View Full Version : Questions from first week after ADHD diagnosis + meds


hendrix
09-26-16, 04:50 PM
I'm very grateful to have a community like this to discuss ADD issues I'm facing, so much appreciated in advance!

Backstory
I'm a 32 year old male, that has always struggled with social anxiety, mainly speaking off the cuff in front of a large group. My memory is bad, and have trouble remembering names, things that were just discussed in the conversation and 'putting together the pieces' of a discussion to provide feedback.

With school I never had an ability to learn by someone telling me. As a result I'd skip 50%-90% of classes, and just learn the stuff on my own with tons of notes. I also smoked a lot of cigarettes and drank coffee during studying as it seemed to help.

I've had problems at jobs related to admin and identifying processes after meetings. This includes tracking where I am on tasks, talking off the cuff about a project in meetings, and I often find myself coming out of a meeting with 'gaps' in what needs to be done in a process, as I'm not always listening/retaining.

Diagnosis
I talked to my Dr. last week and he prescribed 27mg of Concerta and told me to come back in a month.

Results
This is my 6th day taking Concerta.

The first 4 days were fantastic. I had 3 big meetings (6-10 people each) Wednesday & Thursday and was able to remember everything I needed to talk about, provide input/feedback on questions off the cuff, listen to questions then pull on my memory and process everything so that I had an intelligent response. I also was able to do this confidently with zero social anxiety and came out of meetings knowing exactly what needs to be done.

I completed tasks in an efficient manner

I went to a 100 person dinner Friday, and an 80 person event on Saturday knowing only my girlfriend. I had zero anxiety, confidently introduced myself, and engaged in conversation. I was able to listen/follow conversations at the table and chime in drawing on memory. Remembered people's names and stories, then drew on that when I met them later, etc...

Other effects were that I had energy through the day, wasn't relying on coffee/cigarettes, felt more confident, not as needy, not a million things on my brain overwhelming me, etc...


Last 2 days
Last night at 4:30pm I fell asleep hard and slept till 7:00am.

When I woke up the Concerta dose just didn't seem to kick in as much. I've been less able to focus on tasks, processes, work etc... through the day. My mind has been on a bunch of things through the day instead of staying in the present.

At around 3:30 pm (middle of a meeting) I was feeling less able to draw on memory, talk off the cuff about ideas, etc... and started having social anxiety feelings again in the middle of the meeting.


Moving forward
I'm not sure if I'm responding well to the medication or not or how to move forward.

On one hand, I suppose the Concerta could have been helping my executive function to the point where I was able to recall information, focus on conversations, process information, and this lead to an increase in confidence as I knew I was 'capable' of keeping up.

On the other hand It seems there's typically a 'Euphoria' phase with this medication that drops off. I'm not sure if that was the reason I felt better, and it will not be a sustainable expectation.

My questions are:

1. Does it sound like I have ADD and the medication was having a good effect?

2. Is it just a matter of adjusting the dose, and a larger does will eventually lead to a sustainable longer term solution that lasts more than 5 days?

3. Does it sound like the effects on social anxiety were aided by the effects of the medication that last long term or the 'euphoria' phase that is just temporary?

4. Should I wait 3 more weeks for my Dr's appointment or can medication be adjusted earlier?

sarahsweets
09-27-16, 04:19 AM
I think since you are experiencing some positives with the concerta that you should consider waiting to see the doc at your scheduled appt instead of going back sooner. I sounds like you are having a good reaction to the med but maybe you will need your dose adjusted.

kilted_scotsman
09-27-16, 07:06 AM
As SarahSweets says it sounds like you're having some positive effects from the Concerta. Your observation that there will be an initial boost that wears off after a few days is common.

Remember that, as humans, we have short memories for feelings, so we quickly become used to the "new normal" so as well as building neurological tolerance to the med we also notice it's +ve effects less and less..... which leads us to up the dosage until we notice the -ve ones!

It's also worth remembering that things like social anxiety are behavioural.... the meds may produce a short term effect...... this is acting at the neurochemical level..... they buy the space to change our beliefs about ourselves by experiencing previously difficult situations as less threatening....

The meds don't cure the anxiety.... they just dull the symptom like an aspirin..... so the thing to do is to start looking at what your beliefs are around social situations. It is completely normal to be anxious in large groups of strangers, especially if we have to "perform" in some way.

Also... in meetings... there may well be other issues at play..... if you are subconsciously sensitive to "energy" or "atmosphere" you may well find that you are picking up stuff that you are not aware of... this can cause memory fade, tiredness, stress etc.....you are "picking up" messages from others that you don't know how to process so your mind kinda tunes out.

This is associated with the "process" of the meeting NOT the "content".

It's something I didn't understand until I began my training.

Content is what is said..... which is what most people remember/think is important
Process is the underlying interpersonal interaction..... the subconscious body orientated "ulterior" communication channels.... that happen out of most people's awareness.

Learning about "process" makes a HUGE difference in reducing confusion/anxiety etc in social situations.....

So use the meds to give you space to become aware of these things..... other people may not be explicitly aware, however the "process" is what is driving the meeting..... most people are not stressed about this because they learned it early in life..... I think we didn't... or our learning was impaired in some way.... so we don't "get" what is going on.

hendrix
09-27-16, 10:12 AM
As SarahSweets says it sounds like you're having some positive effects from the Concerta. Your observation that there will be an initial boost that wears off after a few days is common.

Remember that, as humans, we have short memories for feelings, so we quickly become used to the "new normal" so as well as building neurological tolerance to the med we also notice it's +ve effects less and less..... which leads us to up the dosage until we notice the -ve ones!

It's also worth remembering that things like social anxiety are behavioural.... the meds may produce a short term effect...... this is acting at the neurochemical level..... they buy the space to change our beliefs about ourselves by experiencing previously difficult situations as less threatening....

The meds don't cure the anxiety.... they just dull the symptom like an aspirin..... so the thing to do is to start looking at what your beliefs are around social situations. It is completely normal to be anxious in large groups of strangers, especially if we have to "perform" in some way.

Also... in meetings... there may well be other issues at play..... if you are subconsciously sensitive to "energy" or "atmosphere" you may well find that you are picking up stuff that you are not aware of... this can cause memory fade, tiredness, stress etc.....you are "picking up" messages from others that you don't know how to process so your mind kinda tunes out.

This is associated with the "process" of the meeting NOT the "content".

It's something I didn't understand until I began my training.

Content is what is said..... which is what most people remember/think is important
Process is the underlying interpersonal interaction..... the subconscious body orientated "ulterior" communication channels.... that happen out of most people's awareness.

Learning about "process" makes a HUGE difference in reducing confusion/anxiety etc in social situations.....

So use the meds to give you space to become aware of these things..... other people may not be explicitly aware, however the "process" is what is driving the meeting..... most people are not stressed about this because they learned it early in life..... I think we didn't... or our learning was impaired in some way.... so we don't "get" what is going on.

Hi KS, I sincerely appreciate the response.

Regarding some of your thoughts on social anxiety, I agree to some extent but also don't feel like the benefits from Concerta are different than what you are saying.

I've worked on CBT for social anxiety and made great progress by understanding thoughts, behaviour, attitude, etc...

At the end though, it seems like there is still a core problem that is causing me to feel judged, negative about social interactions and worry about how I'm performing in social situations. That core problem seems to be more due to ADHD symptoms actually creating a reason to feel judged.

When I'm in a social situation I often daydream in the middle, miss a lot of information and then stress about giving an appropriate response as I didn't listen properly.

I'll try and focus; but, inevitably I end up thinking about 100 other things, and sometimes the thoughts are whether the other person is judging me.

I also seem to have problems 'connecting the dots' and coming up with an appropriate response to questions. Instead bouncing from one topic to another which doesn't 'engage' a group of people.

So, interactions with larger groups of people involve a lot of not being able to process someone else's input then draw on memory to recite a logical response. I'll start thinking about other things, then when it's my turn to talk blurt out something that might have something to do with the conversation. I'm not in the present, but rather spacing out.

Concerta seems to make me able to focus on conversations and stay in the present. Able to retain what someone says, draw on memory, then respond. Not constantly daydreaming about 100 other things, then feeling anxious when I look stupid with an inappropriate response that forgets details that were just told to me.

So to me, it's not like Asprin how it's working in that it's directly effecting the anxiety (or a benzo). It's more effecting some attention problems that are leading to me being anxious.

Btw, I crashed hard again last night. Ended up making a Dr's appointment for Friday. That will be 10 days, and imo enough time to give him some feedback and let him make adjustments accordingly.

kilted_scotsman
09-27-16, 05:01 PM
At the end though, it seems like there is still a core problem that is causing me to feel judged, negative about social interactions and worry about how I'm performing in social situations. That core problem seems to be more due to ADHD symptoms actually creating a reason to feel judged.

Yes, this is almost certainly happening.... remember that this may well have been happening way back into your early childhood, so there will be a deep expectation that things will mess up socially, creating a rather nasty stress/anxiety feedback loop.

Stress on it's own can produce the memory issues and tuning out that you describe..... stress REALLY messes up the brain..... the earlier stress gets going the WORSE the long term effects.

It is possible to work on this with CBT etc however if the sensitisations triggering the stress response go back into pre-verbal childhood, this is often inaccessible to CBT type interventions.

I would agree that ADHD symptoms are going to make for anxiety laden social situations and stimulants can help reverse that process. This gives you the opportunity to reassess your situation..... assess the reality of your situation and how you could adjust it to reduce stress.... this often involved dropping long standing beliefs in what "success" means.

Not easy.... but well worth it.