When Medication Works Too Well

There’s a fairly common thing that happens to people who take medication for mental health issues. When the medication is successful, you tend to start feeling like you don’t really have a problem. This especially happens if you share examples of how your particular problem affects you, and other people tell you bracingly, “Oh, that happens to me all the time! You’re fine!” It’s easy to start wondering if you’re overthinking this, if maybe you’re really okay after all.

This happened to me for the first time about a year and a half ago, a few months after moving to Oregon. Since I was no longer working as a teacher, my insurance had expired, and I was now using Aaron’s insurance. With the change in coverage, my copay for the medication I take for ADHD went from $20 to $60. Previously, I’d paid $40 per month for both my asthma inhaler and my ADHD meds; the new cost would be $100. Now, we’re not destitute by any means. But we do try to spend our money wisely and save where we can. It occurred to us that maybe, just maybe, I didn’t need the medication any longer since I didn’t need to maintain a classroom and manage a room full of children. I was only managing one child, a pregnancy, and a house. It would be okay, we reasoned, for me to exhibit ADHD symptoms in the safe environment of our home.

So I just stopped taking the medication. And at first, it wasn’t all that bad. I mean, it wasn’t great. A few days in, the dishes were piled up in the sink. Crumbs littered the floor. I drifted aimlessly, unable to remember what needed to be done for long enough to do it. I fed and dressed Niko and myself, but beyond that, I was in a fog. Several days after that, the trash was starting to smell when I forgot to take it out… and forgot… and forgot. Toys littered the floor, clothes lay in drifts in the bedrooms. The dishes covered the counter as well as the sink, and fruit flies moved in. Niko wore his pajamas all day, and I couldn’t think of a reason to change my own clothes. I wanted to go back onto medication, but the decision to stop taking it had coincided with my last available refill from my Alaskan doctor, and I hadn’t yet found a new provider. I couldn’t find the motivation or focus to search for a new one and make the necessary phone calls.

It got worse. About a week and a half after stopping the medication, the blackness moved in. Strattera is a medication used to treat ADHD, but since I started taking it about three or four years ago, I haven’t had a single episode of depression. (It’s worth noting that it was originally developed for depression, but test subjects found their ADHD symptoms improving instead.) Previously, I experienced it on a cycle of roughly a year from the start of one episode to the start of the next. It’s now been over five years since I’ve experienced depression (I didn’t experience it during my pregnancy with Niko or for the year and a half between his birth and the start of Strattera). I haven’t been sure that Strattera was what was keeping depression at bay — after all, that’s not what it’s marketed for — but whether or not it’s been responsible, it was about a week and a half after stopping my meds that things took a sharp turn for the worse.

It wasn’t a full-fledged episode of depression. It was just a shadow on the horizon. Just a looming cloud of black emptiness, hovering just close enough that I felt its threat. Just close enough to bring a flood of memories of the dark nothingness, the endless pit. And I completely panicked. I huddled on the couch, sobbing, my grasp on reality weakening. My son was being his ordinary self, directing a flood of happy chatter in my direction, unaware of my desperation. As I tried to cope with the waves of hopeless terror washing over me simultaneously with Niko’s needs, I was struck by a snarling, primal need to eliminate the source of irritation. I wanted him gone. Out of the picture. Permanently.

Bizarrely, it was that sudden attack of internal rage that horrified me enough to snap me briefly out of my panic attack. I pulled myself together, put Niko to bed for the night, and started texting my best friend, who lives in Alaska. I don’t remember what I said, but it was worrying enough to her that she called me seconds later (despite the fact that we almost never speak — 97% of our communication is through text). I picked up the phone up, but I couldn’t talk — I was crying too hard. Bless her heart, that girl calmed me down enough that I could tell her what had happened. She told me exactly what I needed to do — BREATHE. Tell Aaron what’s happening when you’re done talking to me, it’s ridiculous to try to protect him from your issues, he can’t support you if he doesn’t know. Find a doctor first thing tomorrow to refill your prescription, never mind the stupid money, it’s not like you’re poverty-stricken. Call me or Aaron right away if you think you’re going to hurt yourself or Niko, no matter what time it is. I love you. You’re going to be okay.

Obediently, I texted Aaron the general gist, then crawled into bed to sob myself to sleep. I woke up the next morning to my phone buzzing. Have you found a doctor yet? Oh. Right. Actually, I had a doctor, or a midwife group, to be exact. I called the office and explained what was happening. They immediately wrote a prescription and sent it to a pharmacy near their practice, where it waited for me free of charge until I could figure out how to get the new prescription costs to fit our budget — it turns out, thank God, that people move REALLY FAST to help when you mention a terrifying urge to hurt your child. Next time I saw my midwife group, I met with a social worker who gently questioned me about how I was doing, reminding me that I needed to find a general practitioner, since they specialized in births, not mental health.

And just like that, I was back on medication. The black cloud receded. The fog in my mind lifted. I cleaned the kitchen, dressed myself and Niko, and breathed a shaky sigh of relief. And then I started searching our insurance provider’s website for doctors.

Yes, sometimes medication works too well. We forget what it’s doing. We wonder if we really need it. And we forget how to cope without it. Strangely, I’m glad I had that experience, because it gives me a strong contrast between who I am unmedicated, and who I am with a bit of help. I don’t want to find myself in that place of utter desperation, ever again. And that’s why I will continue to take those nasty, gag-inducing pills every single night. I like who I am when I have medication to help me move toward my potential. I like having a fighting chance to think clearly, to focus on tasks, to remember to wash those dishes before they get crusty. I don’t like the fact that I need to take pills to keep me sane; I do appreciate being able to like myself and be myself.

So. Bottoms up. Down the hatch. Chug chug. Vive la médecine!

[Photo credit www.safemedicinedisposal.org]

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Hugging a Butterfly

Today a friend shared a link to an article on the Scary Mommy website, on my Facebook page. I read it with tears in my eyes. The author writes about the slow process of realizing their son had needs that weren’t being met; diagnosing him with ADHD; and, finally, reluctantly, starting medication for him. His reaction after his first day of medication was what made me tear up. This is what his mom wrote:

For the first time in … well, maybe his entire life, Colin seemed truly relaxed. But not in a stoned, disconnected way; more like a relieved way. Like someone who has finally been unburdened from the baggage that has unfairly saddled them for so long.

“I feel so much better, Mom,” he told me. “Why couldn’t we have done this from the start?”

His reaction was very much what my own feeling was, when I started ADHD medication. Relieved. Unburdened. And so much better. Why did I wait so long to admit I needed help? Pride, fear, and inability to see clearly and objectively from the haze of my condition. Medication isn’t for everyone with ADHD, but this story struck home to me. Beautiful.

– See more at: http://www.scarymommy.com/hugging-a-butterfly/#sthash.ZCAANp23.dpuf

Symptom of Childhood

It was supposed to be funny. A T-chart, headed with “Symptoms of ADHD” on one side and “Symptoms of Childhood” on the other, with identical items listed in each column. “So true!” was my friend’s comment with the post. The point, of course, was that all children have short attention spans and are wiggly, and putting a label on these things is silly. In other words: ADHD doesn’t really exist. She didn’t mean any harm, maybe even felt she was championing a child’s right to be a child.

But as I stared at it, I felt like I’d be kicked in the stomach. Looking at it, I couldn’t breathe. I felt the old guilt and shame rushing back, the accusing voices that had tormented me for years from my own mind. If you cared enough, you’d be able to be on time…remember what you’re supposed to be doing…finish your work on time. If you really wanted to, you’d hear when you’re being called…pay attention in class… stop staring off into space…keep your room tidy. If you had enough faith, you’d be able to pray and conquer these issues. Just like everyone else must be doing.

The first time I met a child with an ADHD diagnosis was my first year teaching. He was the sweetest fifth-grader in the world. Kindhearted, generous, well-mannered, and so very anxious to please. He was friendly, full of goodwill toward even the marginal kids, and well liked. But spacey, so spacey. Twitchy. Impulsive. Words would fly out of his mouth at the most inappropriate times, and he’d drop his shaggy blond head onto his desk in embarrassment as classmates turned to look. Small sounds like pages rustling or pencils scratching distracted and irritated him. Writing topics eluded him. To get started on work, he needed me to crouch next to his desk, softly talking him through the process: “Look, here’s a list of topic ideas. Do any look interesting? Okay, now jot down three big details. Do you think you’re ready to fill in small details?…” Mind you, I’d already walked the entire class through the concept, working through an example together, giving time to choose topics. He just…hadn’t heard. Or the task was too overwhelming. Or he couldn’t focus through the sounds of others working.

When he did get started, as long as nothing distracted him, he was singleminded and incredibly creative. Reading his stories, I’d laugh out loud, and look up to see a pleased grin on his face. He didn’t lack intelligence or skill; he simply couldn’t focus without help.

When I first met him, I didn’t know he had ADHD. Our records weren’t computerized at the time, and student files were all kept in the school office. You had to check them out, and you couldn’t keep them in your classroom overnight, so they had to be returned by 4 – giving little time for a newbie like me to sift through the thick stacks of data, assuming I’d even known what to look for. Having been hired the day before school started that year, I didn’t even know at first where to look for these files or what to expect to find in them — and while I wanted to learn about my students, I had other priorities, like developing my first lesson plans, organizing my classroom, and completing beginning-of-year paperwork, schedules, discipline plans — things the other teachers had already finished before school started. So I didn’t know about his diagnosis, but soon I started to wonder.

Then one day soon after school started, he arrived with hair uncombed, jacket disordered, his normally cheerful demeanor anxious and scattered. He couldn’t sit still. He hopped up to get tissue he didn’t need or to get yet another drink from the water container I kept in our relocatable classroom, interrupted, acted uncharacteristically hurt and then borderline belligerent when another student disagreed with him. By mid-morning he hadn’t completed a single task and was distracting other students, causing disruptions. I called him over to me. Head hanging, ashamed, he didn’t even wait for me to ask. “I’m so sorry, Mrs. Malapanis, I’m really sorry, I’m trying but I forgot my medicine this morning and it’s just really hard.”

I took a deep breath. “I know what it’s like not to be able to focus,” I told him gently. “And doing it without medicine must be so hard. But when you don’t have your medicine, it doesn’t mean you can give up. It means you need to find other ways to focus.” I helped him with a few tricks that often helped me: I moved him to a desk away from other students, where the light was dimmer. I asked him to close his eyes and breathe slowly as he thought about the task he needed to complete. And he tried hard, really hard, and by lunch time had nearly finished one task.

The episode jarred me deeply. I felt the tiny seed of disquiet that had been disturbing me lately begin to grow. Why did I identify so strongly with this child? Why did I feel that I did, indeed, know exactly how he’d felt that day?

I didn’t know much about ADHD. The university’s education program focused more on compliance with IDEA (Individuals with Disabilities Education Act) than on recognizing or managing specific disorders, and in the triad of Christian communes where I’d grown up and attended school, if anyone spoke of it at all, it was with scorn. “Those kids just aren’t disciplined enough. They need a better routine. Their parents aren’t doing their job. Public school teachers are too permissive, too lazy to take the time to understand their students. ADHD is a fake disorder. It’s a sign of degenerate times. You don’t see OUR kids running around a classroom like that.”

Actually, that last part was more or less true. Classes were very small in our school — when I was in 6th grade, our 6-student class was the biggest in the history of the school. Students got a lot of individual attention. Even during a group interaction, being one of three or even six students is very different than being one of thirty. So a lot of the issues that a child with ADHD could display in a large, busy classroom might look different in a school like the one I attended. (There’s a good reason that teachers work with students they have concerns about in small groups.)

I’d been taught to believe that ADHD was a fake disorder, a way to pretend a child wasn’t simply badly brought up. The diagnosis was an easy way out for teachers too: medicate a child instead of connecting and managing differences creatively. And supposing a child did have a Real Problem, it was nothing a little prayer, faith, and love — and a bit of effort on the child’s and parents’ part — couldn’t fix.

But poor discipline or laziness were not what I saw here. This boy had loving, dedicated, hardworking parents. His good manners and old-school courtesy were clear signs his parents were doing their job well. And his forgetfulness, his habit of blurting at inappropriate times, his difficulties controlling his body — these things caused him significant distress. He worked harder to overcome them than any other student ever did. There was no laziness here, no lack of caring.

Meanwhile, my own performance in the classroom was suffering. My desk was piled high with unfinished paperwork. I was weeks behind with grading assignments. Some weeks I didn’t even have formally written lesson plans — I just taught the lessons I knew were supposed to be taught each day, with little preparation. I was working 60-80 hours each week, staying at the school late each night, returning after supper many nights or working at home until well after midnight, and working through the weekends — but with little to show for it. I would lose whole hours of time, drifting, getting nothing done. While class was in session, the noise in my classroom was intolerable to me. Visitors commented on how quiet and calm my room was, yet the pencil-borrowing, page-number-reminding murmurs and the rustle of pages, clicking of pens, squeak of shoes on chair legs, and even noisy breathing were enough to constantly disrupt my chain of thought. When students were in gym or art, the hum of the lights and the voices on the playground took their turn distracting me.

[I’d like to add here that despite my personal struggles, my students thrived. I was distracted, yes, but I’m also fairly creative and extremely dedicated. And teaching — getting concepts across — is a knack that I have, not to mention a deep and sincere love for my students. I can’t say that my issues didn’t affect them, because obviously they did. But my students were learning and progressing despite those issues, because I worked my ass off to make sure they did.]

For my third year, I was reassigned to second grade. We had a new principal that year who took a different approach to managing her teachers, including frequent informal observations.  Not long after I returned from maternity leave (Niko was born in October, and I returned after the Christmas break), she called me to her office and told me that my performance was inadequate. She helped me lay out a plan for improvement, including observing in my neighbor’s classroom and having my neighbor observe me and give feedback.

I was stunned and humiliated. But I knew she was right. I needed help, and the worst part of it was that I had known it for some time. I just wished I’d taken the initiative to ask for support instead of having it mandated. That meeting was a turning point for me. It forced me to confront the fact I’d pushed to the back of my mind: I had a problem. A real problem.

The teacher next door is one of my favorite people in the world. She has a heart big enough to engulf every single needy person she encounters. She could embrace the world if somebody could suspend time to allow her to meet every individual in it. This woman spearheads reading committees and student needs meetings. She was passionate about advocating for children with special needs, going so far as to fill out complex paperwork for other teachers if it meant their students would get help. On top of all that, she has a wicked sense of humor and can deliver a pointed one-liner that will keep you giggling all day. She’s the teacher I want to be when I grow up.

So, going to her and pouring my heart out wasn’t hard. She listened sympathetically. “Are you okay?” she asked. I shook my head. “No,” I said honestly. “But I will be. I want to figure this out.” She gave me a fierce hug. “We’ll get you through this,” she promised.

I kept mulling over what had happened. That day back at the beginning, when I told my student that I knew what he was experiencing, had stayed with me, a constant thought buzzing in the back of my head. Now, I pulled it out and took a good hard look at it, along with all the other things I had been pushing aside. It was time to confront the truth.

As usual, I managed this with my typical lack of grace. I was sitting in the deserted library, chatting with my newly-appointed mentor. We’d talked of this and that, until the conversation turned to family. She told me her mother was very ill and had just been diagnosed with cancer. I was listening, truly, but here’s the thing with my brain: there are ALWAYS at least two (usually more) things happening in there. Part of me was reacting with sympathy and concern to her life changing, heartbreaking news. But the quiet place in the back of my mind was roiling with my newfound truth, and it chose that very moment to send  it blurting out through my mouth. It went like this —

She: “My mom was just diagnosed with cancer. I’m having a really hard time dealing with it.” Me: “I think I have ADHD.”

She didn’t even blink. Didn’t pause to shake off the discomfort of having the topic changed from her heartbreak to my needs. Didn’t grimace in irritation. She reached out, put her hand on my knee, and said, “Oh, honey, yes, you do. You sure do.” I writhe in shame every time I think of it, but I think I’ve never loved her more than I did in that moment.

Later, I took an online questionnaire posted by a doctor — not mine — to help his patients determine if they need help. I took the completed pages to my doctor and told him my story, including the confirming opinion of the experienced teacher next door. He glanced over the pages and raised his eyebrows. “If even half of this is accurate,” he told me, “I have no problem prescribing medication.” He went over my options: I could go the traditional route, with highly controlled stimulants. They’re typically very effective, but they also require an appointment with a psychologist and follow-up appointments each time the prescription needs renewed, and they run the risk of being addictive. We chose a medication called Strattera, which was developed to help people experiencing depression, but was instead more successful at dispelling symptoms of ADHD that many of the test patients were also experiencing.

The procedure was simple, but it was the hardest thing I’ve ever done. It meant abandoning a lifelong conviction that my problems were solvable if I just cared enough; prayed hard enough; tried a little bit harder. I’d been taught that depending on medication for behavioral issues, or for mental health, was a failure  of faith. I felt that I was giving up, that I was succumbing to weakness of character. I wallowed in waves of shame, disappointment, sadness.

And then I started taking the medication. It’s supposed to take 4-6 weeks to see effects, but within a week my desk was clean and organized. I had figured out a more effective way to manage discipline. I had designed half a dozen new, adaptable worksheets for my students to use when analyzing books. The clutter in the corners of my classroom was disappearing. I found, as more weeks passed, that I could distinguish between mischievous noise and working noise. When I was giving one-on-one assessments, I could focus on the student in front of me and still know what the rest of the class was doing. The sound of pencils scratching no longer sent me into shutdown mode.

There were other changes, too. When I folded laundry, I was no longer compelled to line up the stripes in kitchen towels perfectly. I no longer needed to design complex color patterns as I stacked folded socks and underwear. If clothes were hung on hangers of a different color, I didn’t grind to a standstill. I hadn’t actually realized these were issues; I still don’t know why I did them, or why the medication affected these odd behaviors. All I know is that I was more clear-minded, more focused, less anxious, than ever before. And something else happened: the cycles of depression that circled back through my brain once or twice a year simply…didn’t. I have not had a single episode since starting Strattera.

I still have ADHD. I still forget things, still get distracted. Time doesn’t make sense to me — it doesn’t progress for me the way it seems to for other people. Sometimes I blurt out things that only make sense to my hundred-thoughts-a-second brain. My desk is never truly clean; neither is my house. Even now, I function best when I have at least three projects and two books going at once, so I can abandon one for the next when my attention runs out and still get something accomplished. But the medication has done something that no effort on my part has ever done — it’s given me the ability to cope. I can manage my symptoms now, even use some of them to my advantage. I’ll always have ADHD, but I’m okay with that.

And I want other people to be okay with it too. Suggesting that it’s a fake diagnosis doesn’t do anyone any favors. Facing its existence, facing that a person with ADHD might need the extra help of medication to deal with otherwise insurmountable difficulties, is the kinder approach. I struggled for thirty years. Thirty years of secret shame, self-hate, and a growing conviction of my own inferiority, before I discovered that I actually could be organized and focused — I just needed more help than I was getting. Children with ADHD greatly benefit from the awareness of the disorder, as do adults.

Speaking personally, my realization that I have ADHD has been like a key to a previously unknown library of management strategies. I’ve been able to find ways of coping that I didn’t know about before. I now recognize, for example,  that trying to power through a work session after my mind has started to drift isn’t a useful approach. Instead, I take breaks when I start to lose focus. I go do a different project, stand up and walk around, do the dishes — and instead of giving these behaviors a negative label (Procrastination! Laziness! Lack of staying power!), I recognize them for what they are: my own way of getting things done. I keep a to-do list, both mental and physical, if there’s something I’m worried I’ll forget to finish, and I try to make things on the list a priority when I move on to something new. I make sure I have another project started so I don’t spin my wheels when I need to stop my current project. And it works, more or less. Am I as efficient as someone without ADHD? Almost certainly not. Am I more efficient than I was before the medication and the new approaches? You bet your boots I am.

I have ADHD. I’ve come to terms with that fact. And even though I cringe when people deride the disorder as a simple lack of discipline or low level of commitment or just not caring, I’m not going to wither in shame whenever I see one of these references. My ADHD isn’t going anywhere, and neither am I. For better or worse, here we are, inextricably entwined. Get used to it.

A note: I couldn’t find the original T-chart I mentioned in the first paragraph. The one pictured as the “featured image” sends a similar, though broader, message. I found it over at Grounded Parents, in an excellent post called “Internet Meme Demolition Derby: Childhood is not a Disease!” It’s well worth a read.