neurostract

> Both Ritalin and Adderall are dopamine reuptake inhibitors.

Methylphendiate (Ritalin) is a dopamine reuptake inhibitor, to be certain: it binds to and blocks both dopamine and norepinephrine reputake inhibitors. It's thought to increase neuron firing rate, but that mechanism of action is unknown.

Adderal, however, is a mixture of dextroamphetamine and levoamphetamine salts. They stop reuptake of the two monoamines not by blocking the transports, but by reversing their action. Instead of taking up dopamine and norepinephrine, they pump it out. It also stimulates the release of the monoamines from the synaptic vesicles into the intracellular membrane.

Ritalin causes dopamine and norepinephrine to stick around longer, making their action last longer. It's like closing a drain half way with the faucet on medium: the water level rises more than typical, but no higher.

Adderal causes them to flood the intracellular fluid. It's like turning the faucet on while flood waters are coming up the drain pipe.

>Something to consider is that your brain is already messed with, so the use of drugs might be needed to un-mess it

Absolutely. I came to this conclusion after a few months of therapy and reading several books about ADHD (Driven to Distraction was the first of a rather deep rabbit hole). I was terrified that I'd lose that creative spark I always held unique, because that's what previous psychiatric medicine had done to me.

Bupropion (Wellbutrin) isn't just a dopamine reuptake inhibitor: it's also a norepinephrine reuptake inhibitor and a nicotinic acetylcholine receptor antagonist (which is why it's also prescribed for smoking cessation). It didn't work with me. I was calmer, less hyperactive: but I had a flat affect. I could concentrate on busywork, but I couldn't think. It also wasn't prescribed for ADHD: it was the second attempt to treat a (non-existent) bipolar disorder when I was 15. I'm pretty sure (at this point) my neurochemistry is such that my reuptake rate is fine, but my release/synthesis rate is much too low. Which is why a reuptake inhibitor seemed to only work part way.

The first tried, however was Depakote. In extreme cases it's prescribed to stabilize mood and impulse control with ADHD. It's usually prescribed to quell manic episodes and control seizures. I only dully remember my time on it. I do remember being in a constant fog, a miasma - while I couldn't really think straight beforehand, I could barely think /at all/ on that medication. I was on 900mg/day. Given my bodyweight at the time, my plasma concentrations were probably well above the typical controlled therapy concentrations of 100mg/L. It was probably closer to 200mg/L, which explains the stupor and slight tremors I had.

Given its pharmacology, I can't see how it is, in good conscience, prescribed to those with ADHD unless a manic skewed bipolar disorder is also present.

But the story of why they were absolutely convinced I was manic/bipolar is another thing entirely.

Came back to add:

I understand what you mean about hearing everything! It's odd, because often I have to ask people to repeat themselves, but it's not because I have a hard time hearing. My 5th grade teacher even had me tested for hearing difficulties. The truth is I hear too well (even after years of death metal concerts attended sans ear protection) ... and I can't necessarily tune other stuff out (or my own thoughts) well enough to actually pay attention to what someone has said.

I think it's telling that I can still hear the refresh rate on most CRTs at nearly 30 :)

You're welcome, and good luck.

It took about a month from diagnosis to beginning medication- my psychiatrist wanted to look into my previous hospital stay, have conversations with my therapist: there was definitely an unspoken worry about my past alcohol abuse.

Get help! It's hard. It is really, really hard. But ultimately worth it.

I neglected to mention that for a good five years or so I experimented with just about anything I could get my hands on: research hallucinogens (2CI, 2CH, 2CB, 5MEO-DMT in addition to LSD and mushrooms), cocaine, dextromethorphan hydrobromide, various opioids...

Alcohol, nicotine and my distractions were my addictions.

> Normally, I'd have a ghostly music video running in my head just below the level of consciousness. Thoughts darting, snippets of music, visuals. All that was just gone and I was just there. Kind of like a flow state when playing sports. It was very interesting.

I know what you mean. I've used the analogy of having a plethora televisions on in my brain, all tuned to different cacophonous channels with the volume to 11 and no clicker. The medication gives me a clicker, so I can turn all the ones I don't want to pay attention to off. It doesn't get rid of my distractions: it gives me agency over them.

>This is where the ADHD as broken leg analogy breaks down.

I don't like that analogy one bit -- it implies that something is broken in me, and once it's fixed I'll be okay after maybe some physical therapy. Something isn't /broken/, my executive functions are /impaired/. Fixing that negative brings a host of positives with it: my brain makes creative connections all the time; my problem solving abilities are fantastic (even more so now that I have agency over those abilities instead of just letting them 'percolate' while I distract myself); yes, I'm a little impulsive -- but that just keeps things interesting ;)

Managed ADHD is a boon. Unmanaged, untreated, undiagnosed ADHD is crippling.

You're welcome. Good luck! Seeking professional help was a very difficult step for me. It meant facing a lot of things about myself that I really didn't want to.

Please keep in mind that if you are diagnosed ADHD: medication, if directed, is only one part of living with it! A comprehensive treatment plan is absolutely necessary. You can't just pill it away. A lot of my treatment so far has been forming healthier organization habits, especially around time use. I had the plan before I started the medication, but I felt like my transmission was stuck in neutral. For me, at least, the medication a facilitator for the cure, not the cure in and of itself.

[throwaway, because I still don't feel comfortable attaching my ADHD to my online and real life persona]

It's been a long road to medication for me.

I was sexually assaulted as a child. My parents divorced when I was a fourteen. I spent three weeks over christmas in a mental hospital with an incorrect bipolar diagnosis when I was fifteen. I basically ran away from home seven years later when I moved to where I am now.

Things were tough the first year. They got better after that, but over time my addictions took their toll. I struggled with alcohol abuse, tobacco addiction and constant marijuana use -- and a pervasive question of, "where did all my money go?"

My professional life suffered for years. The first few months on a job I would do extraordinarily well. But things would slide. I'd end up reading HN, reddit, digg, tumblr instead of working.

I'm lucky at my current position: I've been here for over four years now; I've made it through two buyouts of the company and one CEO resignation.

It's the longest time I've ever spent at a single job.

A year and six months ago I moved in with a person who I'd always thought was my best friend. I didn't know that I'd end up co-dependently (financial, emotional, et cetera) supporting their own addictions. They couldn't remember entire conversations we had only a day later. I took a long look in the mirror and started to see the negative aspects addiction in my own life. My room was never clean. I had clean clothes maybe four times a year when I got off my ass to bring them to the laundry room (in the basement of the apartment building -- a quick elevator ride away). I wasn't brushing my teeth regularly. I could barely get to work on time, and I spent all my free time drunk, stoned or both -- and binging on netflix and hulu and porn. I had dozens of empty beer bottles lining my desk, the floor... and I constantly complained that I didn't have the time to work on the things I spent all my time dreaming about.

I started seeing a therapist. I moved out soon after, into my own place with my own lease.

Four months after moving out, I was still binging occasionally but not eight bottles of beer a day. Not smoking (either tobacco or marijuana, but holding onto my e-cig like a safety blanket). But my place was a mess. There were boxes from the move that I hadn't unpacked yet. There were other boxes that were flattened but not taken out. Recycling was everywhere. Dishes were piled in the sink. My clothes hadn't been laundered in two months. I spent my free time distracted by TV, distracted by books, distracted by computer games, distracted by anything I could get myself distracted by -- if only to escape from the shithole I called my apartment (in fact, it's quite a nice place). My therapist was concerned because I seemed to lack an 'inner parent.' I just passively was, instead of actively be.

Even when I was watching TV, or reading, or listlessly listening to music, I wasn't actively involved - my mind was elsewhere. I had a thousand trains of thought in my head, and nobody minding the switch. It was as if my brain was a room lined with televisions, each of them changing channels at random with the volume turned to 11.

I made an appointment with a psychiatrist, and was quickly diagnosed ADHD and put on Adderal. I was rather surprised, considering its potential for abuse and my history with alcohol and other drug abuse.

Over two weeks my dose was increased from 5mg a day to 25mg a day (15 in the morning, 10 in the afternoon). More than that and I felt too jittery.

All of a sudden it was like I had control over the remote control for that wall of televisions. I could choose to turn them all off and focus in on one, and even modulate its volume.

I could notice when I was getting distracted, and refocus myself. I was able to introspect without falling into a spiral of self doubt, self pity, and self loathing.

I don't binge anymore. I now realize that alcohol binging was self-medication - it was a way to dull my mind enough that it wasn't buzzing with overactivity. The last time I tried marijuana, I realized what it actually did was the precise opposite of what my Adderal did. Now that I know what it's like to actually be able to concentrate on something, I have no desire to use a drug that absolutely obliterates my ability to concentrate.

I still struggle with the urge to drink heavily, but am actually able to have only one or two beers with a nice dinner out on Saturdays. Booze on weeknights is a big no-no. I have a very strict schedule I stick to after work, because if I stray from it I have an extraordinarily difficult time sleeping. I miss my drinking buddies, but I also feel the desire for friendships that are more than planting your ass on a stool and getting shitfaced together. My nicotine intake is down from 72mg/day to 36mg/day. By new years, I will be nicotine free. Marijuana use is nil.

I was diagnosed ADHD at age 29.5. I have years of therapy ahead of me. I struggle with disappointment with my family for not seeing it and helping me. I struggle with disappointment in myself for not being stronger.

It may be overdiagnosed in some children, but it can also be underdiagnosed. And the impact of not knowing what the hell is wrong with you is more devastating than anything I can think of.