I recently went through ADHD diagnosis.  After hearing horror stories by the score from women who had every one of their health issues dismissed as a bitchy complaint, of doctors scorning any self-assessment and insisting that the patients’ chronic suffering was an illusion, it felt marvelous to have the doctor confirm my beliefs and attribute to me the very condition I was afraid I had.

I spoke and a doctor listened. It seemed remarkable. And yet…

Now, here’s where I get all disclosure-y, because this is in no way, shape, or form meant to dissuade anyone from medical care. In a lot of neuro-divergent conditions, you won’t know what will bring relief until you try it, and I would hate for anyone to talk themselves out of healing. This is just what happened to me.

Because the “and yet…” is that the standard medication for ADHD is more or less exactly what they used to give distressed housewives in the 1950s and 60s. A kinder, gentler form, perhaps, but still at its heart methamphetamine.

And I fucking hate speed.  I know I do, and my friends would by and large agree, having seen the outcome of me ingesting any drugs from that class (which includes MDMA, for those of you just joining our broadcast.)  I gamely went for it regardless.  Despite some encouraging moments early in the experiment, within a few days I was having more trouble concentrating, if for no other reason than the side effects of appetite suppression meant I’d stopped eating lunch.  I lost the will to do anything besides clean and shop, everything else seeming futile. Evenings became bleak endurance tests, a prayer for oblivion.  Two weeks in, I was catatonic under my desk, sobbing because my hands were shaking so badly I couldn’t hold a cross-stitch needle. The next day I quit the medication.

So what the fuck happened? Could this have been avoided? What could a doctor have done differently? Not spoken to me straight off, to start with.

What I mean is that a preliminary ten minutes with a screening therapist (not a psychiatrist but a behavioural and/or cognitive therapist) could have saved all of us a lot of trouble. I lost two weeks of my life. I’m a fucking author, and I couldn’t write.  I am, if I had to pick a feeling, a little bit angry.  Because if someone had asked a few more questions like these, I might never have been prescribed a drug I physically cannot take.

When was the last major life upheaval?  

Divorce, death in the family, accident or injury or long-term illness, change of job, moving house: any one of these is a big enough change that it will disrupt any but the most doggedly self-aware individual.  The more recent the chaos, the more it should soften your score.  I for example am dead smack in the middle of completely restructuring my career path.  Add a deadly globe-spanning pandemic that upends the economy, slays millions, and creates more political division than you thought possible in a civilized world, it’s little wonder I can’t remember to call the dentist.  This begs the question, did I need medication in the first place? Or just time and permission to flail as I muddle through a difficult life passage? 

How often do you exercise?  

And I don’t mean getting your steps in, I mean break-a-sweat, raise-your-heartbeat, vigorous movement.  Is the answer never?  If so, that probably needs to change.

For those of us with irregular supplies of dopamine, physical exertion is unparalleled for delivering it.  I cannot overemphasize the benefit of exercise as a way to channel all that wild energy into something healthy and productive.  Running fast on a treadmill is the closest I get to meditating, but dang is it ever effective at keeping my mood up, and at the very least giving me a daily sense of achievement.  I might have forgotten fifty things, but I remembered to run.

Have you used any type of these drugs in the past, and how did it affect you? 

Because I’ve taken drugs.  I’ve taken MDMA that was poorly made and not quite chemically pure and hence speedy as fuck and it was appalling.  Even blissfully pure trips tend to lead to emotionally catastrophic come-downs.  Chemically stimulating the release of that much dopamine all at once doesn’t seem to be something my body likes.  That a doctor gave this to me expecting it to help has left me feeling vaguely betrayed. If it had been a street drug, I’d have told my friends not to buy from that dealer.  

How much coffee do you drink a day?

Do not underestimate caffeine.  I was averaging four strong coffees a day. I switched three of those to decaf.  Game changed.  Enough said.

Again, don’t let anything keep you from seeking care.  But when you’re talking to your care provider, oblige them to learn these things about you even if they don’t manage to ask.  Doctors are under immense pressure at all times to see more patients, get more outcomes. They will not always have the capacity to think this broadly. A psychiatrist is trained to provide medical solutions for mental problems, but medication is not always the best response. Ten minutes spent knowing more things about a patient can change how that patient is treated.  Tell your doctor everything, even if they don’t ask, because your whole life is relevant to who you are now. If you’re draining six coffees every day as you sit there doom-scrolling current events, it’s little wonder you might not have much focus for boring shit like your job.  

And maybe drink a little less coffee.