A little background:
I was diagnosed with ADHD (Inattentive presentation) in September 2020 at the age of 45, and was diagnosed with anxiety at the same time. My ADHD traits are:
- Difficulty sustaining attention with everyday tasks and work, particularly routine or drawn-out work (like analysis and project work).
- I’m often easily distracted, be it by an external stimulus or even by random thoughts.
- When conversing with others, I change topics frequently (usually about 5 times in 10 minutes), and often cannot recall what the original topic was, so I end up having to ask the other person: “What were we talking about?”
- My sense of the passing of time is usually very elastic. Five minutes could seem like an hour, or an hour like five minutes.
- My natural working memory is very limited. It is very difficult for me to hold lists of things or an ordered list of steps in memory. (The average person should be able to hold 7±2 items in memory. I’m limited to 2 or 3.) I can forget something that pops into my mind almost immediately, like in the time it takes to turn around or to pull my phone out of my pocket in order to write the thought down.
- I have poor memory recall ability for names, facts, terminology.
- I have always struggled with Time Management, Organization, Planning & Prioritization. When two or more things need doing, I usually can’t cannot which to do first. Even when I have one thing to do, but it has multiple steps, it can be hard to start the first step, because my mind gets stuck trying to think what the third, fourth, etc. step would be.
- I will hyperfocus on random things (usually not what I need to focus on at the time).
- I have a persistent brain-fog, which feels like it is in two places: in the front towards the top (often extending on both sides as far as my temples), and in the lower half of the back of my head.
If I could sum up the effects my ADHD traits in as few words as possible, they would be: indecisiveness, procrastination, distractibility, forgetfulness
…and worry (as the result of living with these traits on a daily basis).
My doctor started me on an anti-anxiety medication (an SSRI) for a month first. I had done my own research into ADHD, the presentation types, and ADHD medication before meeting with my doctor again. From the information that I had found, I asked him about trying atomoxetine first, but he decided to start me on Adderall and explained his decision with these two reasons: 1) he has seen a good response to Adderall with many of his patients who have ADHD, and 2) atomoxetine can have some very unpleasant withdrawal symptoms.
So, I started on one month of 10mg Adderall XR, and I experienced some improvement with attention and working memory, and alleviated the front half of the brain fog. I was only a little more productive, but I did feel better about myself overall. Still, I was hoping for more improvement.
The next month, my dosage was increased to 20mg. I noticed no further improvement with my ADHD traits, but I did notice having a fast heartbeat (about 110-115 BPM) about two hours after taking the Adderall for the first several days. I think that I was also more irritable in the evenings, and l after it wore off (I’m sometimes irritable in the evenings when I start to get worn out by the day, but this was noticeably happening every day).
- After I reported the raised heart rate, and my doctor noticed that my heart rate was just over 100 BPM in the last two appointments, he took me off of Adderall completely and had me track my heart rate. It turns out, I just normally have a slightly-elevated heart rate, averaging about 100 BPM the whole waking day. (We both agree that I should exercise regularly, but I still haven’t made a habit of it.)
- I practically begged to go back on Adderall, since my work was suffering. He put me on 5mg, which had almost no benefit. Then back on 10mg, which was as effective as it was before.
- I was still struggling to get work done, but my wife had been ill for about three months at that point, and I was pulled in three directions caring for my wife, homeschooling our kids, and trying to take care of work responsibilities… Everything was only half-done, and the house became a mess. I was then informed that my work contract was not going to be renewed (with three-months notice, so I’m still receiving a paycheck, but I’m now looking for a new job).
At my last appointment with my doctor, I asked again about atomoxetine, and he agreed to give it a try. He also recommended that I take advantage of the Employee Assistance Plan available from my employer, for counseling due to losing my work contract and all the other struggles. (I was one step ahead of him; I had already called for a counseling appointment!)