Physical feelings with stimulants for ADHD
Forget that they are called stimulants (Adderall, Vyvanse, Concerta, etc). Many people with ADHD feel tired with these medications. It’s the same people who say they can drink coffee and still fall asleep. What’s happening to the brain physically is that dopamine is being released. This happens with anything stimulating (yes… sex, drugs, Rock and Roll included). However, when a neurotypical person is exposed to this, they have a surge of energy as if they “pushed the pedal to the metal”. An ADHDer brain slams on the brakes. In that case, the only thing I can relate it to is the drag race scene in The Fast and the Furious. A ten-second race is stretched out to two minutes. With the brain getting that “nitrous charged air”, time actually seems to slow down. The ADHD brain picks up more information during the slowed time. This can lead to emotional changes.
Emotional feelings with stimulants for ADHD
One of the most common things I hear when a patient is following up is that their mood has improved and they are less sad. They also have more patience and people around them have also noted positive changes. When you give a “neurotypical” patient stimulant medications, they may note increased anxiety or agitation. I have had so many patients over the years that we were able to get off of SSRI meds or at the very least, required lower dosages. Think about Vin Diesel’s character racing again. Look how calm and collected he is after a race but have him run the family grocery store and he’s got his head in his hands.
If you look at ADHD as a disease that needs to be cured, you’re going to make the mistake that physicians often do. You’re gonna keep escalating the dosage until the patient resembles a neurotypical. What I teach my patients is that ADHD is similar to having poor vision and you need glasses that are “just the right strength”. How do you do that for a patient? Reframe the problem.
Imagine that you have 20 browser tabs open in your mind. (This is when the patient usually chuckles and nods their head). The goal is not to get them so focused that they only have one tab open because that’s when you start getting personality changes. Try to target keeping 3 or 4 tabs open. They are just focused enough to get their tasks done and still fun to be around. In my opinion, this is much better of a gauge than the ASRS-v1.1 that we make patients do. Both are subjective but one leaves a smile on your face, the other one doesn’t.