When I was first diagnosed with adult ADHD I knew nothing about it aside from the common misconception of the hyperactive and rude boy. Paediatrics was my least favourite subject and my Psychiatry posting was all about psychosis and mood disorders. Didn’t even know adults could have undiagnosed ADHD.
When I started taking my meds, I didn’t really know what to expect from a stimulant. I have a lot of experience(way too much really) with using coffee as a crutch to keep me going. I was programmed to assume I needed coffee as soon as I got up or else I won’t be able to function. The reality was of course that it’s only true on certain days, probably because of hyperfocus rather than the coffee, but I tried to create a placebo effect by convincing myself it’s necessary. Coffee was, at best, 20% effective with a ton of side effects, but the way my life was going, it was better than nothing.
So when I started taking methylphenidate, I noticed a tremendous improvement in multiple aspects of my life. Not only limited to things that are traditionally associated with ADHD but in many other aspects of human physiology that are dopamine dependent. Damn it universe! Making me suffer unnecessarily for so many years.
The meds essentially increases the dopamine by reducing its breakdown and increasing the receptors. Throughout the period I’ve been on meds I noticed some seemingly random improvements to my life that, upon further reading were all actually effects from improved dopamine effects on various organs aside from the brain. Well, whaddya know?
Constipation
Since I was a kid, I’ve struggled with constipation. I eat everything and I especially enjoy fruits and veggies. Even despite that I always feel that there are days that my gut is “not moving”. It usually makes me nauseous, burping out acid with what felt like my breakfast despite that being >12 hours ago and should have been digested and passed downstream by then. But when I have that feeling that my gut is stationary, I don’t have other symptoms to suggest that I’m having an ileus(intestinal paralysis), so the doctor in me would just dismiss it and say…nah, you’re just overly thinking all this.
I’d start trying to blame it on my poor lifestyle choices. Lying down too soon after meals. Taking too much refined carbs, taking too little fiber, not being physically active enough, is this hypothyroidism? So for all the above, despite everything I did to fix it, the outcome was the same. It was exhausting and frustrating.
After starting meds, for some reason, it just stopped. Like I’m so regular now it’s strange. Didn’t even need to change my diet. Didn’t matter how soon I laid down after a meal. Doesn’t matter even when I go two whole days with no fibre; Which happens a lot when you’re living alone and too lazy to cook or stocking up the fridge, resulting in you subsisting on a diet of mainly white bread, three times a day.
So apparently, dopamine is involved in gastric motility. Inhibition or simply lack of dopamine actually causes your gut to slow down. This has been identified as the reason morphine and certain sedative medications cause constipation. They block the dopamine receptors in the gut. What methylphenidate does is the opposite. So now from having a sluggish gut, I have a normal one. Heh, who would have thought?
Breathing
Anyone who knows me know that my voice is low. Ever since I was a kid it was a source of embarrassment to me because people often mistake me as a male on the phone. So I’ve been analyzing why my voice is low for many years in an effort to “fix it” and noticed that it’s because I find it difficult to deep breathe. The kind that requires me to pull down my diaphragm. I noticed on some days, with coffee, I can. But most days, I can’t.
I remember attending a seminar by a famous motivational speaker in university who advocated deep breathing exercises to refresh your mind and throughout the seminar she would ask us to stand up and take deep breaths to help us focus. When I was trying to do it, my damn diaphragm was fighting me all the way. I just couldn’t do it. My lungs felt like it was about to tear. It frustrated me so much.
So I blamed it on my sedentary lifestyle, lack of physical activity and my tummy for splinting my diaphragm. Even after losing so much weight and losing 8 inches off my waist, I still couldn’t. What the heck. I even exercised until my resting heart rate went down from 70/min to 50/min. That’s how intense my exercises were.
After starting meds, deep breathing is always possible with some effort. Like, what the heck?? I used to not be able to do it despite how hard I tried. My voice however remains the same cause as I said, I still need effort to deep breathe. I’m too lazy to want to fix it anymore.
So how does methylphenidate help you deep breathe? Dopamine effects the breathing by improving the function of the muscles involved in breathing. It also does a bunch of other stuff but let’s just focus on the thing relevant to this point. Haha. It’s such a welcome side effect cause I used to dread any physical activity like even climbing one flight of stairs because of the efffort it took just to get my lungs to breathe.
Appetite regulation
I think this is one of the more famous side effect of methylphenidate. As an off label diet drug. My relationship with eating is a pretty messed up one. I have never felt what people described as hunger as my cues to eat was my emotions. That meant that I was constantly eating and unsurprisingly at 21 I was 100kgs. I remember my classroom teacher commenting that I was heavier than she was when I was 11 years old. At that time I weighed a whopping 72kgs.
That aside, I noticed that I constantly seek food as a means to make myself feel good, instant gratification. But the thing that soothed me was not the taste of the food or the content (as in people say that sugar is as addictive as crack). What calmed me was the repetitive act of putting the food in my mouth, chewing it and swallowing it. Just eating alone didn’t make me happy. Shovelling it down fast did the trick. I never felt any pleasure from savoring food slowly. Something which would really make me feel disturbed. Like what kind of monster am I?
What I just described there was an interplay of how ADHD makes you eat. The hyperactivity caused me to want to shovel food into my mouth at the speed of light like how a child would fidget and squirm to cancel the speed of their brain. The impulsiveness would cause me to eat constantly and in large amounts, disregarding the fact that I knew the consequences of doing it. The emotional dysregulation meant that my emotional eating was a frequently recurring thing.
So how does methylphenidate regulate appetite? It increases the dopamine in the brain which reduces the emotional dysregulation, impulsiveness and hyperactivity, which meant that it eliminated all the reasons I used to binge eat. Within 3 months of starting my meds I lost 10kgs. Which was remarkable cause I felt like I had to do nothing! This was amazing considering I have been trying and failing to lose weight all these years only to hit walls due to my inability to suppress the triggers for my binge eating. I now can eat mindfully.
Weight loss
Being on methylphenidate is widely known to result in weight loss as a result of eating less and moving more. There’s also a third mechanism by which it reduces ones weight. Our fat or adipose tissues actually express dopamine receptors. Dopamine which binds to certain types of dopamine receptors will then trigger the breakdown of the fat tissues or lipolysis.
This is why, if any of you have been on antipsychotics or antidepressants, you will know some causes weight loss while some make you gain weight. This occurs because all antipsychotics and antidepressants increase dopamine/ dopamine receptors. So the loss or gain effect depends on which receptor it upregulates.
Emotional dysregulation
What do emotions have to do with hyperactivity? Like seriously?
I’ve always been known to friends and family as an overly emotional, people pleaser. While I don’t break up into fits of rage, happiness or tears, I was always easily effected by my emotions. After hearing snide comments about my “oversensitive” nature, I learned to mask. You sad? Smile. You angry? Smile. You happy? Don’t smile too much, people will think you’re showing off.
So where does this fit into the ADHD spectrum? It’s back to the “underpowered filter” again. When we experience and emotion, we get the full blow to the chest. The emotions are not only felt in our head but it quickly becomes physical once our fight and flight response kicks in from 0 straight to hyperdrive.
But wait, theres more! The Rejection Sensitive Dysphoria just makes everything 100 times worse because when we want to express it, ain’t no one got time to deal with your drama.
Chronic Pain
Since I was a child I suffered from bad stiffness and body pains. Being an obese, sedentary kid, I’d of course blame it on the most obvious thing. Lack of exercise and just being to overweight for my endoskeleton to carry. But since losing weight, things stayed the same. Despite trying yoga, obsessively stretching and constantly suffering through excruciatingly painful massages (courtesy of my sensory processing disorder), everything still hurts. Even resting doesn’t help. In fact it makes it worse because I tend to clench everything when I’m idle.
Well turns out, people with ADHD tend to suffer from heighten muscle tone at rest due to problems with motor inhibition. Makes sense right? If our damn filter is not filtering emotions, thoughts, distractions and all, it sure as hell won’t be filtering our motor response.
So to put it in layman terms we spend the whole day with our butt cheeks (and every other muscle) clenched. That results in stiff joint movements causing your joints to grind. Imagine the hell that ensues running a marathon without properly stretching after sitting down for 10 hours straight.
After meds, while the constant butt clenching remains, the pain I experience in the morning has reduced. Making it more easy to wake up in the morning and indirectly improving my mood overall. It’s a nice feeling to wake up to.
Better sleep.
Stimulant–> better sleep? How? Really?
Stimulants make you more energetic throughout the day. Is that the reason why you sleep better? Bacause you are so drained at the end of the day that you collapse? I’d be inclined to assume that was the mechanism but I have a few points to rebutt that theory.
One, I’m not drained at the end of the day. Before bedtime, I feel neutral. I feel calm and able to lie down and slowly lull myself to sleep. Before this, at bedtime my mind would race and I would be aware of everything around me because my brain would be idle making it more susceptible to any sound, smell, movement and sensation. After taking meds my filter would at least get rid of some of the chaos, enabling me to wind down.
Two, I find it easier to fall asleep. Has anyone tried to sleep after drinking coffee at tea time? How did that go? Logically, stimulants would do that too. But why am I sleeping better? Shouldn’t I be tossing and turning, while cursing my decision to medicate my ADHD?
Three, I wake up fresh. Before I started meds, I’d be completely drained before bedtime and wake up in a worse state than a zombie. Often on weekends I’d wake up at noon, often woken up by the back pain caused by too much sleep. Now I’m automatically awake at 6-7 without needing an alarm.
So why am I sleeping better when the nature of ADHD (being hyperactive) and the nature of the treatment (stimulants) would logically make me literally never be able to sleep? Meds make you have more dopamine which literally keeps you awake and inhibits melatonin, a hormone you need to sleep.
I’ll say it again. The dopamine is powering our filters. That allows us to wind down and filter the barrage of stimuli in our brain. Give a non-ADHDer stimulants and you will get the opposite effect.
So overall, life is so much better for me, in more ways than one. Somehow the treatment of one deficient neurotransmitter just solved a million problems. Yet people still don’t believe ADHD exists. Aaa…suka hati korang la! (TN: Keep thinking whatever you want!). I still suffer from the unpredictable nature of ADHD, but I am definitely not going back to living my life before treatment.
These Are the Contents of My Head 