Tag: ritalin

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

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.