Road construction signs in a busy city.

When Life’s Road Gets New Pavement Pt. 1

I recently discovered via a diagnosis that I have ADHD–C. That stands for Attention Deficit, Hyperactivity Disorder–Combined type.  A subtype of ADHD characterized by inattentive and hyperactive/impulsive symptoms. 

Best I can tell, this whole journey started in my childhood—all ADHD patients have ADHD from childhood. It does not develop over time; it’s genetic.

When I was younger, I would have to force myself to sit down and focus on one thing. While that doesn’t sound too out of the ordinary for most kids, for me, it was a huge struggle that involved physical discomfort and sometimes manifestations of physical pain.

I was always daydreaming. Tasks would take me longer to complete than others, but not so long that people would notice. I could finish tests super-fast. I could focus on something for hours on end only if I found it super interesting. These “abilities” would suck my attention away from other things like homework.  

Things got worse in high school, but I got better at deception.

I would do my homework for the second period in the first period, the third period in the second, and so on. Some classes, I just never did homework or assigned reading. I only read things that interested me. I found out how I could fake my way through discussions based on assignments I never did. 

I was damn good at looking like a good student without being one. I don’t remember exactly, but my stats were something like:

  • Graduated high school with a 4.0+ GPA (on a 5.0 scale)
  • Member of two different national honor societies
  • Drum major for the marching band
    • Also did pep band, show choir band, and jazz band
  • Stayed involved with Scouting at a district and council level
  • Was always one of my teacher’s favorite students

College was a whole different universe. 

It was harder to fake my way through not having done the homework. At a large university, you’re an unknown in a lecture hall full of students. It’s harder to succeed when your primary means of achieving a favorable grade no longer works. In high school, I could prove I knew the material regardless of my performance on assignments. Not so much in college. As such, my grades started slipping. A lot.

That’s when I suspected something was happening that I couldn’t control. I sought help.

The Journey: My History

Empty snowy road with cracked pavement
Photo by Tim Wright

The first step in solving the problem is to be sure you’re solving the right problem. In this case, this is where doctors come in. I had many doctors, many wrong diagnoses, several misguided treatments, and many personal struggles at this step. Here’s how it all started. 

It was 2003 when I first saw a doctor about my difficulties in college. My chief complaint during this time was that I could not prioritize tasks. I was unable to distinguish between schoolwork and school-related work. Another way to think about this is the difference between things for a grade vs. things that aren’t. 

Doctor #1 told me it was depression. This diagnosis would inhibit future diagnoses. I think that as soon as a medical practitioner hears “depression,” it puts them in “tunnel vision.” They associate every symptom and complaint with depression. My theory is that depression is so broad that anything can be a symptom.

In any case, I was put on amitriptyline to help with the symptoms. Long story short, it didn’t completely help. There was a marginal improvement, but the side effects weren’t worth the small improvements I was seeing.

I gave the meds a good solid try. About two years later, I saw another doctor who was appalled that my first doctor prescribed the amitriptyline. This time, my chief complaint was threefold. First, my symptoms hadn’t improved. Second, the side effects of the amitriptyline were starting to affect my life in unwanted ways. Third, my brain would just not stop trying to solve every problem. I mean every problem. 

This doctor called it “ruminating thoughts” and transitioned me off the amitriptyline and onto Effexor (venlafaxine). Again, a drug intended to treat depression. Again, a treatment that did more harm than good; I felt so messed up by the Effexor that I tapered off it and decided not to pursue other treatment or diagnoses for several years.

I reached out for help and got nothing but more difficulties. That made me hesitant to seek help for this again. I saw a third doctor who said it was (unsurprisingly) depression and prescribed Zoloft (sertraline). The Zoloft did improve my mood, but it didn’t manage the underlying symptoms.

First Stop: Diagnosis

Bear Doctor
Photo by Alexandra

Earlier this year, I needed a new doctor because the one I had seen left practice. I explained to this new doctor what I’ve been struggling with and for how long. This time, the doctor decided to investigate what I’ve been experiencing 🎉. This doctor referred me to a psychologist who specializes in ADHD diagnosis and treatment.

The process was simple, but I was super anxious about the first meeting. As soon as I started talking, my anxiety vanished. The questions were simple and covered my experiences from childhood to the present day. Questions about how I did in school, work, my personal life, etc. At the end of the first appointment, I got some questionnaires: one for me to answer, one for someone from my childhood, and are for someone close to me now. I asked my mom & Ellie to fill out the surveys for others. The second appointment was a continuation of the first. After the therapist had finished asking questions, there was another questionnaire for me. 

After she tallied the scores from the in-appointment questionnaire, she said, “I think you do have a form of ADHD, probably combined type. I’ll write my report, and we can meet again to discuss my findings.”

And that was all!

I mean, that was all there was to the diagnostic process. That’s not the end of the story by any means. During our final meeting, we reviewed the report, discussed what ADHD–C means, treatment options, and what role each of my providers would play going forward.

The hardest part of the entire process was building up the courage to talk to my new doctor about my experiences and asking for help. 

Second Stop: Treatment

Green and White Pills
Photo by Dennis

I struggled with symptoms for years. I finally have a diagnosis that explains them all. I was super excited to start treatment. There are several different treatment options available—everything from stimulant and nonstimulant medication to cognitive behavioral therapy to meditation. I discussed all these options with my psychiatrist, and we decided that stimulant medication would be a good place to start. This class of drug has been in use for decades, and the meds are some of the safest in use.

My evaluating psychologist can’t treat me, so I took a trip back to my GP. We discussed the report and what treatment options I discussed with my psychiatrist. I was prescribed Vyvanse at 40 mg. It is a stimulant drug, but it’s different than the others on the market. Unlike Adderall or Ritalin, Vyvanse is an inactive prodrug. Inactive prodrugs are medications that are not pharmacologically active when you take them, but they must be converted into an active metabolite in your body. As for Vyvanse, when I take it, it’s a stimulant (dextroamphetamine) with an amino acid (L-lysine) attached (Lisdexamfetamine). The attached L-lysine makes the dextroamphetamine inactive until my red blood cells split the L-lysine off the dextroamphetamine.

Minds Under Construction
Image by Gerd Altmann

I haven’t tried other medications yet, but from what I understand from hearing the experiences of others, this mechanism of action makes Vyvanse less harsh than other drugs. Another benefit is that it has a linear rate of metabolism, so by its nature, it’s an extended-release drug. I can feel its effects for about 12-13 hours. Which is great since I didn’t want to be taking a pill every few hours throughout the day. The only downside is that with firefighter training on Tuesday and Thursday evenings, 12-13 hours isn’t quite enough. I’ll be meeting with my GP again in a couple of weeks, and it’ll be one of the things we discuss.

In summary, for this post at least. I have ADHD-PI. I’ve struggled with symptoms of ADHD my entire life, but now, with treatment, I feel like I finally have the symptoms under control.

My next post will focus on how I see this affecting my day-to-day life and the methods and tools I use to help keep myself focused and productive.

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