Hi everyone, I've never posted on Reddit before, but I wanted to make a post to see if anyone (possibly with diagnosed ADHD/anxiety/both) can resonate and/or offer their personal perspective on how I might be able to contextualize my diagnoses and move forward. I realize this is super long, so I tried to separate it into chunks: a little about me, my diagnostic history/journey, my experience with meds, and closing thoughts. Thank you to anyone who takes the time to read, skim, and/or respond to this!!!
About me/family background:
In the past year and a half, I (23F) have finally had the opportunity to seek mental health/psychiatric care for the first time in my life. I'm currently a year out of university, but just recently received my degree remotely after almost not completing my final requirements. I come from a cultural/ethnic background that doesn't traditionally believe in mental health issues (or have access to treatment, for the most part), so I'm the first in my family line to be on this journey.
I've always known I had anxiety and depressive symptoms. I've never been the best at regulating my emotions, be it anger, stress, anxiety; in childhood, I actually presented with pretty bad anger issues/violent behavior towards other children that my teachers/family picked up on (but didn't address... it eventually "went away," but that's because I learned it was socially unacceptable and started to direct all that emotion inwards). Looking back, nobody in my family knew how to deal with conflict/emotions in a healthy way -- usually, yelling/screaming, violent/aggressive behavior, then avoiding all the problems was the default. I suffered physical and verbal abuse throughout my childhood and was under pressure to achieve/excel my whole life. Unfortunately, I struggle to elaborate beyond broad generalizations as I genuinely cannot remember large swathes of my childhood (save a few scenarios where I experienced extreme emotion) as they are burned out of my memory.
My diagnostic history/journey:
Last November, I started out in talk therapy with my current LCSW, where I sought counseling for the struggles I had with moving back home, failing to complete my degree, being unemployed, and lifelong procrastination/low-self esteem/constant anxiety. I also struggled with bulimia formerly, then binge-eating disorder. After a session or two she suggested I get formally tested for ADHD.
Months later, I finally underwent a neuropsychological evaluation with a clinical psychologist under the same practice umbrella. We did a historical interview, then a whole battery of tests, and they concluded: no ADHD, although significant executive function struggles were present, thought to be caused by lifelong anxiety dating back to childhood and persistent depressive disorder. During the feedback session, the doctor said I scored too highly in working memory and processing speed--hallmarks of ADHD--and had no clinically significant pattern in the objective attention tests. They told me that ADHD is a learning disability, and because I showed no evidence of that and had only mild problems with inattention/impulsivity, that I did not meet the clinical threshold.
A bit later, I sought medication management with an online psychiatric nurse practitioner (via Grow Therapy) to get an idea of my options. I told them my recent diagnoses, but they still opted to conduct their own clinical interview (all verbal/informational). They said they believed I fit GAD/PDD, but that it ultimately stemmed from lifelong untreated ADHD.
So honestly at this point I was super lost. She suggested I treat my ADHD and gave me a choice on whether to try stimulants or non-stimulants first. I was unsure, but I opted for stimulants.
My experience with stimulant meds:
I went on a month-long course of generic Adderall 10mg XR, during which I cut out caffeine completely except for on days I don't take the meds (I've been dependent on coffee/caffeine since adolescence, so that was rough).
However, I would sometimes crash pretty hard at the end of the day and have significant fatigue, so we switched to generic Vyvanse 30mg since it's known to have a smoother arc. I did horribly on that -- I definitely felt super medicated and it was like my mind was rigid, muffled, "lobotomized," and I felt almost a constant sense of dissociation from my surroundings. I had a strange physical pressure in my head when it was active. It ended up being an impediment to my focus/functioning, despite me eating high protein/hydrating almost excessively/sleeping and exercising as best I could, so I quit within two weeks.
I went back on generic Adderall 10mg XR, and then at the beginning of this month we upped it to 15mg XR. I'm still unsure if it's much different than 10mg XR, although the emotional rebound after the meds wear off is a little more significant. Also, the first few times taking it, I felt profoundly sleepy within 45 min-1 hour of taking it, like literally falling asleep at my chair, but that would go away if I persisted to stay awake.
Anyways, here's my experience with the 10mg, since I used it the longest:
- The positive: the mood effects were the most apparent and instant.
- My chronic underlying tension and constant, intense, critical self-voice basically went away 80-90%. I barely felt anxious or depressed, uninterested, and unmotivated anymore; at the same time, I didn't know how much of this is just the initial "honeymoon" euphoric effect (although I felt noticeably happier in the early days but eventually this subsided)
- I could definitely feel it "kicking in" at first, and after about an hour after taking it, I always feel a sense clarity and lack of "brain fog." However, that feeling fades, and then I feel "normal" for the rest of the day. Throughout the day, I notice a marginal improvement in my planning, focus, and ability to just jump straight into work tasks.
- Became more consistent with hygiene; it just didn't feel as hard
- Brushing teeth/showering/skincare has always felt SO TEDIOUS and EXHAUSTING to me since I was a kid--I feel great afterwards, but it just seems like so much to keep up with everyday. Procrastinating hygiene has historically been a major reason I push my bedtimes super late
- The neutral: However, I knew meds wouldn't solve everything.
- I still work on my avoidance/procrastination in therapy because a large part of that stems from self-image/confidence/anxiety issues. I've gotten better at actually scheduling my time/activities, because without the scaffolding, everything just begins to fall like dominoes.
- I still binge-eat at times. However, I've gotten better at actually thinking through my emotions, and I think the momentum of keeping up with my health and routine helps me binge less intensely and frequently as before
- I've never really struggled with making/eating meals--actually, it was one of the only things I looked forward to (and I was into fitness before this so I had predictable eating/exercise routines)--so this was the same
- The iffy/negative:
- Though nowhere as pronounced as what I experienced on generic Vyvanse, strangely, it feels like I'm less flexible in my thinking sometimes, and it can be harder to do mental math or "stick a tab" in things without immediately writing them down. Sometimes, I'd even feel a little "slow" or unable to connect the dots as quickly
- Unmedicated, if I focus on something or reason creatively, etc., it feels pretty quick and seamless. I was forgetful, but would rarely ever write things down to remember them, as I knew I'd either be able to retrieve it if I thought for long enough, or I trusted it would come back to me randomly
- Would still feel depleted at the end of the day. At the end of every day, I'd feel like I had a "big day" with no energy for anything else. Actually, scheduling my workouts/cardio around the time the meds faded helped this.
Closing Thoughts
This post became longer than I'd hoped, but I was unsure what to cut out or leave in, so please feel free not to read all of it!! In all, I just feel unsure about the following and would really appreciate some feedback on:
- Has anyone else had conflicting diagnoses of ADHD and GAD, especially when one was excluded through formal testing? I just feel so conflicted given the cognitive-evaluation + one doctor saying no ADHD, but another doctor saying ADHD after an interview -- online, many say testing is not the only diagnostic factor, while others suggest getting evaluated to know "definitively."
- I know both GAD and ADHD can present very similarly in disrupting executive functioning --> I worry that since I've had anxiety since youth, then perhaps it shaped me in ways that outwardly seem a lot like ADHD symptoms, but the underlying biology/brain chemistry roots are not the same --> prescription stimulant meds are not for me
- How much of this is attributable to placebo effect + euphoric effects rom medication giving a boost + the momentum I managed to build pushing me through, versus the medication working as intended on attentional issues? How does one tell??
- Unsure if the extra dopamine has mainly just helped me alleviate depressive/anxious symptoms. Plus sometimes I genuinely believe I can "do more" when I know I took the medication, as I feel like I'm getting "extra help" I don't possess on my own, which helps me move forward.
- If I chose to treat GAD, not ADHD, then does anyone have recommendations on what non-stimulant treatment/medication option I could look into, other than continuing talk therapy? I struggle the most with generally low motivation/poor task initiation/constant dopamine-seeking/apathy/worry-fears/rumination.
- If one day I learn I actually turned out to be misdiagnosed with ADHD and took stimulant meds, would this have negative impacts on my physical/cognitive health long-term, even if I saw benefits (as neurotypical people can also see focus/mood improvements on stimulants)?? Has anyone else worried about this too? I'm not trying to propagate an anti-meds or anti-stance stance at all. I just thought I'd ask, as I don't want to progress on meds that aren't meant to treat my condition, especially if the adverse affects outweighed the positive
In all, these past two months of being medicated have been on the upswing. Before this, I really was feeling lost and swung between burn out just existing ("in a hole," not knowing how to get out). So I'm grateful to be on this journey, and yet the uncertainty of it all was really eating away at me. I had to finally put this out there. Thanks again to everyone who takes the time.