February 21, 2018 at 6:18 am #76807TyGuyMTLParticipant
I am 42 years old and after a 20 year battle with alcohol have been sober for 1 1/2 years. 3 months ago I felt I was not in a very good place to maintain my sobriety and beginning to experience the thoughts, feelings and symptoms that would lead to a compulsion to drink (or binge eat). The pattern is always the same – Morning after waking up full of energy and clarity able to go to the gym and start my day but by early afternoon I begin to feel strong fatigue, irritability, disengaged, anger, unable to focus or concentrate and a general feeling of depression and defeat. All this would easily lead to an evening of drinking and impulsive/compulsive behavior. I should say that It was strongly recommended that I should be treated for ADHD as a child (smart but doesn’t apply him self, does not stay on task etc) but my parents fought the idea of me being labelled.
So, 3 months ago my Dr. prescribed Concerta and it has made a world of difference! I am able to maintain a sense of “well being” throughout the day and remain productive, engaged and focused on tasks at hand at work (I work in a stressful retail management position). I do not have the defeated feeling of depression which I would normally have at the end of the day.
My concern now is managing my medication long-term and treatment options. I was given 27-54 mg dosage and asked to adjust to the required amount. I question weather this is an ideal treatment long-term because of the stress on the cardiovascular system, blood pressure etc. I have boarder line high blood pressure and sometimes feel the tension in left arm and the stress it causes on the body. I workout pretty everyday, my weight is ideal but still smoke.I do not take the medication until after the gym when I am at work just before noon.
My question is how does someone in my situation move forward? Do some people stay on this medication for life? Are there other medications to consider which are effective but may not have the same health risks? Does other stimulant medications like Adderal (extended release) have the same side effects perhaps people tolerate them in different ways? I am scheduled to see my Dr. for a follow-up so any input and advice would be greatly appreciated.
February 21, 2018 at 9:46 am #76815SueSParticipant
Hi! I, too, struggle with an addiction to binge eating. I have also been on a stimulant for just over a year, but my psychiatrist doesn’t want to take a stand whether I have ADHD or “undertreated depression”, he calls it – since distractibility, irritability, fatigue, etc., can be symptoms of depression/anxiety as well. Long story. But I agree with you about the stimulant helping to keep a sense of well-being throughout the day, and remain productive, engaged, and focused on tasks at hand. I have never felt like this before, or at least not for 15-20 years? It’s hard to remember back farther than that.
Anyway, my son has diagnosed ADHD (4 years now) and goes to a different psychiatrist. He has changed medications a few times and has had his dosage adjusted up over time. His doctor is very knowledgeable about the different stimulants, how they work, what the risks are, etc. We feel very lucky to have this doctor. I know not everyone can have a doctor like this, but my recommendation is that a doctor who works with patients on stimulants routinely, should be able to answer your questions. I don’t know whether a family practitioner will. Generally you switch meds because your body starts to build up a tolerance, and a slight change in the molecule will allow you to start over on a different med at a lower dose. Then you can switch back to the previous med at the same dose and get more of an effect, once your body has “forgotten” about it a little bit. My son’s dose has increased over time, not due to his getting physically larger, but I think due to this tolerance effect. I think it is pretty common to switch back and forth between meds, every 6-12 months (often going off or switching to a different one over the summer). That might not be so applicable to adults, but my point is that if you are worried about side effects, a knowledgeable doctor might be able to keep you on lower doses to reduce the amount of side effects. Typically getting to the right dose is a balance of good therapeutic effect without side effects.
I don’t know if part of the reason you are worried about staying on for life or the dose / side effects is the addiction factor? I think maybe, because of the title of your post. I think about it every time I pick up my prescription. I need to talk to my doctor this week about “dependency” vs. addiction and if there is a difference. My current understanding is that if you are using a medication like this within a doctor’s guidelines and only up to the therapeutic response level, AND if you actually need it due to an ADHD nervous system, you don’t get the “high” from it because it actually slows your brain down so you can focus? So there isn’t the danger of addiction that there might be with “normal” people taking / abusing the same drugs? But like I said, I need to ask my doctor because I know untreated, ADHD tends to lead people toward addiction as an attempt to self-medicate. I haven’t really asked myself the question yet of whether I will need to stay on these meds for life, but your post is a good reminder for me and food for thought.
Good luck to you – I hope you get other answers as well, especially from other adults more experienced in treating adult ADHD!
February 21, 2018 at 9:57 am #76824Penny WilliamsKeymaster
Congratulations on overcoming your addiction. That shows remarkable courage after leaning on alcohol for so many years.
Studies show that people with ADHD who aren’t treated, often turn to drugs and alcohol to self-medicate. You seem to be a classic example of that. The good news is that now you’re getting ADHD treatment, and it will help you stay sober.
Your doctor should have started you on the lowest dose (18 mg for Concerta) and increased only if and when needed. ADHD medications are dosed by individual neurological needs, not age or size, so you start low and work up until you hit the “sweet spot.” The fact that your doctor doesn’t know that this is the standard of care for ADHD signals that you should probably have a specialist managing your ADHD treatment.
This medication primer outlines this and so much more:
ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism
February 21, 2018 at 5:46 pm #76897TyGuyMTLParticipant
Thanks so much Sue and Penny for sharing your thoughts and experience. I am finding it difficult to find a specialist here in Montreal who uniquely treats patients with ADHD and addiction issues. You are so right that left untreated ADHD can lead to other behaviors and substances as a means to self-medicate. I have been through the gamut of compulsive behavior to just “feel better” – excercise obsession, binge eating, drinking etc. I feel that recently including the ADHD factor in my treatment, this answers a lot of questions as to why I felt the way the felt and why I had such problems with alcohol and other behaviors. Thanks again for your insight!
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