There is much interest in the effects of ADHD medication. So I am sharing my experiences. This is part of a series of blogs on getting assessed for ADHD so check out the overview page for links to the other related posts.
I have been prescribed methylphenidate prolonged release tablets. Methylphenidate is prescribed under many brand names: Concerta, Ritalin, Daytrana, Aptensio XR, Metadate CD, Methylin, Quillivant XR, Jornay PM, Adhansia XR, Cotempla, Xaggitin, and probably others. Essentially the drug is the same. I am starting on 18mg once a day and ramping up every 7 days with an extra 18mg.
Methylphenidate is considered the most effective first-line treatment for medically treating ADHD symptoms. It comes in standard (instant hit, wears off quickly, might require more later in the day), extended release (lasts 8 hours), sustained release (lasts 10 hours), and delayed release (kicks in 8 or 10 hours after you take it). The optimum time for when to take it (morning or night, before, with or after food) will be explained when it is prescribed. This varies by brand.
The Run Up
My consultant psychiatrist suggested I reduce my caffeine consumption and stopped drinking alcohol to best judge how the medication is working. To give me a baseline I stopped both 7 days before starting the meds. I didn’t know it was going to be 7 days but from filling in the final paperwork, issuing the prescription to receiving the tablets took 7 days.
Stropping the alcohol was not a problem. The caffeine withdrawal gave me headaches for two days though. And it amplified the cacophony of thoughts in my head. My impulsivity also got worse. My apologies to colleagues who left a box of celebration near my desk. I didn’t mean to eat them all. If it’s any consolation I felt sick once I had.
Methylphenidate is a controlled drug, which means that you have to prove your identity when collecting your prescription. Mine was sent to me by a secure courier (which as far as I can tell is not much different to a normal signed-for parcel).
From deciding to go for an ADHD assessment to being issued the medication I had collected quite a list of ADHD contacts who I’d discussed it with. They shared their experiences with starting ADHD medication. Some had spent 12 months in titration trying different drugs. Some had undesirable side effects. But most started experiencing benefits from the start of titration. So there was quite a bit of excitement to find out what it would be like. One friend described the mental clarity as similar to reading with and without glasses. There was also nervousness. And imposter syndrome. What if they didn’t work? What if I don’t really have ADHD?
I started my ADHD medication on a Wednesday. For no special reason – they arrived on a Tuesday and are to be taken in the morning. I had told my boss and a few close colleagues that I’d be starting medication. I had explained there may be side effects. I also enlisted their help in watching for behavioural change.
The tablets came in a bottle. I was hoping for a blister pack so I could write the days of the week and keep track of when I had taken them. Mine are to be taken after food. I take them just before leaving the house to go to work so by the time I arrive they should be effective.
I noticed 2 changes on day 1. I wasn’t impulsively eating all day (until 8pm when I hit the chocolate truffles). Appetite suppression is a side effect of the tablets. But impulsive eating and eating for mood regulation is a problem of mine. Having put on 10kg in the last 12 months I’m happy eating less.
The second change was that I’m less anxious about time in meetings. About needing to be somewhere else. So more present. The downside is I was 5-10 minutes late for everything. From subsequent conversations with my colleagues they prefer me to be late and really be there than to be on time but fixated on where I should be next.
Other than a dry mouth/ hoarse voice no unwanted side effects. A little bit disappointed that I didn’t get the transformative change from day one that others have reported when starting medication but its early days.
Sleep onset was easier that night. I struggle with getting quality sleep. Sleep onset on day 1 was much improved. My mind was not racing with 101 thoughts.
I got out of bed at 5am (2 hours earlier than normal) and spent 2 hours writing blog posts. The meds should have worn off by then so its hard to explain. I was then nearly late for work – some things never change.
The appetitive suppression only lasted until mid afternoon yesterday. Subjectively I feel like I am getting better quality sleep (could be no caffeine, no alcohol, or the meds). I was expecting to run out of steam mid afternoon after the early start but I didn’t.
Up at 5 again. I hope it is not an emerging pattern. It is the end of the working week and the anxiety of all the uncompleted tasks is kicking in. No significant improvements on ADHD traits but I am still on a low dose.
Days 4 & 5
The weekend. Some people cycle off their meds on the weekend. During titration do whatever your prescriber recommends. I’ve been told to complete the 6 weeks without interruption so I took the tablets. So I took the tablets. I had more early starts. Still no significant improvements. The dry mouth is less of an issue now.
Days 6 & 7
I report back on symptoms and side effects as part of the titration process before increasing my dose on day 8. In filling in the survey I scored subtle improvements across all factors but no stellar improvements. The side effects are tolerable – mostly just the dry mouth which has become less pronounced. My blood pressure is still good. In spite of eating less my weight has not changed.
What if the day 1 effect were a placebo effect? Or the expectancy effect? What if they only worked because I thought they would? What if the lack of sleep is counteracting the gains from the medication. Sleep deprivation – even just a couple of hours, is massively cognitively damaging – in the short and the long term.
Things to consider
I have talked about the emotional rollercoaster of going through this process. If you are about to start ADHD titration have a think about who your support network is. Who you can discuss this stuff with. Who can cheer you up if you get a bit down.
If forming a routine is a problem for you (like 99.9% of people with ADHD) think about how you will track if you have taken your medication. A cross on the calendar. Keeping your medication next to your car keys/bus pass so you get a reminder in the morning. You want to avoid the self-doubt of did I take it this morning? You also want to avoid accidentally double-dosing.
If you are likely to travel abroad while taking ADHD medication then remember they are controlled drugs. You will need to find the rules for the country you are travelling to. It can be as simple as keeping a copy of the prescription. Or require a doctors note. Some countries require you to get a licence to travel with them.
Keep a daily log – blood pressure, side effects, benefits. When you look bask at the end of the week it is easy for it all to blur togeher.
Avoid OJ! And vitamin tablets. Drinks rich in ascorbic acid (vitamin C) or citric acid (orange, grapefruit, and other drinks supplemented with vitamin C) may interfere with the absorption of methylphenidate. Citric acid breaks down the medication before it has a chance to be absorbed by the body.
Be honest with your prescriber about other substances you are taking. Some recreational drugs can interfere with the titration process. Some herbal remedies react badly with the medication causing serious side effects.