Big Ol’ Disclaimer: We are not doctors or prescribers, but two therapists who have a lot of experience working with folx on/off, loving/hating, trying/not trying all types of medications and accommodations for ADHD. Please seek medical advice for all your medication questions!  Continuation of disclaimers galore: we are not giving medical advice, just our opinions. There are a lot of doctors in the world who know what medical terms actually mean and what they mean long term, we very much are aware that psychopharmacology is not our specialty, but we have a lot of experience with people trying medication. Nobody really talks about medication without being hyperbolic: it’s talked about as something that saved your life or that is awful. Most people who find something really effective medication or accommodation don’t talk about it everywhere. They just take the win and talk about it with their therapist. People often get the pop-psych version of what antidepressants, antipsychotics, anticonvulsants, stimulant, etc. meds are, v. How often we talk about something like insulin or blood pressure medications: they carry more shame, stigma, myths and misperceptions. ADHD is a medical condition that can have psychiatric consequences. This is something that is medically warranted but not psychiatrically warranted at all times. People think you can’t go to a regular doctor and get ADHD medication, but you can: it is a neurological difference and a medical condition. Not every person with ADHD needs medication AND it’s not a deficit if you have to take medication. A dilemma David experiences as a therapist is that he is hired by his clients to help wean them off of a medication; we have these thoughts around dependency and what it means to be on meds. What’s strange is how differently we view medication as opposed to other accommodations; for example, no one suggests you work a program to improve your vision to remove your need for eyeglasses (if such a thing exists, barring LASIK), but it’s something we do with medications. David just accepts he’s wearing glasses because they’re super effective. We don’t talk about how effective ADHD medication is for those who want to take it. Isabelle pauses to do a real-time look up of the numbers on efficacy, it is so much more effective than it is for other psychiatric conditions because it is a medical condition (70% of adults and 70-80% of children shortly after starting treatment, per the Cleveland Clinic—see the link below; this is contrasted to a 50% efficacy for antidepressants per the National Health Service—also see link below.).  Also a way to think about how quickly you find a med that works for you, versus an antidepressant. It’s important that an ADHD med can help you and not be the right medication for you. Individuals with ADHD require more stimulation to do boring, nonstimulating, low-novelty tasks, so they’ll self-medicate with their own emotions, using anger, excitement, anxiety or fear—all of those make your heart beat faster, arouse your nervous system. Those emotional states are stimulants. David describes gamifying pairing his socks to make his self-stimulant through excitement rather than anger. For people who find anger or anxiety shutting them down in life, when those things get in your way, you might want to think about ADHD medication—it’s not just about impacting focus, it’s about the emotional consequences that come with ADHD. David reviews how non-stimulant medication (eg. Like Strattera) works like small chemical restraints, slows you down. More effective for anxiety-heavy ADHD. Stimulant medications (eg. Like Adderall and Ritalin) are more a way to stimulate your nervous system so you don’t need to self-stimulate to reach that condition.  David describes that he didn’t get medication until he was in undergrad or college, the before moment was: “someday I’ll read a book.” And the after was “I could read a book,” this is why he’s such an advocate for people finding what works for them, medication nor not, medication for David was the difference between being a C/D student to becoming an A student. The closest he ever got to as focused as he was on meds was when David convinced himself he would be homeless if he didn’t finish a book in 8th grade, aside from that he didn’t read. To name the abuse of stimulant meds: people can abuse any substance: you can abuse food, for example. It’s important that these drugs are prescribed with therapy, so that a person starts to learn what a medication works for and what it doesn’t work for. The medication doesn’t change your life, you take the medication so you can change your behavior, to fix your life. It’s not speed and doesn’t make everyone do a lot of work; rather, it changes to give people with ADHD a more accurate appraisal of their work, but people without ADHD will appraise their work higher (while their actual performance doesn’t change, it just makes you think you performed better). Because of how impacted the self-esteem is of folx with ADHD, this boost in appraisal makes it so they become more accurate when on the medication (e.g you’d normally think you’re horrible at a thing, but on the medication you might recognize you are slightly above average). It reminds Isabelle of Jessie Spano in Saved by the Bell abusing caffeine pills and recognize how horrible Zack Morris was on that show (see links below if you missed this cultural moment) and how the show is essentially a symbol of toxic masculinity. Returning to caffeine—it has a very different impact on your body if you have it every day v. once in a while. If you drink it regularly, it can be a vasodilator (which helps your blood pressure) and helps you with dopamine and serotonin, v. If you have it once in a while it increases your blood pressure—why a random coffee feels so much worse than it did before. This is also why any client that tries medication often has to re-evaluate their caffeine intake. Which is why if you take ADHD meds and also have caffeine, you may turn into Jessie Spano, having a horrible day, feeling anxious and scared.

Psychopharmacology: The study of medicine used to alter brain states and behavior.

Self-Stimulants (emotions you use to make your heart beat faster, arouse your nervous system, up your stimulation level): anger, excitement, anxiety or fear. 

Non-stimulant: small chemical restraints, like a heavy blanket. Slows you down by slowing down your blood pressure. Often more effective for folx experiencing more anxiety alongside their ADHD, because it works against the anxiety. 

Eg. Strattera, Intuniv (Guanfacine), etc.

Stimulant: You don’t have to be angry to be interested, or nervous to be focused, you are just stimulated (your nervous system is stimulated with the medication). 

Eg. Adderall, Ritalin, Concerta, Focalin, etc. 

REMINDER: We are not doctors or prescribers, but two therapists who have a lot of experience working with folx on/off, loving/hating, trying/not trying all types of medications and accommodations for ADHD.  Please seek medical advice for all your medication questions!