Back to methylphenidate

I can’t remember the last time I was unable to fall asleep. I mean I’ve lost sleep on several days in the last month or two, but on all occasions it’s been after I’d gotten woken up in the middle of my sleep. Today is different – it’s nearly 1 am, and I’ve been in bed for two hours tossing and turning, and completely unable to fall asleep.

I think I left it until it was a bit too late today to restart my methylphenidate, after a three year gap. The dosage is half of what I was used to in 2012-13 and 2015-16. Just 5 milligrams to be taken twice a day. This convinced me that it would be okay to take it in the afternoon. Big mistake. I’ve been completely unable to switch off this evening.

The good thing is that this afternoon ever since I took the tablet I’ve had the kind of hyperfocus I hadn’t been able to achieve for I don’t know how long. I continue to get distracted, but it’s easier to get back to where I was. The big change is that I no longer feel the constant need for stimulation. The need to “feel accelerated”, as I call it, which would result in my opening dozens of tabs on my browser and checking websites one by one without any need to do so. Sometimes it would end in the rabbithole of playing online chess, and wasting hours at a time.

I’ve written about ADHD before on this blog, and elsewhere. I’ve written it as a condition where you’re unable to hold attention on what you are doing, and getting distracted easily. In the past I’d come off medication because I missed being distracted – in my methylphenidated state, I have missed the ability to think laterally which I’m so capable of in my “ground state”.

Thinking about it, though, it’s not distraction or the lack of it that’s the problem with ADHD. It’s the constant need for “stimulus”. It’s the constant need to “keep doing something” that makes me fidgety. It’s possibly the same feeling that made me run out of class when I was in kindergarten and do somersaults. The same feeling that would make me open my computer and open a dozen chat windows upon coming home from work a decade ago. Well the latter had its good parts – a lot of the time, one of those dozen chat windows would involve the person who I later married.

It’s funny how I got here today, in this methylphenidated state. As you might know, I’ve been living in London for nearly two years now. And the medical system here is government-run.

In October 2017, when I was in the middle of my last (and largely unsuccessful) full time job, I felt the need to get back on to ADHD medication. I got an appointment with, and met my general practitioner in November 2017. He asked me to share with him my diagnosis of ADHD from back home. In December 2017 I was back in India, and I got back my medical records, and shared a copy with him in January 2018.

In February 2018 I got a call to set up an appointment with the mental health practice. It was at a clinic some distance away from home, and I met the psychiatrist in March 2018. I was administered the usual ADHD questionnaire and told that I would be contacted by the “national ADHD centre” in a “couple of months”.

It was finally in January of 2019 that I heard back about this. It was my GP once again, saying my prescription for methylphenidate was ready, and I should start taking it asap. The next day I got a call asking me to meet the psychiatrist again, in the faraway mental health clinic. And today I started taking the medication. And I’ve been so unable to switch off that I’m unable to sleep!

PS: I’m publishing this a day late. I wrote this last night but couldn’t publish it since daughter started crying and I had to rush back to bed. Hopefully I’ll be able to sleep well tonight

Mental health triggers

My ADHD seems to have become much worse over the last couple of days. Like this morning I had this episode where I couldn’t decide whether to go back home to get an umbrella, and thus turned around twice while I was in the middle of crossing a road.

In part, I blame this on having just read a book on ADHD – the second such book I’ve read in the last week (I found this book from the bibliography of previous one). While this book told me the impact of ADHD on relationships, and helped me understand what someone married to someone with ADHD goes through, in the course of doing so it reminded me of all the problems that one faces when you have ADHD.

So in some way, as I read through and “revised” the list of problems that one has with ADHD, all these problems have started surfacing (more likely I have noticed these issues every time they’ve come up). And this has led to a positive feedback loop, and thus much shorter attention spans and massive distractions and even mild addiction (to online chess).

This is not an isolated incident. In the past as well, when I’ve read material related to mental health problems that have affected me as well, the precise problem gets triggered. So when I read some stuff about depression, I’m likely to have a depressive episode after that. Similar with anxiety.

Interestingly, there is no impact when I read something related to a problem that I myself have never faced – like I once started reading Siddhartha Mukherjee’s essay on bipolar disorder and it had no effect whatsoever on me.

It wasn’t always this way. Long back, before I got diagnosed, reading stuff about mental health issues which I later got diagnosed with would make me feel hopeful – hopeful perhaps that there was in fact a diagnosis for what I was going through and it wasn’t simply “laziness” or “ineptitude” on my part that was causing me all that I was going through. But once I got the diagnosis, and figured out lifestyle changes to deal with my issues, reading more has only triggered the respective issue.

I guess the solution for this is simple – unless absolutely necessary (say there is a specific issue for which I seek help on) I shouldn’t read stuff about mental health issues that I might be facing.

I won’t spare you, though – here is an essay about ADHD that I had written three years ago (which I dug up after a conversation on ADHD with a friend yesterday).

 

11/13: Support

Careful readers of this blog might remember that things weren’t going very well for me on the health front at the beginning of the decade. Increasing stress from a job that was in hindsight not all that stressful led me to seek help, and I’d gotten diagnosed with anxiety and depression. Soon a diagnosis for ADHD followed. This was immediately after I’d quit my (supposedly stressful) job and was trying to establish myself as a consultant.

As I’ve documented on this blog earlier, I came through this difficult phase of life fairly successfully. I managed to use the medication I was on as some kind of a “stimulus“, and then built upon my later success to pull myself out. I also made necessary changes to my lifestyle and working style to take advantage of my brain being supposedly wired differently.

What I’d failed to mention in that post about coming out of depression was the role that Pinky had played in helping me back then. The biggest impact on her was in terms of my erratic behaviour. The medication I was taking, while helping me get out of depression, was also altering my mood in ways I hadn’t imagined, and she increasingly became the target of a lot of my outbursts.

Moreover, she was also really young at the time, and having yet to see the quarter life crisis, found it hard to empathise with what I was going through. She started with the reaction that most relatives of people with mental health issues start off with – denial followed by accusation that I was using it as an excuse. It’s to her extreme credit that she soon came to understanding things from my perspective, and appreciating what she was going through.

After that, she was a constant pillar of support for me as I battled my depression and ADHD. She helped me talk over any fears I had (it turned out I had a lot of them, mostly irrational). She was nice to me when I wasn’t being nice to her. She put up with my outbursts and fights. She forgave my once frequent transgressions, and took my side in fights where she could’ve easily turned against me.

She even regularly accompanied me to the psychiatrist which was never a particularly pleasant experience for her, and stood by me as I made fairly important decisions about life and mind-altering substances. And finally, when in January 2013, I decided to get off the medication, she made sure she was accommodative in case my old behaviours took off again.

I’m still not “perfectly okay”, and possibly will never be. And there are transgressions and bad behaviour on my part from time to time. Pinky, while not condoning such behaviour, has remained patient with me, and constantly helped me improve myself. She has stayed positive through the process, and made extreme efforts to make sure that our relationship remains intact.

And for all this, I can never thank her enough. If I were the religious sort, I would’ve said that I could never thank her enough either in this life, or in our next seven lives!

1/13: Leaving home

2/13: Motherhood statements

3/13: Stockings

4/13: HM

5/13: Cookers

6/13: Fashion

7/13: Dashing

8/13: Dabba

9/13: UnPC

10/13: Pep

Discrete and continuous diseases

Some three years or so back I got diagnosed with ADHD, and put on a course of Methylphenidate. The drug worked, made me feel significantly better and more productive, and I was happy that a problem that should have been diagnosed at least a decade earlier had finally been diagnosed.

Yet, there were people telling me that there was nothing particularly wrong with me, and how everyone goes through what are the common symptoms of ADHD. It is a fact that if you go through the ADHD questionnaire (not linking to it here), there is a high probability of error of commission. If you believer you have it, you can will yourself into answering such that the test indicates that you have it.

Combine this with the claim that there is heavy error of commission in terms of diagnosis and drugging (claims are that some 10% of American kids are on Methylphenidate) and it can spook you, and question if your diagnosis is correct. It doesn’t help matters that there is no objective diagnostic test to detect ADHD.

And then your read articles such as this one, which talks about ADHD in kids in Mumbai. And this spooks you out from the other direction. Looking at some of the cases mentioned here, you realise yours is nowhere as bad, and you start wondering if you suffer from the same condition as some of the people mentioned in the piece.

The thing with a condition such as ADHD is that it is a “continuous” disease, in that it occurs in different people to varying degrees. So if you ask a question like “does this person have ADHD” it is very hard to give a straightforward binary answer, because by some definitions, “everyone has ADHD” and by some others, where you compare people to the likes of the girl mentioned in the Mid-day piece (linked above), practically no one has ADHD.

Treatment also differs accordingly. Back when I was taking the medication, I used to take about 10mg of Methylphenidate per day. A friend, who is also on Methylphenidate and of a comparable dosage, informs me that there are people who are on the same drug at a dosage that is several orders of magnitude higher. In that sense, the medical profession has figured out the continuous nature of the problem and learnt to treat it accordingly (a “bug”, however, is that it is hard to determine optimal dosage first up, and it is done through a trial and error process).

The problem is that we are used to binary classification of conditions – you either have a cold or you don’t. You have a fever or you don’t (though arguably once you have a fever, you can have a fever to different degrees). You have typhoid or you don’t. And so forth.

So coming from this binary prior of classifying diseases, continuous diseases such as ADHD are hard to fathom for some people. And that leads to claims of both over and under medication, and it makes clinical research also pretty hard.

Do I have ADHD? Again it’s hard to give a binary answer to that. It depends on where you want to draw the line.

Zen and the art of shooting

So I was at this resort near Nandi Hills for a day-long workshop on Saturday (actually it was a three-day workshop but my session was only on Saturday so I went there only for one day). One of my colleagues and fellow-teachers had brought along an air gun and at a time when students were busy doing some homework we had given them, we went off for some shooting practice.

First we used cardboard pieces and drew targets on them. I remember taking some four or five rounds at it. First three times I shot way to the right of the target. The following time I decided to correct for this bias and aimed a little left of the target. However, it turned out I had overcompensated and I ended up shooting left.

This was the first time ever in my life that I was shooting (barring toy guns when I was a kid). The first couple of shots I was just getting use to the feel of the gun, the posture, etc. What I found tricky was that there were two viewfinders through which you had to look through simultaneously (genius design – to eliminate parallax error). And then you had to concentrate, focus and shoot.

My first few shots I figured that I thought too much about shooting. I took aim, and then held the position for a while till I was convinced that I was aiming right. Then I would get distracted (damn you, ADHD) and then I would have to try and concentrate again. This would happen a few times until I would go impatient and shoot randomly, and thus miss the target.

After a few rounds of shooting at the cardboard, we moved on to shooting a fruit. Four of us took two cracks each at the fruit, and I was the only one who didn’t manage to hit the fruit at all. On both shots I missed by a long way. I had that sinking feeling I always have when I’m trying to learn something as part of a group and end up being clearly the worst in the group. That’s a frequent feeling for me nowadays.

So for the last round where we used an empty Bacardi carton as our target (the aim was to hit the face of the Bat logo on the carton), I decided to adopt what one of my friends called the “Zen method”. “The first time you take aim, just shoot. Don’t over think”, he said. I had some reputation to salvage.

We all took two shots each at the carton. I did what I was told. As soon as I had taken aim, I shot. I ended up hitting the bat logo once on the tail and once on one of its legs. Here is a photo taken as soon as I had shot the tail (red circle; the other shot on the bat is a colleague’s). The Zen method worked!

shooting

 

PS: I think this is the first time ever I’ve put up my photo on my blog. So all those of you who read this but don’t follow me on any other social medium – you finally know what I look like.

Mental Health: Update

It’s been over six months since I got off my medication for depression (venlafaxine) and ADHD (methylphenidate), so I thought I should just provide an update. The immediate trigger for this post is that I’m reading Nassim Nicholas Taleb’s Antifragile, in which among other things he rants against excess medication, and explicitly picks on medication for depression and ADHD.

Overall, I must mention that I’ve managed pretty well these last six months. Yes, there are depressive bouts. Yes, there are times when I can’t concentrate and I get increasingly restless. Sometimes it is perhaps as bad as it used to be before I started seeing a psychiatrist. But it’s ok. The most important outcome of going to a psychiatrist for a year has been that I’ve gotten diagnosed.

You might have heard this in several places – that ninety percent (or maybe more, or less) of treatment of a disease is diagnosis. And in case of my mental health I find that to be absolutely true. Yes, I took medication for a year. Yes, it helped back then. Yes, as I’ve written before, having those medicines provided me the necessary stimulus to get myself out of the depths I’d gotten into over the last few years. However, I’m certain that I don’t need them any more. But the diagnosis helps.

Two years back my biggest concern was that I wasn’t able to explain my life. There was no story. I had done a lot of things that were seemingly disparate and there were a lot of things that I’d done which I would later regret. So I had a lot of regrets, and I would expend a lot of my idle processor time (in my head) dwelling on these regrets, and wondering why I did certain things the way I did, or why I took the decisions I took. Every time I tried to come up with an explanation for something, I would get the “but everyone deals with that, why can’t you” response.

The biggest advantage of having diagnosed is that it now all fits in. I now know why after getting into IIT with such a good rank I drifted away and completely lost interest. I now know why so many of my initial crushes didn’t work out (ADHD among other things makes you impulsive and blurt out things you aren’t supposed to). I now know why I chose to literally run away from my first job (that’s a long story in itself. Will save it for another day). And I precisely know why I went in and out of three more jobs in the five years after that.

Yes, I might be overfitting in some things (you can see that I’m doing that in the previous paragraph to explain why no relationships worked out). Nevertheless, after a long and ardous search for that one variable or set of variables that would explain a large part of who I am or what I did, when I all I found was noise, I think I’ve found the signal. Till I was close to thirty, I led my life without having fully understood myself. And trying to blame myself for being inferior to other people in certain ways, and constantly regretting my decisions. The diagnosis changed all that. Yes, after a discussion on a mailing list on ADHD some three years back I’d posited that I might have it. Yet, a formal diagnosis from a qualified psychiatrist helped.

So you may ask why I discontinued medication if I know that I have some problems. Two different reasons for the two medicines I was taking. As for Venlafaxine (which I used to take for anxiety and depression), I had a harrowing time in November of last year when I ran out of supplies of the drug and couldn’t find it in any store near my house for a couple of weeks. During this time I would feel weak, have a fever and feel extremely numb in the limbs, but had no clue why that was happening. Later, the psychiatrist told me that these were withdrawal symptoms for failing to take my drugs regularly. I panicked. i didn’t want to get addicted to mind-altering substances. More importantly, around this time I got the feeling that the drug wasn’t doing much help. I would still have the same old bouts of depression. The psychiatrist agreed that I had plateaued in response to the drug. So she recommended a rather slow taper off from the drug (to prevent withdrawal symptoms), which I followed and got off it.

Methylphenidate was useful, and wasn’t addictive (some literature has likened it to wearing spectacles. It affects you only when you’re taking it). Yet, I found that it changed me. Yes, I know that I’m attention deficit and possibly hyperactive, but I  refuse to believe now that it’s a ‘disorder’. The problem with the drug was that it was changing my mind. Yes, it made me concentrate so much better. Long strings of meetings when I would visit the client’s office were a breeze thanks to the drug. My concentration levels shot up. Yet,  I found that it had impaired my creative thinking. I’m extremely proud of my ability to connect disparate things, but I felt that this drug was impairing my ability to do so. I just wasn’t being myself. And I had found that on days when I would forget to take the drug  I would be more capable of creative non-linear thinking. And I figured that with the drug I wasn’t being myself.

So yes, I’ve been off the drugs for a while now and have adjusted to life with it. Yes there are days when I’m constantly fidgety and can’t concentrate to get work done. Yes, nowadays  work that takes long bouts of intense concentration gets delayed. But I’m back to being myself. And I’m back to being good at what I thought I was always good at – big picture thinking and making disparate connections.

Yes, one important factor that has helped me to deal with my condition (no, it’s NOT a disorder) is my work. As a freelance management consultant who mostly works from home (and visits client once every couple of weeks)  I can set my own pace. If i’m feeling particularly fidgety some day, I can take a break till I’m doing better. I don’t have daily or sub-daily deadlines to bother me (this was my biggest issue with most of my jobs). More importantly there’s no one looking over my shoulder to see what I’m doing, so I can freely switch between my work screen and twitter. And trust me, this helps. Immensely.

Since I visit my clients once in 2-3 weeks I end up having lots of meetings during these visits. But I simply draw up on my energy reserves during those times and buckle down and concentrate. Yes, last two or three times after I’ve visited the client I haven’t got much work done for the following three or four days – since I’d be recuperating from that intense expense of mental energy – but again I’m okay with that.

I plan to write on this again in the near future after I finish reading antifragile. I find this to be a rather important concept for me given that I’m prone to making errors (I’ve now accepted that). I think I’ve already started designing my life along antifragile principles. But more on that in another post.

Meanwhile, some other posts I’d written earlier about my mental condition.
1. How ADHD is like being perennially doped
2. On the importance of admitting mental illness and going to a specialist
3. On anti-depressants being like an economic stimulus
4. On mental illness in elite colleges in India
5. On anxiety being like a computer virus
6. On how ADHD can sometimes be advantageous

The Upside of ADHD

Attention Deficit Hyperactivity Disorder (ADHD), a condition that I have, isn’t all bad. In fact, it was a recognition of the qualities of this “disorder” that led me to stop my medication for it. I figured that I prefer the with-ADHD me to the without-ADHD me. I found the latter too boring, not creative enough, and unable to connect seemingly unrelated things – something that I’ve always taken a lot of pride in.

Yet another positive of ADHD, I realized yesterday, is that it allows you to lead a “markovian” life. It allows you to easily get rid of historical baggage while taking decisions, and makes you look forward by taking a decision based on the present. Yes, it can sometimes be a bit troublesome, as it prevents you from following long-drawn-out plans, but mostly it’s a good thing.

It makes you disregard that you’d taken a decision for some reason in the past. It makes it easy for you to disconnect from your earlier decisions, and look forward. It doesn’t allow you to be swayed by emotions – on account of some decision you’d taken in the past, and instead makes you rely on rational reasons.

There’s this documentary called “ADD and loving it”. Maybe I should watch that. And maybe I’ll have something to add to that.