This post is the third installment of the unofficial “Treatment” series, in which I discuss my experiences getting diagnosed with and then treating my Adult ADHD. You can read the first post – about getting diagnosed and starting meds – here. The second post was a very enthusiastic six month update, which you can find here.
So what kind of post is this? It’s a continuation of sorts, of the post My Brain on Back Order, in which I was not coping well with being off my meds for six whole days. I went another seven days without any medication before I received my pharmacy’s alternative offering.
I was prescribed a generic of Ritalin LA, which is usually only prescribed to children under the age of 12. Because of that, its dosages are lower – 10mg capsules as opposed to Concerta’s 18mg capsules. I was given no other directions than what was printed on the bottle: “Take one tablet by mouth daily.”
Nevermind that my usual dose of stimulant is nearly double what a single capsule of Ritalin LA provided. I followed the directions and had a truly AWFUL day. The too-low dose gave me just enough clarity to see all the ways I couldn’t function. I was hyper aware of my distractibility, and I was also incredibly irritable. Everything was frustrating and terrible, and I was convinced that everyone I interacted with was sick of me.
I was working an event with my spouse and our best friend for their business. I spent the day with my two favorite humans in the world, and the whole time I was absolutely certain that they hated me. And what was worse? I thought they had good reason to. The low dose was just enough to spike my anxiety, giving me some Grade-A negative self talk the entire day.
Now, I know that, when starting a new medication, you should take it at the prescribed dose for a length of time to let side effects settle. But gang, it wouldn’t have been worth it. I’d rather be unmedicated than feel like that.
So, the next day I took two capsules, in an effort to better simulate my previous dosage. 20mg is a skosh higher than my beloved 18mg, and I did feel a noticable difference. The first day was similar to my earliest side effects with Concerta, appetite suppression and some slight hyperactivity (I forgot to cut out coffee for the first few days!). But there was no agitation, no anxiety spike! I was able to focus (mostly) and get things done (mostly).
So what’s the problem? Well, there were several. The biggest, most glaring one was that I’d been prescribed a month’s worth of 10mg capsules. Taking two a day meant I only had two weeks’ worth of meds. The second issue was that, over the course of those two weeks, side effects were considerably worse than with my usual medication. The appetite suppression was intense. I could go the entire day without eating, without even thinking about food, until I was damn near faint. And if you’re saddled with toxic thoughts about your body and its relationship to food (like me) and you’re thinking some pithy sentiment akin to, “sounds nice” or, “I wish…”
No. You don’t. This wasn’t some pleasant return to a better eating routine, or not craving so many snacks. This was an utter disinterest in food. Period. To the point where I had to force myself to eat dinner and it would be a fraction of the plate I’d served myself. This was not good. Or sustainable.
The other major problem was, for all of this trouble, the meds weren’t all that effective. Now, I am not a chemist, nor a pharmacist, so I don’t understand the complex differences between Ritalin and Concerta. They are both methylphenidate and both varieties I’ve taken were Long Acting/Extended Release (aka meant to last up to 12 hours). You’d think they would affect my brain pretty similarly.
But the Ritalin did not quiet the constant inner monologue that narrates my every waking thought. I had clarity, I could focus better (I was still pretty distractible, tbh), but there was no quiet. No peace. When the meds wore off (closer to eight hours than Concerta’s ten) it felt like a switch had been flipped. There was no gradual return to distractibility and hyperactivity. It was a dam opening, and all the symptoms and behaviors that had been held at bay throughout the day flooded me.
It left me exhausted. I’ve taken a lot of evening couch naps lately, y’all.
But with Concerta, that inner monologue quiets, hushes to a whisper until it’s gone. And when it returns it’s the same, that little trickle of thought and voice, until it ramps up to my “normal” state. I have not just the ability to focus for ~10 hours a day, but I have peace too. Which then leaves me with the energy/spoons to use my coping mechanisms once the meds wear off in the evening. They help me be more functional the entire day, not just when they’re active in my system.
Still, some focus was better than none. I took the Ritalin, two capsules a day, for two weeks until I ran out. I’ve been unmedicated for about two weeks now. The good news? My insurance is able to prescribe me the brand name Concerta – the pills will be here either today (Wednesday) or tomorrow. The bad news is that the copay is $40 dollars more a month than it was for the generic.
Isn’t the American Health Care System grand?
And that’s the state of my brain at the moment. I spent December and much of January ping-ponging between various forms of “medicated.” December was not a very productive month, if you’ll recall. January is shaping up to be decent so far, but I know there were days where I would have accomplished more if I’d just had the right mix of chemicals in my brain.
Here’s hoping that the differences between the now-defunct generic and the name brand aren’t too substantial. I don’t want to adjust and get accustomed. I want to feel settled and back to the focus I know I can have.
I’ll be back on Monday with the usual Goals Summary. Until then, Bloggos…
BZ
