Vyvanse. That's the last problem-free dose I was on, and I have to get back to problem-free before I can seriously consider another experiment. I accept that this is a fundamentally experimental process, I really do. I just refuse to jump from problem to problem. I have to make sure I have a stable baseline of experience to compare with.
My doctor suggested that amphetamine may just not be my drug (his turn of phrase), and that we should consider trying methylphenidate (Ritalin) or atomoxetine (Strattera). I'm not ruling that out, but I don't think I should jump there from a crisis if I can avoid it.
In any case, it is clear that Spansules were definitely not my thing. Not only did I have negative side-effects, I didn't feel like I was getting the level of positive effects that I experienced on 30mg or 40mg of Vyvanse. This is surprising, since 20mg of Spansules is pharmacologically equivalent to 50mg of Vyvanse. I guess more amphetamine is not what I need.
So, back to 30mg Vyvanse for me. In addition to the 30mg of Vyvanse, though, I also have a bunch of 5mg dexamphetamine sulphate tablets. My deal with my doctor is that I'm going to try splitting those into 2.5mg halves and spreading 2 and then maybe 3 of them over my work day. My hope is that the smooth base of medication from the Vyvanse will prevent an evening "crash" without causing insomnia, and the tablets will let me play around with a bit of a higher dose during the day.
The best I've felt this whole time was when I was on 40mg of Vyvanse with a 5mg dexadrine tab at noon, but even on 40mg I remember feeling like I was sleeping a little too lightly and wasn't tired enough in the mornings. I think it is worth trying 30mg of Vyvanse as the base and seeing if I can't get back to the same level of positive effects by augmenting with the 5mg tabs.
I have to keep remembering that my goal is to get just enough help to be happy. I can't shoot for feeling awesomely focused all the time, or I'm likely to end up chasing that goal into riskier meds and doses than I'm really comfortable with. I'm getting a sense now, though, for how this process can take you in that direction. It is so tempting to just try a little more medication. Then when you get the negative symptoms, you get the offer to fix it with another medication, or a different medication. Going back to less seems like a step backwards, a concession, a defeat.
Well, I don't see it that way. Going back to a known good state is the only way to recover the stability necessary to make a good decision on your next steps. Maybe I'm just lucky that my unmedicated state was already not too shabby. If I was coming to meds with my life falling apart, I can see how it would be a much harder decision to back off in that direction again.
I'd noticed a bit of irritability in the evenings on the Spansules during the week. I didn't take it too seriously, as short-term side effects are not unusual after changing doses or medications. I'd also noticed, with a little more alarm, some difficulty maintaining an erection around the same time. Again, I was willing to wait it out and see if there was really a long-term pattern.
Well, those things came together to make one big unacceptable problem on Sunday. Suffice it to say that my grumpy, anxious self made a nice wreck out of the end of the day. I had a horrible night, and I spent the morning lying in bed contemplating my own worthlessness until I couldn't delay getting up any longer.
Luckily, I did manage to get up and take my dose. An hour later, back in my right mind, I called my doctor and said I had to back off to 30mg of Vyvanse. That's the last problem-free dose I was on, and I have to get back to problem-free before I can seriously consider another experiment. I accept that this is a fundamentally experimental process, I really do. I just refuse to jump from problem to problem. I have to make sure I have a stable baseline of experience to compare with.
My doctor suggested that amphetamine may just not be my drug (his turn of phrase), and that we should consider trying methylphenidate (Ritalin) or atomoxetine (Strattera). I'm not ruling that out, but I don't think I should jump there from a crisis if I can avoid it.
In any case, it is clear that Spansules were definitely not my thing. Not only did I have negative side-effects, I didn't feel like I was getting the level of positive effects that I experienced on 30mg or 40mg of Vyvanse. This is surprising, since 20mg of Spansules is pharmacologically equivalent to 50mg of Vyvanse. I guess more amphetamine is not what I need.
So, back to 30mg Vyvanse for me. In addition to the 30mg of Vyvanse, though, I also have a bunch of 5mg dexamphetamine sulphate tablets. My deal with my doctor is that I'm going to try splitting those into 2.5mg halves and spreading 2 and then maybe 3 of them over my work day. My hope is that the smooth base of medication from the Vyvanse will prevent an evening "crash" without causing insomnia, and the tablets will let me play around with a bit of a higher dose during the day.
The best I've felt this whole time was when I was on 40mg of Vyvanse with a 5mg dexadrine tab at noon, but even on 40mg I remember feeling like I was sleeping a little too lightly and wasn't tired enough in the mornings. I think it is worth trying 30mg of Vyvanse as the base and seeing if I can't get back to the same level of positive effects by augmenting with the 5mg tabs.
I have to keep remembering that my goal is to get just enough help to be happy. I can't shoot for feeling awesomely focused all the time, or I'm likely to end up chasing that goal into riskier meds and doses than I'm really comfortable with. I'm getting a sense now, though, for how this process can take you in that direction. It is so tempting to just try a little more medication. Then when you get the negative symptoms, you get the offer to fix it with another medication, or a different medication. Going back to less seems like a step backwards, a concession, a defeat.
Well, I don't see it that way. Going back to a known good state is the only way to recover the stability necessary to make a good decision on your next steps. Maybe I'm just lucky that my unmedicated state was already not too shabby. If I was coming to meds with my life falling apart, I can see how it would be a much harder decision to back off in that direction again.
Wednesday, November 17, 2010
50 mg Vyvanse + 5 mg Dexedrine
I've spent a week on 40 mg Vyvanse with 5 mg Dexedrine at noon, and it has worked quite well. No more irritability or tension in the afternoons, and it didn't just shift to the evenings as I feared. Not sure why this is, but I bet it has something to do with how rapidly the medication wears off. Perhaps my body was getting rid of the Vyvanse very quickly, leading to a low, and the Dexedrine fills in this low so I get a smoother tapering off. I'll have to remember to ask my doc.
In any case, I've been finding that my ability to stay on track is better now in the afternoon than in the morning. Since this coincided with taking an extra dose of medication, it suggests that a higher dose of Vyvanse in the morning might be in order. I spoke to my doctor about this yesterday, and today I'm starting on 50mg Vyvanse.
In any case, I've been finding that my ability to stay on track is better now in the afternoon than in the morning. Since this coincided with taking an extra dose of medication, it suggests that a higher dose of Vyvanse in the morning might be in order. I spoke to my doctor about this yesterday, and today I'm starting on 50mg Vyvanse.
Wednesday, November 10, 2010
40mg Vyvanse + 5mg Dexadrine
The tension and irritability never really went away. It was still there on Monday. While I was speaking with my doctor on Tuesday, I realized that it always started in the early afternoon. He thinks that I'm a fast metabolizer, and the vyvanse is wearing off partway through the day.
So, today I took 5mg of straight Dexadrine a little after noon. Definitely helped the tension & jitters so far. I guess I'll see what happens this evening when it all wears off.
So, today I took 5mg of straight Dexadrine a little after noon. Definitely helped the tension & jitters so far. I guess I'll see what happens this evening when it all wears off.
Friday, November 5, 2010
40mg Vyvanse, Day 7
I think the stress/jitters are getting better gradually. I am very glad I decided to stay on each dose for 2 weeks. I'd have no idea what 40mg was really going to feel like if I was changing again today.
The big question now is: Is it really helping my symptoms? Again, I'm glad I'm not changing after only a week. I think it is helping. I'm finding it easier to stop distracting myself when I'm at a tough spot, which was always my big problem. I'm starting new jobs more easily, and sticking with them more easily. That's a big deal.
My hardest time is when I'm between big tasks. That's when I have to look around at what there is to do and pick the next thing. There are usually a few big things I could tackle, and a whole bunch of small things. I get paralyzed. The small things seem trivial and meaningless. The big things seem like too much of a commitment. Sitting down and doing an analysis of the options is way, way too formal, of course!
The frustration of trying to choose, combined with no clear deadline for doing so, leads me to distract myself. This leads to more frustration when I realize I've ended up getting nothing done.
I was in this situation yesterday, and I pulled through. I picked one thing and just did it, and I got it done. I started to distract myself, but every time I was able to snap out of it relatively quickly. Maybe the meds make it harder to fall into the numb, semi-trance state of self-distraction. They make that prefrontal cortex planning section of my brain keep saying, "Hey! Hey! Stop it! You have something to do!"
I remember thinking before I started the meds that the side-effect of irritability might not be so much due to the meds themselves. Maybe it's just that once you take the meds, you find yourself no longer able to ignore all the crap you've been putting off for so long. That would irritate anyone.
The big question now is: Is it really helping my symptoms? Again, I'm glad I'm not changing after only a week. I think it is helping. I'm finding it easier to stop distracting myself when I'm at a tough spot, which was always my big problem. I'm starting new jobs more easily, and sticking with them more easily. That's a big deal.
My hardest time is when I'm between big tasks. That's when I have to look around at what there is to do and pick the next thing. There are usually a few big things I could tackle, and a whole bunch of small things. I get paralyzed. The small things seem trivial and meaningless. The big things seem like too much of a commitment. Sitting down and doing an analysis of the options is way, way too formal, of course!
The frustration of trying to choose, combined with no clear deadline for doing so, leads me to distract myself. This leads to more frustration when I realize I've ended up getting nothing done.
I was in this situation yesterday, and I pulled through. I picked one thing and just did it, and I got it done. I started to distract myself, but every time I was able to snap out of it relatively quickly. Maybe the meds make it harder to fall into the numb, semi-trance state of self-distraction. They make that prefrontal cortex planning section of my brain keep saying, "Hey! Hey! Stop it! You have something to do!"
I remember thinking before I started the meds that the side-effect of irritability might not be so much due to the meds themselves. Maybe it's just that once you take the meds, you find yourself no longer able to ignore all the crap you've been putting off for so long. That would irritate anyone.
Tuesday, November 2, 2010
40mg Vyvanse, Day 5
Definitely less jittery today. I still find myself doing these big sighs, though, like I do when I'm really stressed out by something. I feel stressed out. Is it justified? Is it just that my life right now happens to be stressful?
Hard to tell. It feels justified, of course. When I step back and review what has actually happened in the last day or so, though, I'm not seeing the big stressful stuff. I think the meds are still making me feel on edge.
This is very different than the first 30mg. That made me feel calmer, if anything.
Today was better than yesterday. Tomorrow may be better still. We'll see.
Hard to tell. It feels justified, of course. When I step back and review what has actually happened in the last day or so, though, I'm not seeing the big stressful stuff. I think the meds are still making me feel on edge.
This is very different than the first 30mg. That made me feel calmer, if anything.
Today was better than yesterday. Tomorrow may be better still. We'll see.
Monday, November 1, 2010
40mg Vyvanse, Day 4, Evening
Productivity today was good. Mood, not so good. I've been jittery and kind of irritable since around noon. Low-grade headache. Not even a very typical headache, more like occasional aches shooting along different parts of my head. I haven't taken anything for it yet, because I don't want to mask any side effects.
Also kind of stiff, probably because my jitters/irritability have been causing me to clench.
Also kind of stiff, probably because my jitters/irritability have been causing me to clench.
40mg Vyvanse, Day 4
I had less trouble getting to sleep last night, though I did end up waking a few times. I'm working on a bit of an odd problem right now, though, and I was waking up because I was dreaming about it. This is not unusual for me when I work on something right before bed. I'm not going to blame the meds right now.
Otherwise, I feel good this morning. We'll see what the day brings.
Otherwise, I feel good this morning. We'll see what the day brings.
Sunday, October 31, 2010
40 mg Vyvanse, Day 3
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.
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.
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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