So, I said I'd post back after I had a hold on whether or not the medication was helping; well here goes, I anticipate that this post will run a bit long so I'll try to put a TL;DR at the end, so skip forward to that If you don't want the read the whole thing.
My Doctor put me on Vyvanse. It a "New" still under patent medication that combines Adderall and Ritalin into a complex ratio and time release formula. Don't ask me how they managed time release when it's a powder in a gel cap but that's the claim. Anyway, the shit's expensive, one cap a day cost's around $300 USD for a 30 day month's supply. I have insurance that's considered "good" by American standards any they would only pay 3/4 leaving me with a $75 USD a month price tag for what I now consider an absolute necessity. But that's a rabbit hole for another time. I was extremely hesitant at first because of that price tag but I actually had a very strong sense that my Dr could be trusted on this decision. Unfortunately, I took just over a week from getting the prescription to getting the pills because the local pharmacy had to order them in.
Ok, I actually have to take a moment on a tangent here. I managed to avoid the insurance hole but this is actually kinda important to my decision-making process. When I was in 5th-7th grade - this would have been back in 2006-2003 when I was between 11-14; good lord that's well over a decade ago - I was struggling with school and my parents decided enough was enough and pressured the school district into conducting a series of tests to see if there was anything diagnosable. They also took me to a behavior specialist all the way over in Denver to have some tests done (it's my understanding that ADHD was suggested ass a possibility way back when I was in 1st and 2ed grade but, due to the prevalence of the over-diagnosis of the condition then, these tests were the first follow-up they ever did.). The tests were... inconclusive at best. it placed my IQ in the mid 120's via the Raven's Progressive Matrices test, pointed out that my auditory attention span was subnormal, I had above average logic and comprehension skills, but that was about it. I ended up with a Federal 504 learning plan (504 I believe refers to the section of the "no child left behind" law that mandated that students be accommodated) despite having no officially diagnosable condition. I also got me placed in the "gifted" program a dual state that frustrated everyone involved. Anyway, all of this is to point out that while resulted in some accommodations like extra test time (which has proved invaluable of late) it effectively changed nothing, I was still struggling and there was still no answer.
Continuing that thread, this march I finally got to meet the only licensed medical psychiatrist within 100 miles of where I live (conveniently in town at a presbyterian medical serviced mental health clinic). the man is an oddball. not in the personality sense (not that he doesn't have quirks), but in the "how the hell did a man like this end up here" sense. I live in the central United States attending a small university attached to a small town on the interstate that is literally only alive because the university is here and it's conveniently half way between the two major cities in the state. There is also a smaller east-west highway that runs through where this town is the only stop for about 100 miles but that's minor in comparison. Anyway, this Dr. is a bigshot, privio0us department head of a major hospital on the east coast, who fell off the map due to personal circumstances and ended up in the middle of BFN. And, in the mother of all coincidences, (relative to this situation at leat), He not only know and worked with the psychiatrist I went to in Denver all those years ago, he had helped develop, write, and publish, the major test I'd had administered there. In a twist of irony, the test was worthless because the scale hadn't been adjusted to my age at the time. All of that together with how well he was able to read me and extrapolate from the little bit of information I was able to relay to him in that first 30 minutes meant I held him is a fairly high regard. He also implied that people like me were his area of study and that the had a great deal of experience with treatment in the area.
TLDR: I got lucky and the psychiatrist I could visit was probably the best one in > 800 miles for my particular case
Ugg, two paragraphs later I get back to the medication. I was started off on 30mg of Vyvanse assure that it was the best option to start as The Dr. experience indicated it was simultaneously the most effective, held the lowest possibility for complication and side-effects, and easiest to find the right dosage level on. Fortunately, I didn't just accept the $75 price tag and move on, I was able to find and claim an offer directly from the manufacturer that would cover part of the out of pocket expense so long as I paid at least $30. $30 is still more than double what I've ever paid for a single prescription before but it was acceptable inside my budget. If I have to the Dr. has assured me that we can explore cheaper options but it will be much easier to find the right balance because we'll know how I respond to Vyvanse, and what maximum effectiveness looks like.
As for what Vyvanse does for me? The range is subtle in a given the moment. but the results are night and day as far as I'm concerned. Because of the number of patients, he covers I can only visit the DR ever 8 weeks or so, that's just how far he's booked out. there are waiting lists for cancellations in case you have a need to get in sooner but that's a crap shoot. you get at most day's warning sometimes as little as tow hours if there is a cancellation. As such I've only seen him three time total, once since I started the medication. I've been moved from 30mg to 50mg a day and the effect is definitely noticeable now, I suspect I'll be moved up to 70mg when next I see him (he was estimating I'de respond best somewhere around 50-70mg anyway).
Before I got here starting a completing a given task was a tossup with the odds increasing towards the low end the less the topic of the last held my interest. I'd long considered that the norm, berating myself for not having the willpower to stick to uninteresting tasks (That, in particular, being the reason I went and sought treatment in the first place, procrastination had become a way of life and I saw little to no hope for improvement on my own). I always wondered how people did it, how could they possibly get so much done in a day when even the simple things took me longer that the norm. Now I realize just how prevalent the small distractions were. Small things like following trains of thought even when they were irrelevant to the task at hand add up fast. Those 5 minute breaks to research a tangentially related subject or check up on that thing that could wait, or "let's change the music, the current style is boring me" all add up to hours arguably waisted when the original task shouldn't have even taken that long.
During my first meeting my Dr pointed out that I'm a hyper-focusing personality, I latch on to subjects and tasks and pursue them to their end, all else be damned, and if that thing I'm focusing on falls apart I' would just find something lest risky and focus on it, like video games. He's right I have a great deal of trouble letting a task go. I thinking it's an interesting duality considering the ADHD diagnosis. my therapist thinks so too but neither of us has had time to as him what he thinks of the duality. In that first meeting, he expressed the concern that starting treatment of ADHD with medication had two possible outcomes. Either I'd start being able to function "normal" so to speak, able to focus on a task to completion while also being able to switch tasks if needed; or, it would exacerbate my tendency to focus on the wrong things and cripple my efforts to succeed. This was actually a strong fear of mine as well, but i didn;t have much left to loose at this point so it was Do or Die in regard to my academics.
ADHD is treated with CNS (Central Nervous System) stimulants. Adrenalin is a good example of a CNS Stimulant. They are though to re-balance dopamine and other chemical levels to counter some "defect" in the physical layout of the brain. CNS stimulants in addition to improving function while used in people with ADHD is shown in multiple studies to create permanent improvements in cognitive function with long-term exposure. IE. even if you stop in the future you retain some of the benefits.
^^ Which is the textbook way of saying "if these people take amfetamines (aka legal, clean, regulated meth) they adjust and do better" Which says nothing about what happens during that adjustment period.
The effect of the 30mg was hard to even pick out in regard to concentration but the first week was weird as fuck. The first and very noticeable effect was the elevated heart rate. I think I posted this before but as I'd taken to wearing a gifted Fitbit at the time I notice that my mean rate was about 10 beats/minute higher. My blood pressure was correspondingly higher as well. I also felt giddy and full of energy like I was anticipating something really fun or exciting, there was also the "heart flutter" feeling. all in all a textbook steroid/adrenalin response. I felt those effects and was acutely aware of them for the first two weeks or so but I seem to adjusted since. During those two weeks, it DID become incredibly hard to let things go. If I wasn't finishing things fast enough or was having difficulty I could feel myself becoming quickly and uncharacteristically frustrated and angry but completely unwilling to give up till I finished. Being late because I had to tear myself away from something became the norm for a bit. Around that same time sleep became a problem, I hand;t been getting enough sleep even before I started but I moved from 6 to 4 or less a night. melatonin was the Dr. suggestion but since it works in conjunction with the rest of your brain's chemical balance and mine hadn't fully adjusted yet it did jack shit at first and just gave me a hangover instead.
I started feeling even more forgetful, I felt I was having to backtrack and pick up my keys and wallet or glasses or phone from wherever I put them down last more often than before. But in retrospect, it's hard to tell if I was actually more forgetful or just more aware of how forgetful I was being. In the third week things finally started to feel more normal and the average time I could concentrate for did seem to improve.
When I met the Dr. next (pretty much exactly a month after I got the 30mg) I explained all this and was moved up to 50mg. Same thing as before with the price, and manufacturer discount. except for this time, I didn't have to wait for it to be ordered in, guess they just didn't keep the lower doses in stock (I think they are mostly only used for people just starting it anyway so makes sense). I didn;t have the physical reaction problems like with starting the 30ms's but the concentration effects were markedly improved. Focus became a choice instead of a fleeting thing day to day, and my fear that I would be unable to turn my focus away to a new task seems unfounded. Sleep is about the same as it was on the 30ms's but melatonin seems to work now so long as I take the right amount. normal human dosage is between 0.2mg and 1mg but as was pointed out I don't exactly have a normal brain chemistry, especially now and he recommended 3 mg. It seems to work will when i remember to use it instead of just staying up.
As an aside, I've greatly reduced my sugary drink and thus my caffeine intake in the last five years or so but about a week ago I had need to stay up and while caffeine has never had much of an effect on keeping me mentally awake it did make it harder to fall asleep. but This time the addition of caffeine was like I'd hit the nos button and started cranking out productive, correct work. This is the reason I suspect that a dosage increase will still be needed. Caffeine is an unacceptable long-term solution. The aim with medication is to hit the top of the curve without going over while staying at the top of that curve as long as possible.SOURCE: http://adhd-treatment-options.blogspot.com/2008/12/adhd-genes-influence-medication-dosage.htmlFULL TL;DR:
I likely still have a bit to go on finding the right dose but so far It's a significant improvement. Sleep is a problem but melatonin seems to help and it's a relatively cheap over the counter solution. If you plan to pursue treatment yourself do some research and try to find a recommended experienced psychiatrist who deals with ADHD patients. Finding the right dose will take time and you'll need to let yourself adjust before declaring that you don't like how they make you feel. I took 3 weeks before I was comfortable and other people might take longer or need some fine tuning of their particular prescription combination to meet their budget and correctly help them. Sadly medicine is an art form because there are too many independent variables to get ti right the first time or even the third.
If you're tired of just coping with it, or even if your not. seek help, it can get a whole lot better.