I have written a post previously about the horrors of being a doctor with ADHD despite so much romanticising about how that makes us like some genius doctor who solves everything. The reality is far from that. But I would be lying if I were to say that there aren’t any benefits to it.
One benefit that I have found most helpful is that my understanding of pharmacology helps me navigate my ADHD meds. Scroll any social media platform on the topic of ADHD meds and you will get a mixed reaction towards it. For some, it was immediately life changing. Many others have suffer through the process of finding the right medication, finding the most suitable brand or preparation, titrating the right dose, figuring the perfect time to take the meds and the worse, side effects.
When I started my medication, I was put on a short acting methyphenidate. I was told to take one tablet everyday at breakfast. That was obviously going on the premise that I was having trouble, or “stress” at work. I was also told that I wouldn’t need to take it on days off and weekends. Sigh, when will people stop assuming work is my stressor? Haha. It’s not. If anything I am the most alive at work.
At that time I did not read up on it beforehand. So, the results? A massive crash at 11am. Why? the half life of that medication is 3-5 hours. Meaning, by the 3rd hour the meds would have lost all effects. Meaning I got an “awesome” reminder of how my life used to be like for the past 36 years. Horrible!
Of course it took me a while to notice what was actually happening. I am after all, a very “blur” person. Once I made the association, I started reading up on how other people took the meds and also about the long acting preparations.
I learned that the principle of treatment of ADHD is to stabilise the neurotransmitter dopamine in the synapses. Even in a normal person, dopamine requirements fluctuate from minute to minute, hour to hour, day to day. This means taking a fixed dose daily, at a fixed time not the ideal way to go about it. On days you need more dopamine, you will be under-dosed, and days when you don’t need so much you will start having side effects akin to an overdose. Aaaah…ADHD! The gift that keeps on giving.
So I went to my psychiatrist with a proposition. Can I take a long acting pill in the morning with half a short acting pill to kickstart the effect while waiting for the long acting to take effect? And also since the long acting only lasts 8-10 hours I want to add on half a tablet short acting every 2 hours after the long acting meds have worn off to support me till bedtime.
He agreed with my idea and we went with it. The experiment was I guess a success in the sense that I could sustain the effects of the meds throughout the day. The main issue is predicting how much I need to take per dose. Some days 5 mg of short acting doesn’t quite cut it. Other days the side effects just kills me. Why? Because I’m just a human and I can’t predict the future haha.
So the red line is the long acting which I take around 7am. I take it with half a tablet of short acting. The short acting kicks-in at 15 minutes. So by 1-2 hours the long acting kicks in and the short acting starts wearing off. So by 11am-12pm. I’m usually shrouded in a fog so I would take another half tablet of short acting which would last me until around 3-4pm. By then the long acting will start to wear off and my safety-blanket that is my work is ending. So I take another half to one tablet, depending on how I feel, to help me with the disorganised, unstructured horror that is my home/social life.
During PMS when my hormones are all over the place I sometimes just take two tablets of the long acting one in the morning and one in the afternoon.
This is the best regime for me. I just have to tolerate the side effects or the brain fogs every so often when I misjudge my needs. It is truly a game of Russian roulette but it works best for me.
The fact that I simply play around with my meds horrify my friends and family. But this is the reality of ADHD. You are treating a deficiency. Much like giving insulin for a diabetic. Some days they are going to eat more, some days they are going to take more sweet food and carbohydrates. So they would need additional units of their insulin to achieve the desired control. If they were to take the same dose every day, the control will not be good because some days it will be high and other days, on target or low.
The insulin they take will not “stimulate” their bodies to normalise their internal insulin production by the pancreas (endogenous insulin) and once the half life of the insulin is reached, the insulin levels in their body will return to their baseline and they will be unable to control their sugar levels at the next meal without another shot. It will not repair their pancreas and in the long run it will definitely NOT cure their diabetes.
Same goes for ADHD meds. Once it’s out of the system, it does nothing to change the anatomy and chemistry of your brains. I suppose there are some studies that shows these changes in kids but gentle reminder, adults don’t grow anymore after a certain age. I can’t fix my brain any more than I can make myself grow taller.
**Side note: I will write a follow up post on why this level of self experimenting may not be a feasible for everyone
** Side Side Note: The post is up
These Are the Contents of My Head 
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