On Wednesday, after months of hedging and waiting for appointments and testing, I finally went to my family doctor about some medication. The psychologist had suggested I seek something for both my ADHD and dysthymia, but Laura thought I should start just with an ADHD drug to see how I handled the side effects.
I was torn. I know I can have bad emotional side effects with drugs. I don’t take antihistamines because they make me feel hopelessly depressed or dangerously irritable. There’s a hole in the wall in our bedroom the size and shape of my fist after a wrong combination of cold medicine.
But I wanted some relief. I had cautioned myself about putting too much hope into the drug route, but I couldn’t help saying to myself after I get some medication, I’ll be able to do this. I had taken Wellbutrin for a few years in the early 2000’s, and while it had lifted me out of the depths, the therapeutic effects diminished after about a year, and the only reason I kept taking it was so that I didn’t have the drop-off from stopping it. (It turned out that vitamin B-12 had better effects and I was able to taper off and quit Wellbutrin about two years ago.)
I hoped for some significant change. I recently saw the film Limitless and hoped the drug would be something akin to that. I did not expect to be sipping Mai Tais in Monaco with millions of dollars in the bank within a week, but wanted some result on a smaller scale. The way Bradley Cooper’s character is depicted prior to the drug in the movie felt familiar: life a mess, can’t seem to keep up with the world, the color somewhat drained from experience, not even able to bathe some days. When he first takes the drug he cleans up his apartment and writes his novel. I would be satisfied with those two steps alone. I don’t want super-human, manic abilities or loads of money and power, just a little nudge in the right direction.
The morning of my appointment I awoke feeling nervous. My appointment was at 10:00 and I got up at 6:15 with my oldest son. (Seriously, what is it with him that on school days he acts deeply insulted when I wake him up at 6:45 but on his first vacation day he hits the ground running at 6:15?)
My last visit with this doctor was a couple years back when I asked him to write my Wellbutrin prescription instead of my psychiatrist. The psychiatrist’s office was more than an hour away, and I would have to drive down every three months for a five minute appointment. I didn’t have “a doctor,” because I just go to the walk-in clinic when I’m sick. One of my issues is that I don’t take care of my own health appointments very well. I don’t maintain anything well, including myself.
I thought it was time for a doctor, and my doctor is awesome. He’s a transplanted Scot with a wonderfully dry sense of humor. For instance, on one visit he went through my family health issues with me, asking me if we use car seats for the kids and about smoking in the house (there isn’t any) and so forth. He also talked about the importance of a will for making sure the kids would be taken care of. He recommended that I make a will as soon as possible. After a pause, he added, “Not that there’s anything wrong with you.”
At the first visit, though, he noted my blood pressure was borderline high. I said that doctors always mentioned that and said, “Oh, you just might be nervous.” It was true, I said, I had an anxiety disorder. I had it tested again later at the pharmacy and came back and he suggested I try some relaxation techniques right up until and during the testing and it turned out to be normal.
So, being nervous that day, I cut down on my caffeine use that morning. My caffeine use had ramped up these last few weeks. The weeks from semester midterm until Thanksgiving are always very busy in my job and certain tasks have piled up and I feel more pressure to do them. Also, November is a busy month, with both of my kids’ birthdays, my father-in-law’s birthday, and Thanksgiving (that we host at our house) all within two weeks, from November 17 to December 2.
I left a little early to drive to the doctor’s office, which is only three blocks away. They are very efficient at this office. When I had signed the last piece of paper at the receptionist’s desk, the nurse came out and said “Jonathan!” I turned and looked at him confusedly. It was still twelve minutes before my appointment. “Is that you?” he said. “Uh, yeah,” I said.
He led me back to the exam area and took my weight: 244. Yuck, I thought. I had neglected exercising recently. “Same as last time,” he said. He showed me into the exam room and went through my history. He asked if I had had a flu shot or wanted one. Yes, I said, even though I wasn’t sure. I didn’t want side effects from the shot to interfere with possible side effects from the medication. But I am around a lot of college students and thus a lot of flu. During the H1N1 scare, a deliriously sick student showed up at class once to hand me a note that said that she had the flu, exposing my entire class to it. I ran and got hand sanitizer and Lysol.
He took my blood pressure, and I practiced my meditation breathing to calm myself. 128 over 80. Top end of the normal range. I waited a bit and then the doctor came in.
“Hello, I’m Doctor MacDonald,” he said. I said that I knew; I had seen him before. He looked at the record on his laptop more carefully, and said that it had been about two and a half years. He asked how tall I was and I said six foot four. He said I had grown considerably since last time; the record said my height was four inches.
He asked me about why I was here, and I explained about the ADHD testing and handed him the report from the psychologist. I showed him the diagnosis page, and explained that the report was based on both interviews and a battery of cognitive tests, and how that on I.Q. measures I am in the superior range, but in all the executive function/working memory kinds of tests I rank average or below average for my age.
He asked me if I had any unfinished projects around the house. I explained about the kitchen that has been 90% renovated for three years, about the flower bed that I’ve been promising to work on for four years, about the holes in the wall that were patched but not painted for years, about the wooden kayak that I have 90% complete in the garage that hasn’t been touched in four years, and so on. “And your wife puts up with this?” he asked.
“Well, yes and no,” I said. “I am seeking treatment, after all.”
He asked about the recommendation from the psychologist, and I reported what she had said about trying both an antidepressant and an ADHD drug. He took the report to scan into the computer and came back. He started with a history lesson on ADHD. Being a voracious reader, I already knew everything he told me, but I let him talk so that I could understand his point of view on the subject. He told me they used to say to kids with ADHD, just sit down and behave. Then, people would go see the doctor for three minutes and say to kids, take this pill and sit down and behave, and there was little understanding of what’s going on. He was impressed with the battery of tests the BRAINS Foundation had done. He said that he wanted to prescribe me Ritalin for the ADHD, but not anything for the dysthymia now. In one respect, he had the same point as Laura: let’s not load up on two drugs at once in case there are side effects.
In another regard, though, he disagreed with the psychologist. My psychologist said that I had the depression for so long that it has become part of my personality. The dysthymia paired with the ADHD sap all my energy and ability to work. This doctor, however, told me that “dysthymia is a personality disorder, so it’s just part of who you are. We’re not going to try to treat that now.” He did agree with Laura, though, that treating the ADHD might open up these areas where I am blocked and the dysthymia won’t be much of an issue.
He explained that he was going to try me on Ritalin, the generic version anyway, and that it would be 10mg twice a day. One when I get up and another four hours later. I knew from my reading that this was the classic “work day” dosage, designed to last for an eight-hour work day. He told me that if it didn’t work to call back in a week and he would up the dose, probably to one pill in the morning and two in the afternoon. I would also make a follow-up appointment for three to four weeks later.
He further explained that since Ritalin is a controlled substance that I would have to take a signed paper prescription and that they couldn’t call or email the prescription in. Not a problem, I said. Like I mentioned, the doctor’s office is three blocks away from my house and my office. I could even walk there to pick it up if needed.
After my flu shot, I then headed out to Meijer to drop off my script at the pharmacy. This being the day before Thanksgiving, I expected a crush of people at Meijer. It wasn’t too bad, though, and the pharmacist checked her stock quickly and said that it would be ready in about forty minutes. I picked up a couple things I needed and then went to Lowe’s to pick up a some other stuff. We needed a couple of new switchplates in the family room. Laura had painted the room and the old switchplates had been painted over a few times.
I went back to the pharmacy, picked up my bottle of tiny pills and headed home. At home, Laura and her mother were in full Thanksgiving prep mode. They were cooking like two madwomen, and, as is their style, they bickered constantly. They have a very close relationship, but they just work together by bickering. I find it enormously stressful to hear, but that’s how they work.
I told Laura briefly about the visit. She wasn’t happy I got the flu shot because she worried it would make me sick on Thanksgiving. I sat down to read the insert about the side effects. Laura and I had been concerned about me starting a new drug for Thanksgiving, but I decided to try it anyway.
From what I had read, ADHD stimulants had a very different effect than anti-depressants. I had little problems with side effects on Wellbutrin other than trouble falling asleep for the first week. However, the therapeutic effects of it, as with most antidepressants, take weeks or months to kick in. ADHD stimulants are like caffeine: the effects kick in quickly and wear off in the same day.
The list of possible side effects and problems was long, but comparable to Wellbutrin. So I took it at 12:15.
I started to notice the effects within ten minutes. “I feel strange,” I said to Laura. “Calm.” She thought it may have been relief at finally getting the doctor’s visit done. I went about installing the switchplates. It took about five minutes. Normally, I would have thrown the bag on my desk and let it sit there for a week.
Laura and her mom started up the bickering again, arguing about what dish to use for the spinach. They were really going at it, and I thought it was funny. Not laugh out loud, but funny in a sort of removed way. Usually I would get caught up in the emotion of their argument and get all tense.
Laura asked me if I would take Alec, our five year old, outside to play later on. “Sure,” I said. I noticed that I didn’t have my usual resistance to it. Normally, I would agree to do it but feel resistant. Being out in our yard reminds me of all the outside things I haven’t taken care of. I also have to fight the boredom of just sitting and watching him play and the worry of him running out into the street or falling and hurting himself (he broke his arm twice when he was three).
In fact, I did one better. I went downstairs to Owen, who had just turned eleven, and asked him if he wanted to go to the park. He did. He came running upstairs and said “I’m going to the river park!” It was significant; he is autistic and almost never uses first person.
I told Laura and she looked at me sideways. I never volunteer to take the kids out. I do it when she asks me, but I have to get over my resistance first. My automatic response when she asks me to take them out is to think of an excuse why I can’t. I often don’t mention my excuse and have to just get over it to be able to go.
The park usually seems fraught with difficulties. I have to keep track of both kids, even when they want to do different things. I have to talk to strangers sometimes, which I find difficult. And I may have to “explain” about my kids sometimes; my older son is autistic and my younger son is speech delayed and impulsive, in special ed without a diagnosis yet, but has trouble getting along with peers.
None of those things seemed to be of any concern to me. I felt the slightest sense of dizziness, a listed side effect, but otherwise seemed coherent.
It’s a short drive over to the park and they were overjoyed to be there. It was a warm, sunny day, low fifties, blue cloudless sky, quite warm for late November in Michigan. The park is next to a river with a paved trail and fishing platforms. Alec likes to go to the platforms and throw sticks into the river below, but Owen likes to stay in the playscape. Normally, that seems like a problem. I worry about leaving Owen alone in the playground.
However, it seemed clear today what to do. I would take Alec to the first platform only, and I could see where Owen was playing. The playground is fenced in with only one exit, and there were only a couple other kids playing that day. In fact, there were more dogs than people in the park.
As I walked over to the platform with Alec, I realized that I was feeling the full effect of the medicine. For the first time in a long time, I felt both calm and awake. I felt the sun on my face, fully. The day was bright and beautiful. I felt full of calm optimism, not a sort of manic rush that comes from loading up on Excedrin. I stood with Alec on the platform and looked over at the water rushing by below and felt a simple joy at the sight. I watched Alec look for sticks and felt full of love for him, even when he flashed his severe plumber’s crack bending over to pick up a stick. I looked across the park at Owen and saw him standing high on a platform on the playscape with his blue coat and knew he was safe and happy. I started to well up a little bit at the feeling. The greatest part of the experience was the lack of tension in my jaw and in my chest. Normally at the park I am trying hard to relax, trying not to keep checking my watch, forcing myself to stay there a little longer for my kids’ sake. Today I was prepared to stay as long as they liked.
Walking around the path with Alec looking for sticks, we met some dog walkers coming the other way. The dogs were little rag mops, but one had an attitude, stood his ground with a severe bark. I grew up with dogs around and so can recognize a dog putting on a show, so I laughed. What happened next astounded me: I had a conversation with the dog owner.
Normally, I can’t think of what to say to strangers. I get nervous and clam up, only to think of what I could have said later. I bent down to talk to the dog first, “You’re a noisy one, aren’t, you?” I said, holding my hand out for him to smell.
“Oh, he’s not vicious,” the owner, an older woman, said.
“I know,” I said, looking at her, petting the dog. “I had dogs growing up.”
“Oh yeah?” She said. “What kind?”
“We had a mutt first. Some kind of border collie my mom found in a parking lot, and then a golden lab later.”
“A little bigger than Sam here,” she said.
“But you act like a bigger dog,” I said to the dog. The owner laughed. They left. It seemed so easy. I could just think of what to say.
Alec and I went back to the playground and I was eager to try out my new people skills. I talked to another dad about the weather quite easily. I also noticed for the first time a well-rendered Spongebob Squarepants mural next to where I usually stood. I thought it might have been new because I never noticed it before, even though I usually stand in that spot when I watch the kids. The paint was peeling, though, so it had obviously been there for a long time and in all the years I had been coming here I never noticed it.
Suddenly, Alec raced by holding his butt, and I knew I would have to find a bathroom right away. We headed over to the bathrooms but they were closed to the season so we were stuck using a portapotty. He really balked at the sight of it when we got inside, but I coaxed him onto the seat. He did his business, and there was no hand sanitizer inside. I went back to the car with him and there was none there either.
I would normally worry about what to tell Laura. She’s really insistent about germ management: we wash hands and sanitize a lot. With good reason: when Alec was three he became ill with a stomach flu that nearly killed him. But the answer seemed clear: I would just tell her, even though she wouldn’t like it, but I would put Alec in the bath as soon as we got home. It seemed an easy decision.
Normally all this would have caused me enormous stress: getting Alec to the bathroom before he soiled himself, worrying about leaving Owen alone for a few minutes, worrying about telling Laura about the lack of hand sanitizer. But all these decisions were easy, and I dealt with the whole situation without tensing up.
In one of the classrooms where I teach there is a noisy air conditioner system. When it is running, there is both a rushing air sound and the sound of the motor of the blower droning. When we all arrive to class on a warm day, the air is already running, and in a long class it may run for an hour when it will suddenly cut off and the whole room seems quiet and more relaxed. We’ve all tuned out the sound for so long that we don’t realize it’s there any more until it is removed and its absence is stark.
It was the same with the effects of the Ritalin. My underlying tension suddenly disappeared. I didn’t have to worry and mull over each moment. I made good decisions. I could act without fighting constant resistance, worry, tension. In the middle of the effect, I did a “death check.” I can always measure my overall mood and sense of optimism by reflecting on my own mortality. If I am in a good way, I can accept my own mortality. In all states of mind, I believe a death is a true end to the conscious self, that afterlife is wishful thinking. In a good state of mind I can accept this with equanimity and logic. When I am in a bad way, I am terrified of the finality of it, and filled with regret over the opportunities I’ve missed, and the failures I’ve had. In that state of mind, it seems so unconscionable that I would live now with a mind that can’t understand its own end.
Standing there in the park with my kids in the sunshine I felt okay with the fragility of life.
When I made it back to the playscape with Alec again, I saw a woman calling loudly to either a dog or a child. The woman had bleached blond hair, flashy sunglasses, a white embroidered hoodie, and a smoker’s voice. She kept calling louder and louder; “Come on! Over here!” the way one would speak to a large dog. I kept looking for the dog as we were walking.
From behind a short wall, the dog appeared: a miniature brown poodle about ten inches tall with a four-inch poof on its head. I laughed.
The owner said, “She’s so spoiled that she won’t go on the leash. She’s going deaf, so I have to yell at her.”
I started to say something, and then all the old tension came rushing back. My jaw tightened up and I felt my arm muscles tensing. I managed to force out, “My, my,” looked at the dog, and then shrugged my shoulders and left to find my kids.
I thought that was odd. I looked at my watch, 2:30. I looked at the dad I had talked to earlier, and then I didn’t want to talk to him. I worried about the kids. I looked at my watch again to calculate how much longer I would have to stay to make them happy.
I realized then the Ritalin had worn off. It had not only worn off, but had dropped off like a cliff. I had two hours and fifteen minutes of benefit. And then it just disappeared.
I drove the kids home and talked to Laura about the whole experience briefly. We didn’t have time for a big conversation because of the Thanksgiving preparation. But I felt changed by the experience. Even though the benefit was short, for the first time in a long time I felt optimism and possibility, like the future was open to me.
At four o’clock I took my second dose. I felt calm again, started taking care of things around the house without being asked. At five, I went to lie down for a nap. The literature had warned me about trouble sleeping on Ritalin, but I took a very, very good nap. Falling asleep and waking up are key worry times for me. But not this time. I had a good, sound sleep from which I awoke refreshed.
Again, though, after a little over two hours, I felt the tension creeping back into my jaw. But I felt overjoyed at the benefit I had experienced that day. I told Laura that night that if Ritalin were illegal, I would find a dealer. Then I would lobby congress tirelessly until it was legal.
It has the exact benefit I hoped for. The feeling of the full benefit is what I described as a clean energy before. I can just do things that need to be done. I have energy, I feel calm, I can act decisively, I can hold conversations with people, I can ask for help at the store, I can make phone calls, I can make decisions without that constant internal war going on. But I don’t feel manic, I don’t talk excessively, I don’t feel jittery, and I don’t feel like I have to work as fast as possible until the feeling wears off, like I do when I load up with caffeine and Excedrin. I feel relaxed and less inhibited without feeling dopey like I do when I have a drink.
The next task will be to get the dosage right. I’ve been taking three a day stretched out over the day. I try to take them at times I will need them. In the mornings I’m more awake and I have coffee, so I don’t take it first thing. I have trouble in early afternoon and in the evening with feeling lethargic and pessimistic so I save it for then. I’ll be calling the doctor on Monday to adjust my dose (I can make phone calls now, remember). It has carryover into the down time, though. I can do things better knowing that later on I will be on it again and will have the energy and focus needed to get things done.
This Thanksgiving I am most thankful for Ritalin. It allows me to appreciate life.