Does ADHD really affect a lot of people, or do a lot of people just take ADHD medications?
It’s easy to jump to the conclusion that it’s the latter but my own experience the last few months points to ADHD perhaps being more prevalent than first thought. In any case it’s a subject that warrants a closer look…
For me personally, ADHD has always been a bit of an afterthought when it comes to mental health diagnosis. It’s always played second or third fiddle to the big guns of depression and anxiety which have overshadowed poor little ADHD. For many years it didn’t even get its own full blown diagnosis from my prescribers and had to make do with a “well.. you might be a little ADHD, would you like some medication for it anyway?”.
So, I took the meds (Focalin, AKA Dexmethylphenidate in my case), used it infrequently when I needed to sit at a computer and do focused work and always identified myself as having depression and anxiety, not ADHD. Maybe it was also the case that the depression and anxiety had a far more pronounced impact on my life that I didn’t really pay much attention to it. That was certainly the case the last couple of years, where life stress really ratcheted up the depression to a point earlier this year that it started to impact work in a big way which caused its own set of serious issues I’ll explore more in a future post or podcast. So, shit got pretty bad… but when that happens it forces you to try different things to get better.
For me this came down to 2 things; I did an intensive 8 week outpatient program (9 hours of group therapy a week, plus individual therapy), and more importantly I realised the level of psychiatric care I was getting was just not enough. I think this is a common issue right now with prescribers being very busy, it can be hard to get an appointment, and in my case my prescriber was just not available between appointments if I was in crisis and needed help. So, I reached out to a former colleague of mine who had recently set up a mental health practice in the hope of seeing one of his team. After briefly explaining my history and current challenges he told me that I should really see an experienced MD level psych, that the care I had been getting was not what I needed, and that he was going to treat me himself. I can’t tell you the relief in the midst of the worst depression and anxiety I’ve had for years, for a Dr that I know personally, trust and respect to say this. I went from seeing my prescriber every 4-6 weeks to weekly appointments. We switched medications right away and 3-4 weeks later the fog started to lift on the depression and this is where I started to notice the ADHD more.
Instead of our appointments being spent talking about how bad the depression was or how I was managing my anxiety by self medicating with a 6 pack of Modelo in the middle of the day, we were talking much more about my ADHD and the difference between an extended or immediate release Focalin. I was starting to see that the ADHD was maybe much more of a thing than I’d realised before.
My therapist suggested around the same time I read a book on ADHD by Dr Daniel Amen and this is where I really began to understand things in more detail. In his book Dr Amen breaks ADHD down into 7 different types, which I think is incredibly important as ADHD can present in far more ways than the classic hyperactive, can’t concentrate in class stereotype we all know (which by the way, was not me at all growing up). As I read through the 7 types it became clear that I checked a lot of the boxes of Type 3 “Overfocused ADHD”
- Excessive or senseless worrying.
- Getting stuck in loops of negative thoughts.
- Difficulty shifting attention from one thing to the next.
- Tendency to hold onto their own opinion and not listen to others.
- May or may not be hyperactive.
Now, how many of these symptoms sound like depression and anxiety? At least the first 3 above which are all about excessive worry / negative thought. But for me personally this is mixed with some other symptoms which I'm learning are not always so negative, and that’s around being creative, coming up with lots of ideas and initiating new projects. Let’s gloss over the not being quite so good at finishing off projects for now ;) I’m managing this with a combination of Zoloft, Focalin and generally having more awareness of my ADHD and learning about how to manage my life around this.
My own learnings from this whole experience:
- Embrace the positives of ADHD, work around them, design your life to take these into account and not see them as negatives.
- Put systems and processes in place to help prioritise and manage tasks and enlist someone else's help to gate-keep starting new things all the time (thanks Gretchen!).
- Goto therapy if you have ADHD and don’t just rely on a stimulant.
- Just like with any mental health condition, manage lifestyle basics like sleep, diet and exercise before taking medication.
- If you do need medication, find yourself the best, most responsive prescriber you can who will spend as much time with you as you need.
If you’re curious about this whole topic then have a listen to the latest episode of the Fellowman podcast with Dr Nick Nissen which is all about how he treats ADHD without using stimulant medication. Nick details his bio, psycho, social approach to ADHD which uses therapy and coaching combined with lifestyle interventions, supplements and non-stimulant medication.