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).

 

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

Anxiety and computer viruses

I think, and hope, that I’ve been cured of anxiety, which I was probably suffering from for over six years. It was a case of Murphy’s Law taken to its extreme. If anything can go wrong, it will, states the law, and in those six or seven years, I would subconsciously search for things that could possibly go wrong, and then worry about them. And worry about them so much that I would get paranoid.

Let me give you an example. Back in 2008, after a four-month spell of unemployment, I had signed up with a startup. Two days after I signed, which was three weeks before I was going to start work, I started worrying about the health of the startup founder, and what would happen to my career in case he happened to croak between then and my joining the company! It had been a major effort on my part to try and get back to finance, and that job was extremely important to me from a career signaling standpoint (it played a major role in my joining Goldman Sachs, subsequently, I think). So I started getting worried that if for some reason the founder died before I joined, that signaling wouldn’t happen! I worried about it for three days and broke my head about it, until sanity reigned.

This wasn’t a one-off. I would take ages to reply to emails because I would be paranoid that I had said something inappropriate. When I landed in Venice on vacation last year, my office blackberry didn’t get connected for an hour or so, and I thought that was because they had fired me while I was on vacation. It would be similar when I would look at my blackberry first thing in the morning after I woke up, and found no mails. I needed no real reason to worry about something. It was crazy.

When a virus attacks your computer, one of the ways in which it slows down the computer is by running “background processes”. These processes run in the background, independent of what you intend to do, but nevertheless take up so much of your computing power that it becomes extremely hard to function. Anxiety works pretty much the same way. Because there is always so much going on in your mind (most of it unintended, of course), a lot of your brain’s “computing power” is taken up in processing those unwanted thoughts (the brain, unfortunately, has no way of figuring out that those thoughts are unintended). And that leaves you with so much lesser mindspace to do what you want to do.

So you stop functioning. You stop being able to do as much as you were able to. Initially you don’t recognize this, until you bite of more than you could possibly chew a number of times in succession. And then, having failed to deliver on so many occasions, you lose confidence. And lesser confidence means more worry. Which means more background process. And means diminished mental ability. Things can spiral out of hand way too quickly.

I’ve been on anxiety medication for over seven months now, and the only times when I realize how bad things were are when I happen to miss a dose or two, and there is relapse. And having been through it, trust me, it is quite bad.

On the positive side, the impact a well-guided medication process (administered by an expert psychiatrist) can have on anxiety is also tremendous. For the six years I suffered, I had no clue that I was under a cloud of a clinically treatable condition. I didn’t know that it was only a virus that had attacked my CPU, which could be got rid off with sustained dosage of anti-virus, and I had instead thought my CPU itself was slowing down, maybe rusting (at the ripe old age of late twenties). After I started responding to my medication, I was delirious with happiness, with the realization that I hadn’t become dumb, after all.

It was sometime in March or April, I think, when I realized that my medication had come into effect, thus freeing up so much mind space, and I started feeling smart again. When I met the psychiatrist next, I told her, “I feel exactly the way I felt back in 2005 once again!”.