Day Sixty Five

It's hard to believe I started this at the end of June, and it's the end of August now.

I can't say the prescribing has got any easier. I did have a really good GP appointment (a two weekly routine) with a doctor who was open about their own periods of depression, and relief through anti-depressants. We were on the same page about seeing the brain as an organ, and with the analogy of diabetes, and insulin - there's no reason to think that the brain isn't subject to the same kinds of differences that occur in most, if not all other organs in our bodies.

We're each of us put together a little differently, just like all the other animals and plants in nature.

After the good appointment, and then getting to the pharmacy, the same problem cropped up with the good doctor having overlooked dating the prescription. Normally it's printed automatically, but as methylphenidate is a controlled substance, they want the doctor to verify the date, and they aren't used to doing it. So five out of five mistaken/rejected prescriptions. I'm hoping that my errant memory with pull something out of the hat, and I'll remember to check it over carefully next time. It seems like some patient transgression, to check over the work of your doctor, but it's one I'm going to have to commit if I want to avoid making double trips, or triple between GP and pharmacy. Have life. Could spend time better.

I'm still on the minimum dosage of three 5mg tablets per day, and it's working well.

I do have a good life, and it's getting better.

Previously I'd never really got anywhere financially. Life was far too chaotic. It's not like that suddenly solved, but that seems to be changing as well, with some business plans that seem to be the right thing at the right time.

I'm dating, it's going well. Conversations are easier, eye contact is easier. Lots of things are easier.

I still forget what I'm talking about sometimes, but it tends to come back, or I'll be reminded by who I'm talking with. Being 'out' about adhd, and bipolar, is leading to some really good friendships, and interesting conversations. I'm much less stressed about forgetting things around people who know the score, and it's got the point of being able to joke about it. ADHD can be funny when you're talking to people and digressing at 80mph in the 70mph zone.

From what I can see it's plain that these conditions are part of most people's brain makeup, but often at very low, or varying levels - it tends to all be cyclical, which makes the picture more complex.

There's also possibly, probably an awful lot of people who are dealing with variations of similar conditions, who have no idea that some of the struggles they experience may be related to a mental health condition. It's estimated that 90% of the population of any prison may have mental health problems before incarceration. Are we doing the best by these people?

In the current system, where you need to be in extreme crisis to guarantee knowledgeable assistance, there is left a huge number of people who are below that threshold, but still living with a mental health condition, that could be playing havoc with their life, make relationships very hard to maintain, and that might be wrongfully ascribed to 'character'.

Everyone has their own way of expression a condition, just like we all have our own ways of responding to stress. Stress can bring out behaviours that are quite different to how we see ourselves when calm, and relaxed.

One thing I would do when I was moderately depressed was eat.

Though in the most depressed state food hardly had flavour, so it was a mechanical process. But that was my emotional 'go to' in the past. On the medication, I have lost most of my interest in carbohydrates, and I'm having things like brown rice and tuna, just because that's what appeals.

'Willpower'? Is it really what we think it is? Is 'will' actually something quite different from what we might have imagined for so long?

I can feel the rhythm of the medication now, after taking a tablet. I'm careful to overlap a little in the afternoon, because I can sometimes get irritable if I go through the very last part of the drug leaving my system. It's something I'm starting to sense coming, so I'm slowly making an internal reminder system about when the next tablet is needed. It works out around 0700, 1200, and 1700, and then I'm fine to let it tail off in the evening when I'm relaxing or writing. If I'm socialising I might push the time around a little to suit what I'm doing.

There's a XR option, which is a one-a-day slow release version. That's probably going to be an option to think about in the future.

I've been writing a lot. There's no sense of 'block' anymore. I feel pretty much myself, even an easier, more relaxed version of myself. And I was pretty easy and relaxed already (well when not dealing with depression). I'd probably say I'm the happiest I've been in my life. But it's also helping me focus on what I'm doing, and also to make sense of the past, and remember the other good times along the way.

I wouldn't mind the idea of a holiday from the medication. Do I want a lifetime relationship with it?

When I've had a few days without, between prescriptions, or if I just forget, I noticed things go scatty pretty fast. It seems more full on than I remember, but in most biochemical changes the brain has 'bounce'. Stopping a medication usually takes the brain a few days to re-regulate it's chemical mechanisms to a 'normal' blood supply.

This is London. It's a stressful place anyway. An alternative would be to find a more relaxed lifestyle and place to live. If I can get away somewhere with a pool and no much to do, it could work out just fine.

For the time being I'm on 'speed'. Just the tiniest amount. And it's all good.




* The follow up to this blog, is the start of new 'mental wellness' writing and social media project called "This is The Way Home". It can be found here:

And also here on Facebook:

Day Twenty Three

I've been taking a minimal dose of the ADHD medication Medikinet for three weeks now.

My life has changed significantly in that period, and in nearly every sense for the better.

I met up with my psychiatrist two days ago to assess my dosage, and to talk about how things were going. We're going to stick to the 5mg three times a day - the minimum dosage. I'm suffering very few side effects, but the changes in my life have been quite rapid, so I'm happy to stick with what we've been doing. There's little understanding of exactly how the methylphenidate works, but plenty of anecdotal and experimental data to suggest that dosage does not relate to body mass, and that varying the dosage can have little or no effect for many people who use it.

I want to stress here, as this is a public blog about ADHD, that methylphenidate is a balancing medication. For people who have significant symptoms of ADHD it can help return to the user normalised functions of 'willpower',  concentration and focus. For people who have few, or no symptoms, it can be a problematic, and addictive drug, causing anxiety and stress. Also, Medikinet just happens to be the brand I have been given by my pharmacy here in the UK - there are many variations which are identical, including the well known drug Ritalin.

So what has changed?

As this blog attests, I've had times when I didn't think anything was happening, but the longer view has given me a better and more positive picture.

The big thing, is that I am able to stick at things, organise myself better, and get some enjoyment from the tasks that I need to get done.

I'm a single parent of an eight year old daughter, and through everything I've managed to look after her well in the seven out of every fourteen days that she's with me at home. It has been a struggle though, and I'm very pleased to have more energy for her now.

For over 18 months, from late 2009/early 2010 I have suffered severe depression, following my relationship separation - something which I found so stressful that it induced a manic-depressive episode the likes of which I hope never to repeat. The depression phase is something that was slowly lifting naturally, and before starting the ADHD medication I felt that I was nearing the end of that. It's a very, very slow process, but the medication seems to have accelerated my recovery.

I'm able now to sense more meaning in being alive, which is a relief I can not overstate. I still have many 'butterfly brain' moments during the day - even some socially awkward ones where I will forget what I'm thinking about in the middle of a sentence, or have anxiety about forgetting important upcoming events. This of course, is not restricted to ADHD sufferers, but mental health conditions are not discrete illnesses - they are an extension or variation of processes that naturally occur in all people. This is key to understanding where anyone is on the spectrum of mental health.

There are many people who live with mental health conditions which are actually very positive (such as involuntary hyper-organisation, or a gift with numbers that veers towards autism).

The only requirement of a condition to need care and diagnosis is if it's impairing normal functioning (in any sense) or causing a loss of enjoyment of life.

The people who come into contact with the health services are often people in the midst of a full blown crisis, but that leaves millions of people around the world with difficulties that may never be addressed because they haven't reached the very high threshold required to receive care.

In serious illness, on the NHS, it usually takes the disclosure of suicidal thoughts, or intent to harm someone else, to trigger proper care. This leaves many people suffering needlessly - both the people who are below this very high threshold, and anyone, who quite reasonably would not want to disclose such feelings.

I've become much more social in the last three week. I still have low level anxiety, almost constantly, but I can put it out of my mind enough to hold a decent conversation. Eye contact seems much easier as well.

My relationship with food has changed significantly too. It's no longer a 'filling in' activity, or an 'emotional response' activity, and as such my body weight has started decreasing. I've lived in a somewhat overweight state for a long time, and given that I used to run, and complete half marathons, this is an anti-depressant all of it's own.

This is also slightly disorientating, as I can see now that food, particularly high carbohydrate food, was something I counted as a reliable 'fix' amidst an unreliable emotional rollercoaster ride.

My mood is still prone to go in cycles - the bipolar element is still there, and even yesterday I had a couple of dips which left me close to tears. It's hard to say whether these are caused by a thought or an external event but my gut feeling is that, like everything with mental health, it's both.

A way to understand this is to look at brain function as covering two overlapping spheres - emotional response and rational reasoning. There is an interplay there, meaning a strong emotion may prejudice my reasoning, and likewise the result of reasoning may induce a weak, or a strong emotional response.

The cyclical nature of bipolar represents the interface between those two areas becoming weaker or stronger during the cycle of a day, week, month, or even over years.

The view I've arrived at is that this varying of the interface is a normal part of brain function that everyone experiences - lots of people have low days, grumpy days, or unusually happy and productive days. I'd go so far as to say that the menstrual cycle in women includes monthly variation in this interface, where suddenly a slight event can bring tears or even anger.

It's not very well understood, but there is plenty of anecdotal evidence to suggest that men have similar cycles.

I only found out recently that my parents had become quite worried about my moods when I was a teenager, so much so that they began to mark the low points on a calendar. I have wondered how much different my life may have been, had some kind of action had resulted from that observation but there wasn't any. Where I grew up, in New Zealand in the 1970s and 80s, it's very questionable whether I would have received any useful care from the medical system of the era.

Even today in modern countries, ADHD, and bipolar are still regarded with suspicion by many people, and in fact by many doctors. Personal bias about what causes behavioural problems plays a large part in determining whether sufferers get the help they need.

This relates to a fundamental problem with those labels and 'modern' psychiatry - those terms are not a diagnosis in the same sense as known physical-based illnesses. They come from the DSM - the , the 'bible' of modern psychiatry, and a small amount of research reveals that these labels do not relate to a known physical mechanism - they are simply the groupings of behavioural statistics that originally came from soldiers in the American army, from a document written in 1943 by William C. Menninger called 'Medical 203'.

Indeed I've purposely used that term 'physical' illness in an incorrect sense - but this is also the commonly accepted sense. It's a whole other topic, but seeing bipolar or ADHD as something other than a physical illness is one of the biggest and most damaging misconceptions that we have inherited from Dualism. The concept of Dualism - or a separated mind and body - was coined by Descartes, a 16th century philosopher. But it has it's origins much further back in religious practices, where the idea of a soul, separate from the body has been conceptualised for thousands of years.

I don't have a fixed belief that the 'soul' or  'mind' concept is wrong, but from my experience, I gained an insight about how that the dominance of post-religious moralism, and the separated 'mind' concept are overstated and flawed in many respects.

I think this is the cause of much human suffering - not just for me, but for a vast number of people alive on the planet today. This encompasses many, many things - from the reasons why the events in Norway, Whitehaven, and Columbine have occurred and how to prevcnt them, the daily struggle so many people face with mental health stigma, the ongoing problems with the cycle poverty, right through to challenging the accepted premise of the existence of prisons, and our punitively-based justice systems.

I'm starting a project called 'This is the Way Home' - the purpose of which is to state this case, provide evidence, and back it up with easily understood information and analogies. I'd like to not just help myself, but help as many other people as well, to understand how their brain works - and how this can be the key to alleviate suffering, increase feelings of meaningfulness to life, and to greatly enhance personal happiness, within ourselves, and in relation to other people.

More later...

Day Eighteen

I haven't written for a while. I'm allowing myself to be busier than I have been for a long time, and it's a real tightrope walk between wanting to move forward, and trying preserve the progress I've made.

Busyness is good. It has always been a natural state for me, probably to the point of being too busy to really have a good look at what exactly I was doing, and whether that was what I really wanted, or was good at.

One thing I want to work into my new life is the ability to switch off, and slow down when I need to. I think everybody finds it hard to remember to slow down sometimes, and there is little about modern life which helps to facilitate that.

I had a brief time between prescription repeats where I stopped taking it for three days.

The drug I am taking, called Medikinet, is heavily controlled. It is closely related to the street drug 'speed' - this makes it's use controversial, and also makes it a target for pharmacy break-ins. For these reasons, it is only prescribed in two week intervals.

As a patient, this adds a mental load of remembering to set up and attend ongoing appointments. It also means that some pharmacies are reluctant to stock it, or they are still adjusting to the idea that psychiatry has begun to recognise that ADHD is not a condition which magically goes away after childhood.

It's true that many changes take place during adolescence, and that some people will cease treatment during those years, but the benefits of the medication is ongoing for others. The BBC had an excellent radio feature presented by Rory Bremner  which followed adults dealing with the condition, and the potential effects of medication.

My three days off the medication were not a disaster, but during that time it was much harder to remember to get back on it. My mind seemed to work faster, in an uncomfortable way. I'm sure there must be rebound effect, similar to when you start taking it, during which time your brain is over compensating for the new chemical state it is in.

After visiting three pharmacies, and having to go back for another prescription mistake/correction like the first one I had, I found a local place that was willing to order it in. I'm going to try to go back there in future - routines are a treatment in themselves, and they help me order my life.

I had been coming to the end of my depression naturally up to this point. My mood is quite normal, but the remaining feature is a constant low-level anxiety. There are certain periods of the day (and later at night) when it will recede, but it is the one thing that makes being alive so unrelentingly uncomfortable. I haven't had a day feeling good in my head for more than eighteen months now.

One fear has not materialised - I had assumed that taking a drug like methylphenidate would increase my anxiety, but I don't think that's the case. I would say it's unchanged, and I'm managing to get more done, which in improving my life will help rid myself of the anxiety eventually.

I feel like this situation is very slowly improving, as I start to take on more tasks, socialise more, and stop thinking about my mental process so often. I've had to build a faith that I can get through this, and that I can work my way back to having an enjoyable and stable life in the end.

I don't have days when I feel like giving up. I just have many days wishing the process of recovery was faster than the almost imperceptible changes that happen in the background of my mind.

Hopefully, all going well, there will be a time when I realised that I've a mood-stable, anxiety free day, and I will to do something to celebrate it.

I don't think I'll need much encouragement for that.

Day Nine

Yes, day nine.

So what happened to days five, six, seven, and eight?

The thing that always happens, a distraction from my thoughts spiral into a different mode of doing and thinking - like a butterfly flapping it's wings in one country, and causing a cyclone in another. And here I am back again, on a day which has been good from the start. A new temporary cycle of productivity begins.

In those non-blogged days I did remember to take the Ritalin, but sometimes not at the right time. A few days in I got so frustrated with the lack of progress that I tried raising my dosage to 10mg in the morning, with the last 5mg tablet in the afternoon. It helped a little, but something else was at play.

I also have bipolar (Type I), and amount 18 months ago I developed stress-triggered Type II - a seven month manic episode, followed by crippling depression, and a barely recognisable life.

This means I'm dealing with more than just the inattention of ADHD that is at the heart of the problems with trying to build a life. It's also a lot to do with my mood, which when not too stressed, ebbs and flows in 3-4 day cycles. Like the tendency to be distracted, this has been present in my life since childhood.

In fact, although I entertained the idea that I might have bipolar, I never saw how much it drove my work and personal relationships. There had been other periods of chaos - just not to the same extent. Still, it had a terrible effect on trying to maintain friendships and jobs. I just thought I was endlessly searching, when in fact I was endlessly alternating between periods of organisation, and periods of disarray.

Mental health is a big subject, but it's important to know that the labels of depression, bipolar, ADHD, OCD, and schizophrenia don't indicate a well understood medical condition/mechanism like leukaemia or diabetes.

The labels indicate collections of observed symptoms, which often overlap with one another. The causes behind them are not known. The standard psychiatric text, the DSM, is the origin of these diagnoses.

The DSM in turn was based on something called 'Medical 203' - an American military study from the 1940s, which statistically grouped mentally ill soldiers.

So how did I end up taking the ADHD medication. The short answer is that prescribing medication for mental health conditions is just as fuzzy as the definitions connected to each diagnosis. This isn't a sure solution - it's part of an ongoing effort to find out what works best.

Anti-depression medication was a disaster for me - it created a much more dangerous situation where my mood could plummet without warning. Lifelong bipolar medication is indicated for people who have episodes spontaneously.

At the heart of all of the identified conditions is the stunning complicated mysteries of the brain and consciousness. They are all heavily connected to creativity, self-belief, and what we think of as 'free will'.

Lastly for today, I want to point out this very good blog by Seaneen Molloy, who writes about mental health, and is based in London. Well worth a read.

Day Four

I wake up feeling better again, like I did at the start of day two.

I feed the cats, take a tablet, and make a coffee. I work as a freelancer, on location mostly, so my client-based work schedule varies greatly. This means the structure of my day can be very loose. Or it can mean 14-15 hours days on a strict timetable. When a structure is imposed on me, I don't find it hard to follow, but I can find it frustrating when I have very little information about what is happening next.

At home however, even the basic tasks like making breakfast, having a shower, or attending to correspondence or bills becomes a random set of tasks - I find it really hard to put them into a sensible order, and remember it the next day.

I'm finding the medication does help with that. Tracking thoughts becomes less like trying to catch butterflies with a net, and more like arranging fridge magnets into a message. Ideas become 'sticky' rather than 'slippery'.

I manage to garden for a little while, picking at weeds. Before meds I would take one look at all the tiny plants coming up and my head would get dizzy just trying to find an approach. Today I just grabbed a bucket and started in a corner. I didn't finish it. I still got distracted.

But if the changes keep heading in this kind of direction, then I have every reason to feel hopeful that I may have found a long sought after answer.

Day Three

I woke up this morning, not quite as full of pepper as I'd hoped.

The metallic taste in my mouth isn't as strong as it was. Same with the headache. Getting to a state of verticality seems like quite an effort. The point of waking up is the end of the longest gap between tablets. I'd done some reading which mentioned a 'come down' effect, feeling lethargic and possibly irritable as the drug winds down in the bloodstream.

I'm also conscious of the energy I had yesterday, and the sense of belief that this was going to work out for me. Only over a longer period am I going to find out what all the effects will be. So I'm going to aim to blog everyday for the first fourteen days, and then weekly after that until things settle down into a pattern.

It can take months to sort out the correct dosage for an individual, and sometimes after that time a particular medication may not be working, so a new one is tried, and the process can start again.

Even if I don't have quite the lift I had yesterday, I can take something from the fact that I'm writing this blog again, and I'm about to do some invoicing of clients. These are good signs.

Two hours later, and no invoicing completed. I'm remembering it now, but I must have lost track of that thought about five minutes after I had written that. I've taking to having a bright green sticky note on my computer monitor. It reads "What am I meant to be doing?" Little things like this can provide excellent, non-medication ways of helping to stay on track.

However the rest of this, the third day, becomes harder and harder. My mood is crashing downwards, and around early evening I'm out of energy to put things right. I'm learning not to fight this - I put the little energy I have left into making plans for the next day. Getting work ready to execute the next day, and having an early night are two ways to help ensure there's a minimal amount of downtime between productive periods.

I forget to take the evening tablet, and only realise before going to sleep.

I leave a note for myself about what I want to do the next day. Even with today being somewhat of a write-off, this is still an improvement on life pre-Ritalin.

Day Two

I woke up feeling better than I did the day before.

I often wake up to a thought process already in progress. It's like my brain stays busy all night. It's been much worse in the last two years. At the depths of severe depression it was like waking up with a buzz saw next to my head. I would go to sleep dreading the moment of waking.

Today everything is a tiny bit quieter. I make a coffee and take one of the 5mg tablets. Getting any sort of routine going was next to impossible, right from when I was a child. The only times I succeeded were when I scheduled eccentrically. I can remember at age nine or ten, writing out morning routines that were filled with times like 7.03 am and 8.24 am. Everything done to the minute.

Today, on day two, there's a feeling of calm. It's still subtle, but even with a late start I manage to organise myself and help my daughter get ready for school. I'm too busy to figure out what's happening but I don't care - it seems to be doing what I'd hoped it would do. I'm still having distracting thoughts, but they come at a slower pace, and seem less able to bump me off course.

At 1pm I take another tablet. Again I have a sense that I'm still feeling the morning dose but I stick to the schedule. There'll be room for fine-tuning later.

Overall I'm feeling really good about what's happening. The first two to three days will reveals the extent of possible side effects, like the metallic taste in my mouth. The body has a way of masking those out once it has got used to them, so there's a chance they will decrease.

The positive effect is like having discovered a focus control on my mental picture. I've been setting up this blog, and writing this, and the 'Day One' post for almost two hours now.

Previously I would have been up and down from my desk, chipping away at many different things in succession. Very little progress on anything.

It has not gone away entirely - I got up to get a drink, and then found myself upstairs putting on socks preparing to go out and buy a birthday gift for my daughter. During the process of getting a drink, I had completely forgotten that I was in the middle of writing this blog. This is the point where the train has diverted onto another siding, the driver completely unaware.

This is what happens constantly. I used to make jokes about it. In small amounts it's funny, even endearing. I would manifest as feeling inept at remembering significant dates, and birthdays - even my own. It can be as intimate as drifting away in the midst of making a hot drink, and suddenly finding yourself pouring hot water into the sugar bowl, instead of your cup.

As mentioned yesterday, the condition has an ebb and flow. When it gets intense, it is nothing short of debilitating.

I take the lunchtime tablet, but I notice the afternoon gets slower and slower. Concentration always gets more difficult. I'm noticing the effect on my appetite - food seems less appealing. Not in a bad way so much as just less 'relevant'. I can feel the hunger sensation, but the bond between that and my natural impulse to do something about it seems to be lessened.

I realise I've hardly eaten all day, so I make myself prepare something. Some weight loss would be nice, but taken too far, too quickly it becomes a stress on the body. Some people end up needing to reduce or even stop the medication to avoid getting dangerously thin.

The sensation of a emotional 'tone', isn't so high anymore. Getting to bed, and off to sleep is an easier process than it has been for quite a while.