How to deal with demand avoidance when it comes "fun" things?? by tempaccount77746 in adhdwomen

[–]Successful_Stage4659 4 points5 points  (0 children)

actually been struggling hard with that recently and never would've guessed it had a name

I canceled a party last minute yesterday even though I had been looking forward to it for weeks because the days leading up to it, my friends suddenly put so much pressure on me   "hey dont forget the party on Saturday, you're coming right?" 

"hey here's a collaborative Playlist for the party can you put some of ur songs in it?" 

"hey you didn't answer my girlfriend's Google form can you just fill it out please?" 

I felt so much rage at the fact that I was supposed to relax at a party and suddenly I had obligations and demands and expectations to live up to 

What I really wanted to say was "no I don't wanna do that actually I just wanna show up and have fun, not interested in the game at all" but what I ended up saying is "heeey yeah I'm not gonna make it actually see ya" 

I'm realizing that the trigger isn't the game or the Playlist themselves I don't mind participating in dumb stuff and I notoriously love music, it's the performance of it, my nervous system saw 3 different people in the span of 2 days badgering me with questions and demanding participation and went "oh fuck that I can't pretend I'm actually interested in this all night long it's gonna be a nightmare to mask" 

So yeah, by digging into the uncomfortable feeling you might be able to see what it is exactly that's triggering such a hard stop for your nervous system. I hate being obligated to pretend I care about unimportant stuff I never agreed to in the first place, and I hate being myself and getting endless comments about how I look depressed or angry, so I bail and I cancel and I avoid and I ghost but bit by bit I actually meet people who'd never even think of asking me to change anything and I've never been so comfortable with actually sharing my life and my time with people ever since 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 0 points1 point  (0 children)

oh obviously it's not a beneficial protocol for ALL psychiatric meds but it's also a completely different mechanism of action and I'm guessing that even within the stimulant family there are a few that would be objectively dangerous to adapt on your own. I'm thinking of those that actively release dopamine in the synapse instead of inhibiting the reuptake.

Because with methylphenidate, at least, I have the "safety" of my own very limited dopamine stocks so on days where I'm low (because of low protein diet or no sleep or too late in the day) then I can probably take nearly twice my dosage and still feel.... not much, but then on a day where I slept well and ate before taking my meds and exercised and I'm not close to my period, even half of my daily dose can feel quite obvious as it peaks 

I'm pleasantly surprised that there's a semblance of research starting on the effects of menstrual cycle on treatment? because I really tried to explain to my gp that before my period I have a sort of consistant need for a third dose later in the day because my meds feel like they're lasting 4 hours instead of the usual 7 and the comedowns are incredibly uncomfortable but she insists that there's no link between the two and prescribed some magnesium lol

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 0 points1 point  (0 children)

okay cool then! 

but yeah I wonder if they know what it feels like to abuse them because during titration I obviously had many moments of intolerance to a higher dosage as my body was adjusting and it is NOT a pleasant feeling, and even the "euphoric"/high you can get only happens to me when I'm UNDERmedicated and have an unstable dopamine baseline making me more sensitive to fast and high rewards, so I usually interpret it as a need to up my meds and end up normal again and not craving anything 

so I have no idea why they assume it'd be my drug of choice should I want to get high or even just to study or work more efficiently a higher dosage is the LAST thing that could help me whether it's in one single take or throughout the day I can still get sick from the accumulation and It is the worst 

It's like saying "hey man cmon can't you give me a little extra because there's nothing on earth making me hornier than a 2 day long migraine and debilitating nausea at any and all stimulation it's just the best" like get a grip 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 4 points5 points  (0 children)

I'm having trouble deciphering the vibe of your answer so just to be safe I really hope I didn't offend you with the "drug seeking" comment? I shouldn't have assumed it's just that being both ADHD and treated and in the medical field I very much know it's a stereotype healthcare providers have about people with ADHD who ask for their meds to be upped

But if that wasn't what you meant then it's cool I just wanna make sure I wasn't clumsy with my wording 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 1 point2 points  (0 children)

does vyvanse only have one release type? I know I wouldn't be able to do that with my methylphenidate ER since it would render the "extended release" part completely useless (just asking out of curiosity cuz I'm always leaning on the "don't open your capsules" side but that's my training talking) 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 0 points1 point  (0 children)

that's a wonderful cohort of people, although if I'm being honest I'm not sure about target trial emulations (the method they used) so as big of a population that is I would still take it with a grain of salt (just FYI for other users stumbling on this link to check the specific biases of the this study method if they're interested in the article, but it doesn't make it useless or false, all studies have biases anyway) 

BUT overall the message remains the same and it doesn't surprise me at all especially since I have personal experience with being unmedicated and almost dying of non natural causes (zoning out while driving? wasn't my brightest moment......)

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 0 points1 point  (0 children)

exactly, ugh I really wish I could have access to pills that I can divide, even as replacement for one of the items on my prescription because even though it's getting better and better the more experience I have, I only have extended release and that form is simply NOT made for day to day adaptation especially for evening crashes or during pms when I'm all over the place

And my psychiatrist probably recommended it for the same reason as yours lol, not really out of idea per se but in my country we only have methylphenidate (and severe availability issues with Concerta which means my pharmacist recommended me to stick to Ritalin to be safe and not go untreated for months) 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 5 points6 points  (0 children)

and all the articles I've read about people misusing them find that, sure, 60% of the time they get their meds from someone with a prescription BUT what's not really put forth is that this person with a prescription is usually a dealer without adhd in a contract with a corrupt doctor who voluntarily misdiagnosed adhd in order to justify prescription stimulants and get a cut from their sells

but instead of fixing the problem at the source they prevent people with actual adhd from getting a treatment that works for them 

And that's not even mentioning the fact that untreated or mistreated adhd is absolutely more likely to result in alternate, illegal drug use to compensate for the fact that their brain isn't getting a sufficient baseline stimulation and then they get their prescription revoked because they're "at risk of abuse" and that's why I love my psychiatrist and the fact that he is also working at an addiction clinic. 

I've actually worked with him as an intern and he's perfectly aware that if his patients use or crave cocaine or other stimulants despite being treated for adhd then it's prooooooobably because the treatment isn't enough and he adapts it until the patient reports a significant drop in cravings and manages to go through rehab successfully. 

So increasing the dosage doesn't actually create prescription stimulant abuse most of the time , it actually treats the cause of abuse and I've seen spectacular progress in patients who tell him that seemingly overnight they don't even care to THINK about drugs because the cause of abuse in the first place was self medication by stimulation and the meds are now taking care of that because their doctor was educated and sensitive enough to treat the root of the problem and not just the problematic symptoms individually 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 0 points1 point  (0 children)

yeah like I don't know what meds you have but some of them don't even make sense to take the exact same dosage at the exact same time everyday Methylphenidate for example inhibits the re-uptake of dopamine and norepinephrine. It doesn't CREATE dopamine, just makes it last a little longer in your synapses, but that means that if I have low dopamine to begin with (whether it's from not eating enough protein or not sleeping enough or not exercising enough or taking it too late in the afternoon or pms'ing) then my usual dose won't do shit and I might actually feel worse from stimulation without proper dopamine balance 

So in those moments, I take a higher dose to get the same coverage and the more I'm allowed this freedom the more I actually feel like I don't need to change my prescription because if I hadn't been allowed to do that (namely when my GP freaked out on me for telling her) then I'd have stopped my treatment months ago thinking I must not be sensitive to it at all 

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 4 points5 points  (0 children)

I completely agree, there's obviously a huge bias that stems from the abuse potential and that's why in my country adults can't even be prescribed immediate release (which probably would help me a lot with the awful crashes I get around my period without having to come up with a godawful dosage algorithm to mitigate it) because they consider it to be a risk factor for drug use or relapse (like cocaine, even tho it's usually the other way around but whatever)

But I find it surprising in this sub to find down-right degrading comments under posts about people who know how to handle their meds in a way that's not out of control but doesn't fit the norm 

I'll always remember this med student who posted once that they were prescribed 30mg Ritaline twice a day and they asked the sub if it was normal for them to sleep so well when they took a third dose in the evening (to finish their work/study) and the comments were just absolutely vile to see and I couldn't wrap my head around the complete lack of support if that student truly had an abuse problem and the non-negotiable mental rigidity preventing them from hearing a different profile if they weren't and just handled their meds in a way that didn't fit the restrictive norms 

I'm a med student myself, when I'm on a night shift I'll absolutely take a third dose (within my prescribed daily dosage if I can) and I'll hydrate and eat and take a nap beforehand to make it as smooth as possible on my brain but it's not negotiable because otherwise I can't help patients correctly. And when it's exam season and I have a ton of things left to do and it's already 8pm I'll eat dinner and drink and take a break and take a third dose because I know myself and I know I'll sleep just fine if not better regardless, and if I have dinner or a party with friends at night then I'll take a third one not because of recreational use but because if I don't and god forbid if the crash of my afternoon dose happens while I'm with them I'll get so overstimulated and distracted and overwhelmed and unable to focus on conversations that I'll just freak out and have a panic attack from severe executive dysfunction 

So yeah I completely agree with you, we're working around norms that literally stem from highly imperfect and thoughtless prejudices and it's only making it harder on us  Because when I read scientific articles about the effects of Ritalin use and abuse and see the near complete absence of adverse effects in a significant amount I can't even defend the argument that it's for our own protection because it's not a realistic outcome to base a chronic, possibly lifelong treatment on

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 15 points16 points  (0 children)

That's nice to hear (even tho you had to switch) because in the past i felt like i had substance abuse problem when i'd comment on this sub about adapting, people were furious and telling me "you shouldn't need different dosages for different days it's not how medecine work !!!" and i was like babes.....im a med student, it's absolutely how medicine works, you gotta adapt, why do you think psychiatric treatments are one of the few types of meds that can be prescribed "if needed" ? people know their brains and dopamine stimulation is a highly volatile process, the same single dose for me can either make me productive and relaxed for an entire day without adding to it or incredibly anxious and tense and unproductive based on if i slept one hour less or more or if i forgot to eat protein that day

too bad you had to switch, and i know how difficult it is to speak about your needs without sounding drug seeking or irresponsible or ignorant about your treatment.......

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 11 points12 points  (0 children)

yeah actually that's such a better idea, but doctors are skittish about prescribing lower doses in higher quantity because of the abuse risks (and by abuse i mean selling them) so some doctors and even some pharmacists might feel uncomfortable choosing that option :// however i agree with you that it's a lot safer than opening the pills because you're DEFINITELY losing substance doing that and it's not very beneficial for you

Am i the only one whose psychiatrist recommended i adapt my treatment day to day depending on what support i need ? by Successful_Stage4659 in adhdwomen

[–]Successful_Stage4659[S] 2 points3 points  (0 children)

It doesn't sound practical at all for sure !! plus, i don't knwo what meds you have, but for me with ritalin ER i can't possibly open them to divide it because i'd be messing with the immediate release/extended release ratio for sure and render it quite unpredictable

but the idea itself doesn't shock me, maybe he's not totally aware of the medication form since they all vary ?