I'm back on the medication treatment for my ADHD train today. 🚂🚃🚃🚃

Let's talk about ADHD some more to celebrate. 🧵
Boring disclaimers first: I'm not a medical professional. ADHD and most psychiatric conditions are extremely personal and specific, so I'm going to be sharing my personal thoughts and experiences, but only as one perspective to consider for yourself and others.
Practically nothing I'm going to say would I claim is common to everyone with ADHD. The human brain is a weird and complicated and unique thing.

I don't think ADHD brains are more diverse than neurotypical brains, but the differences matter more, and get more attention maybe?
So ADHD. Attention deficit hyperactivity disorder.

First of all, it's an extremely terrible name for the condition!

ADHD is a dysregulation of attention and reward motivations in the brain. To only describe that as a deficit is misleading.
"Johnny can't have ADHD; he spent 16 hours on Saturday doing [INSERT HOBBY ACTIVITY] and forgot to even take a break for meals!"

Easy first mistake! If Johnny is doing something his brain immediately enjoys, he will gladly spend hours doing it at the expense of anything else
It's not necessarily a *lack* of attention. It's the inability to control how much attention span given to something.

Too much attention/repetition/interest in things that are immediately gratifying, too little attention/motivation/desire to do things with delayed payoff.
So back to my ADHD experience. I wasn't diagnosed with ADHD until the last year of undergrad college.

Granted, I very much had it all throughout childhood; I was an awful student, everything was so much harder than it had to be, but ADHD just never crossed anyone's mind?
I was impulsive, couldn't pay attention in class, sensory stimulus and emotional regulation were always difficult, disorganized, etc etc.

And those statements are super qualitative and require a ton of perspective that I lacked at the time. That was just how life was!
I can't speak for my parents, school therapists, etc, but ADHD certainly never even crossed my mind as a possibility.

I fell for that trap, where I was able to point to my hobbies that required HOURS of attention, so ADHD didn't seem like something to educate myself on more
One of my favorite examples was the art I was making with duct tape during high school!

Duct tape comes in all sorts of colors! So I would precisely cut out pieces of duct tape with an exacto knife and lay it down as small posters that would take 20-50 hours of work.
Is it unhealthy or cause of alarm to spend 50 hours on a piece of art as a hobby? Absolutely not. Working on a long hard task and then finishing it is super gratifying!

The fact that I did that piece in the span of less than a week in four sittings might have been a concern...
Thanks to Steam for tracking my later stims like Kerbal Space Program and Factorio so I can know the exact number of hours (in the thousands each) of time I spent on those video games because they were immediately gratifying to my brain and I could keep pressing the happy button
So my ADHD brain likes to operate on a very short task-reward cycle, because it doesn't value the payoff of more abstract things far off in the future.

Action, payoff, action, payoff. short short short.

We're talking something in the 10-45 minutes range personally.
Does this mean I'm completely unable to do something I don't enjoy for four hours?

Not really... I can grit my teeth and lean into an unpleasant task, but ADHD means it's incredibly taxing and I will come out the other side emotionally exhausted from fighting with myself.
Because doing something important but boring that my brain physiologically doesn't want to do becomes a constant internal fist fight/bargaining with myself to keep going, because I have to, or want to, or should, or whatever.
Which is why people with ADHD will tend to have such dramatic/uncontrollable meltdowns.

In the wrong state of mind, something simple like sitting quietly through an entire church service may involve unbelievable turmoil inside an ADHD.
90 minutes of literally doing nothing except sitting quietly can be such a difficult, emotionally taxing, experience. With enough self-control I was able to smoother any signs of discomfort, which was "mature" but made it harder.

But then it's only 10AM and I'm E X A U S T E D.
So yeah, as a child I would have these explosive meltdowns that seemed to just come out of nowhere, because "why in the world would Kenneth be tired? We just sat there for two hours? It isn't even lunchtime yet"
Needless to say, I was a challenging child.

It's a testament to how incredibly supportive and privileged my family and mentors were that we just gritted our way through it and I came out of childhood on such a successful trajectory.
But since there was never a diagnosis, I never took any stimulate medication as a child.

But I think a major point about an ADHD diagnosis that isn't talked about enough is the cognitive therapy it enables.
Anyone diagnosed with ADHD later in life can look back at the WEIRD habits they developed over life, and go "ohhhh yeah, that was an ADHD coping mechanism"

And there's a TON of them. And most of them won't work for you, but if you know to look at the list, you can go shopping
So once I got diagnosed, I could start reading ADHD blogs/books/etc and use it as brainstorming for different techniques and coping mechanisms to make my entire life easier.
But not only the coping mechanisms, but the context and understanding of what's going on is important!

i.e. Doing chores on the weekend? Embrace my need for breaks and every 15 minutes of work gets myself a reward.
Because I can be more self aware and check in with myself, and I know and understand why I need a break after 15 minutes, but it only needs to be 90 seconds.

And sustainable 15 minute chunks are more productive than 45 minutes, a meltdown, and nothing for the rest of the day.
So fast-forward to my last year of undergrad, and since my sister finished her degree at UC Davis and moved out, I got a random new roommate, who happened to be pre-med.
She spent like the first month of us living together watching me study and chore and move through life, and finally sat me down to have a talk because she was noticing some patterns and how did I have no idea what ADHD was?
So I started medication.

I'd say that my official clinical treatment was grossly lacking in any cognitive therapy by only handing me an Rx and a two hour educational video on ADHD, but I'm a self-motivated learner, so maybe I could have asked for more CBT if I had needed?
ADHD stimulant medication is incredibly difficult to grapple with personally from a social cognitive perspective.

It's a schedule II narcotic.*

You know... like oxycodone, morphine, and opium...

* - Technically IIN, but about the same as II.
Practically everyone I've talked to in depth about ADHD who has also been diagnosed as an adult grappled with this same difficulty as me.

Does Adderall make me a drug addict?

Is Ritalin me being a junky through a legal loophole?
And these are incredibly difficult personal questions.

I have never figured out what to say to someone to convince them that medication is right for them.

Because there's no way that I could even know if that's right. Medication is a huge hammer for a complex problem.
And it's not like many doctors help you feel less bad about it either.

To fill my Adderall Rx, I have to periodically pass a drug test.

Which I understand, because it's a schedule II, but holy shit does the premise of the drug tests piss me off once you understand the context
ADHD means that my brain is chemically unable to regulate reward and stimulation.

People with ADHD are more prone to get into things like illegal narcotics, because... we badly need intense stimulation and life can be incredibly hard.
So you can take this one schedule II narcotic, but only if you test negative for every *other* schedule I/II narcotic.

No soup for you.

I mean, it's never been a problem for me, but that comes from SUCH a place of privilege, hard personal discipline, and some luck.

It just pisses me off on principle. And maybe it's more complicated than that if I did test positive. I've never found out.
So anyways, back to me in college.

I get a diagnosis, which didn't really feel so much like a diagnosis than me managing to win over the psychiatrist to give me some of the guud stuff.

They gave me the smallest dose of Ritalin, read me the schedule II riot act, and off I go.
Next morning I get up, take a pill, and it's like the light switch in my brain is finally flipped on!

Suddenly I realize that I've been running at 40% for my entire life, and suddenly I can just... do whatever I want/should without bargaining!
The problem is that a big part of stimulate meds is that your brain can acclimate to it.

And my brain tends to acclimate to meds pretty rapidly.
But the Rx label said to take one pill every morning, and after a week increase if needed...

So I did.

And it was the most amazing month of my life. 10 days on one pill, then I woke up one morning and it stopped working, so two pills, then 10 days later three pills...
Pretty soon I hit the liver toxicity limit for my liver, because I didn't learn the fine art of drug holidays, and I had to switch to Adderall.

And maybe my need to titrate my dose up/down on a daily basis is relatively unique. I have no idea. But I never take the same dose
My medication experience is a constant trade-off of titrating my dose based on today's schedule, and yesterday's schedule, and yesterday's dose, and what I expect tomorrow's dose to be.

The label says 3x10mg per day, but it's 0-40mg any one day of the week.
If I took 30mg every single day, it'd stop working within weeks.

If I don't take as least one, preferably two zero days per week, I can feel the impact per mg slipping and I'll need to take more 0mg days later to make up for it.
So medication on its own is nowhere near a cure for me.

Maybe for others it is, but for me, medication is only the guardrails that let me build behaviors and a lifestyle that can accommodate my ADHD on some level of medication.
So again, the medication is important, but not as much as the label of the diagnosis as a search term for educational material on coping mechanisms and learning how to listen so incredibly closely to how my brain is doing every day to be self-aware of what I can do.
I ultimately stopped taking medication after college.

Not so much because I wanted to, but because my health insurance changed, and the task of getting a new psychiatrist and go through the whole history and diagnosis again just seemed too daunting.
And my psychiatrist during grad school was AWFUL.

Really laid on the attitude during my visits that I was just drug seeking, and maybe I wasn't even taking all of these myself, yada yada.

Wasn't even engaged on WHAT my treatment was, let alone if we should jigger with it.
She just... accidentally wrote me an Rx for instant release instead of extended release once, and I didn't realize until the next day when I opened the bottle and it was a totally different pill.

Called her: "Well, you filled it, so I can't write you another script for 90 days"
So I got to learn how to manage IR instead of XR that quarter.

In some ways, it was nice having another tool in my toolbox. XR for full days, IR if I didn't need a 12 hour dose...

Or slept in past 10AM, because XR after 10AM trashed my sleep the next day. :(
She was BAD. At one point, she ordered the ADHD clicker test for me, where they sit you down in front of a computer for like 45 minutes and every time the light blinks, you click the mouse button.

Response times and accuracy are measured and a 👍/👎 diagnosis is spit out.
Bonus points for anyone who immediately notices the impending disaster that's about to show up on my chart...
This clicker test was three years after I had already been diagnosed with ADHD and started treatment...

And she made this test seem like a formality, and didn't tell me to make sure to show up with my meds completely out of my system...
So, that clicker test came back negative.

Kenneth Finnegan does not have ADHD.


Which was now a REAL problem for my doctor, because the test came back negative.
But... you know... I was on Adderall while taking the test... so really, that result was maybe more a testament to the fact that Adderall works?
So THAT was a whole conversation at my next appointment, and "ohhhhh well yes, you have to take a zero day"😐"the day before the test."😐"I figured that was pretty obvious"

So she ordered the test again. And told me to take a day off before it.
Remember how she accidentally wrote me a script for Adderall IR because she thought that was what I was on instead of the extended release I was actually taking?

Bonus points for anyone who notices the impending second disaster that's about to show up on my chart...
Yeah, so the second test came up negative too.

I now had two negative clicker tests on my chart, and "ohhhh well yes, you need to take more like 3-4 days off meds for XR"

No. Fuck you and this clicker test science experiment. Give me my Adderall and leave me alone.

And that's how the last year of my clinical treatment went before I changed insurance and ultimately gave up on meds.
Granted, I'm not even really convinced that entirely off my meds I would have failed that test.

Remember how I talked about how unique and personal each person's ADHD and coping mechanisms are? Clicker games are one of my jams.
That clicker test was designed in like the 70s, and I spent my entire childhood training on computer-mouse reflex tests.

So maybe that wasn't a good diagnostic test for me in any context? Because clicking is one of my stim rewards, so 45 minutes of it wouldn't be boring AF
So fine, first job out of college, new insurance, I hated my last psychiatrist.

But I've gotten a few years to sit in the eye of the maelstrom that was my brain, so I got plenty of time to catch my breath and educate myself on coping mechanisms, so going off the meds is possible
So I never bothered trying to engage a new mental health dept. I just stretch my last month's supply across about a year and a half for only when I was having *particularly* bad days and eventually was entirely managing my ADHD cognitively.
The debate about when people should start on meds and go off of them or if you're obligated to eventually stop vs take them until you die, etc etc is COMPLICATED.

And anyone making sweeping recs about your 5yr plan for ADHD treatment better be extremely versed in your situation
But management without meds might be possible!

I haven't been as successful over the past six years as I might have been on meds, but... it was easier in other ways?

I used the time to install life style patches to optimize for ADHD, and then moved on with life.
And the volume of engaging resources on possible coping mechanisms to try out and see if they work for you now is AMAZING! Just the @HowtoADHD Youtube channel is better than what I had 10 years ago
I just... never made ADHD a pillar of my self view? I was happy to learn how to manage it and move on.

This comes from a complicated emotional relationship to ADHD, the meds, etc, but I just don't think me talking about ADHD regularly is... very interesting? *glances up*
I'm not ashamed of my diagnosis, but I'm not going to put "| ADHD |" or #neurodivergent in my profile either. 🤷‍♂️

I just don't think it's a very interesting part of my personality for most people vs everything else I bring to the table.
I mean... except for today. We're going to beat this horse for a while because I think it might be helpful/interesting for some subset of my followers to get a random exposure to this discussion today, but I'm the same person I was 6 months ago, +/-.
So the last five years has been me mostly without ADHD meds and managing with my toolbox of coping mechanisms.

I also like the restaurant menu analogy in the video I linked earlier, but I'm an engineer and I like the toolbox analogy.
Identifying your coping mechanisms can be really hard! Many of them are the things you do by reflex when you're most stressed, so you may not even realize.

But identifying them, and either mentally or literally listing them out can be pivotal for when you get in trouble.
When I've had a bad day/series of days and I'm spiraling, being more aware of what coping mechanism tools I have at my disposal and which ones are more effective than others for one kind of stress or another can make a huge difference avoiding the crash!
And the most amazing secret about the ADHD community that everyone else should be aware of, is that even without ADHD humans don't have unlimited supplies of attention/emotional energy.

And the ADHD peeps have been sharing tips and tricks for that like their lives depended on it
So I expect a lot of neurotypicals could read a lot of the ADHD coping mechanisms and think they sound surreally trivial/obvious, but maybe some fraction of the skillset to be that finely attuned to how your body is doing every day could be valuable?
Listing my coping mechanisms is hard. Some of them sound really weird without context, and all of them are more effective for one type of pain/discomfort vs others, and English doesn't really have a dynamic vocabulary for all the different ways you can be "tired"
Candy, snacks, coffee are typical go-tos. My coffee intake is also heavily modulated week to week to maximize impact.

5 minute walks in the middle of the day to think. Changing venue is REALLY valuable for my attention.
Anyone who's sat near me at work will be real familiar with my habit where I will come over and sit down in their cube to chat.

Or not chat, but just be somewhere else to silently roll my thoughts around for a while somewhere else. (sup @techobrien?)
Tactile fidgets. My work desk always looks like a little toy store with random little bits of debris that I manipulate while doing something else.

And the crazy part is, if you had asked me about my fidget collection, I would have said I didn't have one
That's how instinctively some of these habits come about. YEARS later everyone starts talking about fidget spinners (which are exactly one of an entire field of dedicated instruments of fidget) and I go ".... ohhhhh yeah"
Personally, I'm not going to spend money to buy dedicated fidget toys. They all seem expensive, and a little conspicuous, and work vendor reps were always more than happy to send me free fidget toys as long as we called them "samples" during the conversation.
I don't know if I would classify my attraction to dangerous activities as "coping mechanisms" but they're certainly valuable parts of my coping.

I climb 150' radio towers and play with chainsaws on my weekends because they're stimulating.

And stimulation is clutch for ADHD
So without medication, I would say that I found a sustainable lifestyle of reward and interest and architecting my life in such a way to not have as many of the awful things I really don't enjoy.

Until March...
The pandemic quarantine TRASHED my coping mechanisms.

Just, took 3/4 of my tool box and threw them out the window.
Daily venue changes, gone
relaxing walks, gone
casual chatting with other humans, gone
my weekend adventures, gone
Easy access to high fat foods for lunch, gone
All the fidgets on my desk at work, gone
TWITTER! Not gone, but it's a dumpster fire, and not a reward anymore.
This left relatively few options in the Skinner box that is my apartment, so I needed to start pressing those buttons more rapidly during quarantine to manage my ADHD.

Entire pots of coffee

These sounding like my feed in April?
Which was ok, until I had pressed those buttons so many times that those stims stopped working...

My limited set of tools were becoming less effective, and I didn't have time to develop a whole new tool kit.
So it's now the beginning of May, and I'm slipping down the hill of stimulation with not enough tools, that are quickly wearing out, and it's pretty clear that I'm soon if not immediately in trouble.

Thank god I was dialed in enough to notice that early and call mental health
I called the adult mental health department, and pretty much said "I'm in trouble. I need help"

And so starts the turning of the wheels of the bureaucracy of my health care.
After talking to the advice nurse who answered the phone, I got a callback within an hour from the on-call therapist to run through the standard 40 questions to evaluate if I'm going to kill myself before my appointment the next week.

I wasn't going to. My brain is just bored
Granted, "just bored" is a bit of an understatement.

ADHD is a very real and serious issue, and I was getting myself wedged in a very real and serious situation.

Even as a child pre-diagnosis, I had never had so many of my existing coping tools so suddenly destroyed.
Second week, intake with my therapist. Info dump of my history, why I'm there, etc.

In hindsight, where I really screwed up was in that original phone call to not insist on a referral from the on-call therapist to both a therapist and psychiatrist.
Because it wasn't until the third week at my second session that my therapist wrote the referral to psychiatry. Therapists can't write prescriptions. They focus on CBT and provide the "rest" of the treatment.

The referral was out another three weeks...
Beginning of June, and I mean... I'm ok.

I'm chemically bored, very stressed, my depression is creeping back in through the cracks, but I'm handling it. Friends are noticing and becoming concerned (thanks, BTW), but I've already got the appt scheduled and everything.
I'm holding on by my fingernails as I continue to slide at this point, and digging deep in the barrel of tricks for stimulation.

You know the CPU/network/disk activity graphs for your computer's operating system? I stimed on that for four hours one day. Just.. watched the graphs
Not at all a healthy stim watching dstat run in a terminal for four hours. Kind of the "hollow calories" of stimulation.

But I was getting to a point where the activation energy of setting up deeper stims was getting insurmountable.
Wasn't able to concentrate long enough to clear off my desk to play with solder.
Wasn't able to make it through a whole episode of a TV show.
Wasn't able to perform the executive function of deciding which book on my nightstand to pick up, let alone actually read.
I am incredibly lucky that even when I'm this far in my tailspin, I really don't have many *destructive* tendencies.

The most regrettable things I did in my desperation for stimulation over the last month was picking fights with friends. 😞
So I'm looking back at a lot of hurt feelings over the last two months, but it would have been SO easy in a different situation for me to have gone for such worse stims than that.
And like a lot of this thread, this kind of over-simplifies it.

It's not like I was going "My ADHD is bored; let's lash out at some friends to get strong emotional reactions"

All of my motivations are more complex than that, and I wasn't self aware enough at the moment of.
My ADHD is very co-morbid with my depression.

My anti-depression meds help me cope with ADHD, and my ADHD meds double or triple the effectiveness of my depression meds.

So none of this is simple or isolated.
But back to my story.
I finally make it to the beginning of last week, and my appt with my psychiatrist.

I go into that meeting relieved and calm and confident, because I know that once I'm back on meds this will all be possible again.

One pill. Easy mode, engage!
That appointment was a fucking trainwreck.

We went through the normal intake process. Go over my history. Go over why I'm there. Go over a survey of co-morbid symptoms. Go over my chart.

And we come to the end of the appointment, and her conclusion?
I don't have ADHD, and I never should have been prescribed stimulants in the first place.

Honest to God, I had a psychiatrist tell me my diagnosis from 10 years ago was wrong during intake.
Things that jumped out to her:
* I had been managing my symptoms fine off of meds for the last six years
* There's two negative ADHD clicker tests on my chart from 2014
* She felt that some episodes of euphoria from 2009 pointed to me having bipolar disorder.

Would you believe that twat of a psychiatrist in 2014 didn't write any doctors notes on those negative lab results that she accidentally sent me to on Adderall?

Just, a blank lab report on my chart saying "Kenneth does not have ADHD"
So she thinks I have bipolar disorder and we've got 12 minutes to come up with a treatment plan for that.

And I don't know anything about bipolar. I haven't even really thought about ADHD in five years.
But she was gracious enough to offer that if I was really confident that I had ADHD, she could end the call right now and refer me to another psychiatrist who might be willing to write me the Adderall script I was there for. 🙄
And I hadn't shown up to this appointment armed to go toe to toe with a psychiatrist for what was wrong with me.

She's trained in this crap, and I had gotten the diagnosis ten years ago. This was just restarting a prior treatment!
So I dunno. Maybe I have bipolar? She's drawing lines between a lot of my symptoms and the condition. It doesn't really make sense, but I really don't know anything about bipolar.

So she puts me on a mood stabilizer, and throws me a bone and puts me on a non-stim ADHD med.
So that appointment went a little sideways.

But now it's the end of the day, and I've got a new condition and two new prescriptions to learn about, so we dig into articles on the Internet.
And it quickly becomes clear that things have gone horribly wrong.

Bipolar is a RIDICULOUS theory.

Sure, "impulsive" is on the list of symptoms for bipolar, but it's manic go off and move to a different state impulsive, not 2 second lash out at people in frustration impulse
And on this Rx for Intuniv as an ADHD med she wrote that I can take drug holidays as desired like for Adderall.

First of all, the effective halflife for Intuniv is apparently on the order of weeks for ADHD, so I bet you could never notice a zero day on that.
And Intuniv is also a blood pressure medication, and some of the things I read are real adamant about not missing any doses, because they can trigger a hypertensive reaction.

So now I kind of feel like this psychiatrist is trying to kill me...
First thing in the morning, call the mental health clinic.

"I need a new psychiatrist. Right. Now.

My schedule be damned, I'll take any slot you've got, with anyone."

I'm talking to a nurse, thank God, so she says "give me an hour to do some trading and see what I can get"
First of all, nurses. Holy shit.

These people should be paid more than doctors. They're the ones who actually save your life.

The doctors just get to wear the stylish lab coat and sign the paperwork.
And the nurse managed to get me an appointment in the adolescent department six days out.

So I just need to make it six days, and then hope that this second roll of the dice doesn't also come up bad.
This is when things get ugly.

I've been holding on by my fingernails for the prev week just trying to make it to this appointment, and all I got was a mood stabilizer that may cause a deadly rash, and an ADHD med that might reduce symptoms in 4-6 weeks.

But I'm spent.
So I go into free fall.

And I don't like calling it that, because I feel like it trivializes people going through MUCH worse free falls, but it got bad.

I've been wearing out the easiest happy buttons I've got just to make it to this point, and I've got another 6 days
But I've got maybe 45 minutes of usable focus for life logistics at this point per day, and nothing over 5 minutes at that.

Dressed in the morning, 30 seconds.
Making breakfast, 3m30s
Toast for lunch, 1m45s
Brushing my teeth, 2m15s
Making a pot of coffee, 1m50s
Actually cooking something for lunch or dinner? Pffth. That's half my day's executive function right there.

Shower? That's 8 minutes.

Laundry? There's three separate trips to the laundry room for that, let alone dealing with clean clothes once it comes back.
In an ADHD crisis, these tasks seem impossible.

And it's not only that they're hard and I can't *do* them.

It's that my brains executive function is failing and I can't even plan them.
If someone had been here and asked me "what do you need? How can I help?", answering that question in the middle of an ADHD meltdown would have been almost as hard as doing the tasks myself.
Supporting a loved one or friend going through an ADHD meltdown is really hard, just like supporting someone through any kind of crisis.

It takes a level of intimacy to open the floodgates in the middle of a maelstrom, and questions which require executive function don't work.
And supporting your loved ones with ADHD is a whole diff thread, but my first advice would be to focus on questions and actions that don't require executive function.

"What are you feeling?"
"What is causing you anxiety?"
"You should take a shower, it will make you feel better"
And notice how vastly different "you should take a shower" is from "Do you want to take a shower? Do you think that would help?"

Don't put on me the executive burden of planning out the whole shower process and trying to determine if that will be a net positive in the end.
So the week between my appointment last week and my new referral this Tuesday was ROUGH.

We're talking top five worst weeks of my life rough.
I've got so little concentration and executive function that I can't cook, I can't take a shower,

I can barely set up any activities of any complexity to entertain myself to gain cognitive resources, because I lack the cognitive resources to get started.
Work is a disaster.

I've already taken several sick days to lay in bed earlier in the month, so I'm clocking in and... sitting there.

Not paying attention in meetings at all, still crashing for an hour in bed after every meeting anyways.
Working the ticket queue at least is providing free stimulation. I sit there, a ticket pops up, I grab it, I work the puzzle for 5-45 minutes, close the ticket, take a 20 minute nap, wait for another ticket.
Personal projects like FCIX are completely overwhelming at this point, but the urgency of tasks for FCIX are continuing to ratchet up, so I need to put together a plan to spend most of my 45 minutes of being functional on Saturday towards my email inbox.
The planning for this starts Friday morning.

After breakfast, I pour the rest of the day's coffee in a random jug I've got sitting in the kitchen, and set up delayed brew so Saturday morning I'll get woken up by a fresh pot of coffee.
Friday evening, I find a random project laying on the floor in my office and a laptop, and move them to the middle of the hallway to find in the morning. https://twitter.com/KWF/status/1271852261052788736
Saturday morning, coffee clicks on at 8:30AM.

I spend the next 45 minutes listening to and smelling the coffee while in bed, until I can motivate myself to get up and pour myself a cup.

Way back to bed with coffee, find the WRT54G and laptop on the floor, and bring them with me
The next hour is spent poking around in the CFE bootloader and NVRAM. Not really trying to achieve anything; just poking around, reminding myself what it looks like and how it works, the mental equivalent of running my fingers through a large bin of something tiny.
This, plus the ENTIRE pot of fresh coffee, is enough that I'm able to get up, turn on my desktop, log into Gmail, and spend almost an hour getting into a flow to hyperfocus on clearing out any urgent emails from my inbox from the last month and a half.
And that's it. I'm completely spent.

Some toast with peanut butter for... breakfast? Lunch?

And back to bed for a couple hours of more sleep.
But now I've achieved something finally, so the fact that I managed to nudge my attention towards something that was a source of anxiety was huge and means that I'm able to calm down more for the rest of the day because I finished my entire days todo list:

☑️ Handle email
This means that later that day I was able to put my shoes on, and go for a walk around the block, which also helped, so I was able to come back and solder some LEDs to some perfboard. https://twitter.com/KWF/status/1271994713533370373
But that's it. I'm done.

Sunday is spent almost entirely in bed. The fact that I had over-exerted myself the day before is well apparent.
Monday is another day of trying to put out enough smoke signals to make it look like I'm a functional human being, but requires more time napping than making any sort of progress.
And that brings us to this Tuesday. 40 days after my original phone call to the Mental Health department because I realized I was in trouble, and this appointment with my new, new, psychiatrist is make or break for me.
A month and a half ago, and up until last week, my attitude was that I need help and we should try and find the best treatment option for me.

That is no longer the case. The time for us to explore any options that I don't absolutely know will work right NOW was the prev 40 days
I went into that appointment with one goal: I am taking Adderall in the next 24 hours.

I wasn't going to lie to my new psychiatrist, but I'm showing up with a baseball bat and a crowbar, and we're going to drill directly to the fact that I need Adderall. Right. Now.
And I hated myself and everyone else that we ended up in this situation.

At this point, I haven't eaten anything other than toast or cereal in more than a week. I haven't taken a shower in six days.

I was angry. If I got jerked around, we're hitting the blackmarket tonight.
She opens the video call with "Hello, how are you doing today?"

Me: "I have ADHD, and I am in a lot of trouble. Right now."
And you know what... going into that appointment as angry and wound up and strung out as I was...

The thing I did not expect to happen was to have her get MORE wound up and angry than I was. 🤔
Here's a psychiatrist with a new patient who called her department 40 days ago, got *re*-diagnosed with bipolar during his last intake session, hasn't be able to cook in the last week, and is experiencing constant suicide ideations* because it's the only stim he can manage.
* - The suicide ideations are a chronic issue for me, but VERY different than planning or considering suicide. I haven't come anywhere close to even thinking about suicide in more than a decade, but my brain will reach for visualizing it as a stim when I'm in a bad place.
I was absolutely nowhere close to ever wanting to harm myself at any point in the last month, and if I had ever noticed that I was moving in that direction, that's an immediate 911 call.

That's a brain that can't be trusted anymore, and you need someone else to take over.
So what I did not really expect to happen during this appointment, was that my new psychiatrist would go off like the explosion of a feisty middle age Latina that she turned out to be.
Honest to god, I had a medical professional I had just met yelling the phrase "DO YOU WANT TO SEX AS MANY PEOPLE AS YOU CAN RIGHT NOW?! DOES THAT SOUND REMOTELY LIKE YOU?!" at me over the phone this week. That's how amazing my week has been.

Me: "Well yeah... I don't think she ever wrote that on the..."

So at this point, my new psychiatrist is going at a mile a minute and pounding the desk about how we're going to fix this right now.

"It's only 3:30! If I order something right now, we can get it filled before the pharmacy closes! What are I ordering you?"
"What can we do right now to make this go away?"

Me: "This is the part I'm really frustrated about... I don't want to tell you how to do your..."

"No. You know what's going to work. We can change things later. What am I ordering right now?"
She didn't even like my suggestion of starting on 5mg.

Full strength. 10mg. Right now. Ordered.

I had to talk her back down that I'm not able to take it until next morning anyways, so I will pick it the next morning.
So the next morning (yesterday), I'm at the pharmacy two minutes after they open, I pick up my Rx, and sitting back in my truck sobbing with exhaustion, take 10mg of extended release Amphetamine/Dextroamphetamine Mixed Salts.
It takes me 20 minutes to drive home from the pharmacy, and I can already feel it starting to kick in by the time I park my truck.

Within an hour, I'm feeling the full force cold slap in the face of a full 10mg dose for a brain who hasn't seen this drug in a long time.
And it's all gone.

The suicidal ideations. The hopelessness. The crushing weight of how hard every decision has to be. The popcorn brain that feels like a record scratch every 30 seconds.

Now granted, this isn't me completely back to normal or cured.

Adderall has given me... executive function? A bridge to be *able* to perform tasks regardless of how stimulating they are.
But that's not the same as being mentally centered.

"Cured" would have been me being able to focus on work and get things done for the last two days.

I instead opted to spend every free moment between tasks for work to write a 200 tweet thread about ADHD.
Because, Adderall or not, my brain is still starved for stimulation and... moral successes? So the first few days here are going to be a jittery mess of jumping between the easy things.

And it's partly my prior experience that's making sure it's only the easy things.
I feel like I could go scrub every square inch of my kitchen with a toothbrush right now.

And with SUCH a high first dose, that's probably true.

But Adderall doesn't change the fact that I've got an empty tank right now, and running entirely on NOX makes for a BAD crash.
A valuable mental shift for me was that my meds are not the cure for ADHD.

These are the guard rails, or gutter bumpers.

You're not going to do well at bowling bouncing off the bumpers all the time.

But how much easier is it when you don't have to worry about gutter balls?
So, what to take away from this thread?

Well, I've been getting a lot of private messages going "wow, this is me, I think I have ADHD"

And all I can say is that you should explore it. Build a mental health team and talk to them about it.

And diagnosis or not, research ADHD
If you know someone with ADHD, or someone who you suspect may have ADHD but hasn't opened up to you about it yet...

I guess the answer is still "research ADHD". Knowing is half the Battle.
You can follow @KWF.
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