I may finally have found my perfect combination of medication
December 10, 2020
Trigger warning: mental health, depression, anxiety, medication
For as long as I can remember I’ve dealt with a combination of depression, anxiety, and ADD. I got the official ADD diagnosis as a child and the depression diagnosis came along in my teens. Let me tell you it’s been a struggle to find what works for me but I think I finally did. For a really long time I would get anxiety about my anxiety, because realistically I was managing even if I was uncomfortable and so many other people had it worse than I did so what did I really have to complain about? A lot, it turns out.
I remember being on Ritalin at a young age. We tried Adderall at one point, I think to eliminate the need to visit the school nurse for a midday dose of Ritalin; I don’t remember the specifics of it but my mom tells me my whole personality changed and not for the better. Needless to say the Adderall didn’t last long.
Therapy on and off. Tried a few different prescriptions that didn’t work. Concerta and Strattera both completely killed my appetite *and* had the added benefit of making me too nauseous to eat even if I could force anything down. In my early teens I did what many rebellious teens did and decided “forget this, I’m tired of the runaround I’d rather just deal with it.” It was easier to deal with the anxiety and the depression as a constant side effect of my inability to focus than it was to continue trying medications. I think part of it was that I was trying to get results that just weren’t feasible from the medications and actions I was willing to try at the time.
Enter college. I have no idea what I want to do with my life. Settle on Interior Design because that’s what I don’t want to do the least, if that makes any sense. Switch birth controls to a pill from the shot. Decide I need to try and get treatment for my depression because some days I call out of work or skip class because I just can’t manage to find the strength or willpower to get out of bed. I started seeing a new therapist and we try a few more medications aimed to try to treat everything at once. Wellbutrin is a huge no go for me, apparently. I never thought I might throw up yawning until I tried that one. Provigil did work well for a while, although it’s a really strong medication and I should have known that it wasn’t going to work forever. For a little while I was on top of the world! Look at me go! And then I had to up my dose a little bit, which kept me up just a little bit longer at night, and soon I was only getting about 4 hours of sleep every night. Doctor and I both decided this wasn’t sustainable and eventually I stopped the medication and the therapy.
By this point in my early 20’s I had developed a fair amount of coping mechanisms. Smart phones were starting to get smarter so I could rely on setting reminders in there, but anything important went on a sticky note on my phone so I couldn’t ignore it. I adapted and sought out work environments that were more conducive to my overall ability to focus. Fun fact: for a lot of people like me this ends up being some manner of retail environment due in large part to being able to balance “it’s enough the same that I’m comfortable and confident in what I’m doing” with “it’s different enough from day to day that I’m not going to drive myself insane” despite the fact that it also usually comes with a large number of other stressors that don’t help anything but you deal with it because the thought of working an office job is the least appealing thing you can think of.
I motored along well enough. Switched birth control pills because a few days before my period was expected to start I’d get so nauseous I’d have to call out of work. Another fun fact, well, two fun facts (for me anyway): I had no idea how much hormonal birth control affected my overall anxiety and depression, and that nausea is very much hormone related for me because that’s how I felt the first 4 months I was pregnant. Tried out a telecommuting job for about a year, that was terrible for a lot of reasons but my mental health was definitely a casualty as well.
Eventually I left there and took a job at a failing hardware store while I decided to try cosmetology school. A friend of mine talked me into it because I had always loved coloring my own hair and I figured if it didn’t work out I could always just go back to working retail. About the same time I decided to stop hormonal birth control altogether and holy crap I didn’t have any idea how much of an impact it has on the rest of the body. Once I stopped taking that I found I didn’t have those bouts of insane nausea anymore, or the inability to get out of bed some days, and oddly enough eating sweet things didn’t cause physical pain in my teeth anymore. Weird, I know right?
Motor on a few more years and discover that my anxiety and depression get really bad about the time I’d be ovulating every other month. Barely surviving the day, staring blankly at the wall and having to actively remember to breathe type of bad. I brought it up at one annual exam and that doctor told me it was generally a normal side effect of the monthlies so I left it alone. After another year or so of this and with my 30th birthday approaching plus wanting to start a family, I decided it was finally time to get my shit together.
In December of 2017 I brought it up with my OB at my annual exam. Because my insurance changed I had a different doctor at the same practice and she’s the best thing to happen to me medically. Obviously we had to start with some bloodwork so 9 vials of blood later it turns out my vitamin D levels were looooooooooooow. Another thing I didn’t realize could have such a huge impact on the way the brain functions. Got that in order but the original issues were still there. Starting to improve, for sure, but definitely still there. Knowing that family planning was in my future she recommended Zoloft and I’ve been on that since.
Once I got used to it, so many things changed. I still lacked the self-discipline to create and stick with the more rigid type of schedule I really need to be successful, but I didn’t feel like I was dying all the time anymore so I put that in the win column. Turns out having a kid can create that type of scheduling, and my daughter’s overall routine had a (probably not that) surprising impact on setting my own schedule which in turn helped my mental state some. So now we’ve gotten the depression just about taken care of and the anxiety super manageable, but everything still kind of feels like I’m in a fog. I think the best way to describe some of the bad days is that everything you want to do is on the tip of your tongue and you just can’t remember where it was you were going to start. I did some brainstorming and some self reflecting. Knowing that generally once I’m up and moving I’m fine and the issue is mostly with getting the motivation to start moving, I tried playing around with that. Setting up a coffee pot on a smart outlet gave me the opportunity to have the caffeine I’ve been self medicating with since my early 20’s to be ready and standing by for when I did get up. But that didn’t make a significant impact on how long it could take me to get moving, especially when left by myself and not having to be responsible for the small human I created.
Circling alllllllllllllllll the way back to my childhood, I thought about the Ritalin. I mulled it over, unsure if I really needed to add another medication to what I was already taking, but eventually I wore myself down and decided it couldn’t hurt to ask and it couldn’t hurt to try. What did I really have to lose by trying to dial in my approach and fine tune my treatment? After a hiccup or two getting an appointment set up during a pandemic when so many things are already so complicated I met with a doctor who listened to me. And actually heard what I was saying. And trusted my previous experiences and opinions. And so I was given a trial prescription to go back on Ritalin.
My original idea was to take a low dose in the morning when my husband got up for work thinking that it might kick start my day. That was almost the case. I didn’t just spring awake bright eyed and bushy tailed but when my daughter woke me up an hour before she might normally get up and certainly earlier than I prefer to get up, I didn’t feel like I couldn’t function. I didn’t feel like I needed to lay down on the couch with her so she could watch cartoons and I could try to sleep more with her sitting on top of me so I’d wake up if she got up. I cooked breakfast. I made coffee. I put away the dishes, and loaded the dirty dishes in the dishwasher, and vacuumed up all the crumbs from around where she normally sits at the dining room table. And then the rest of the kitchen. And the living room. And the hallway. And so on. By the time she was ready for a nap around 11, we had been up for 4 hours and I had gotten more done in that 4 hours than I typically would in a whole day with her around. When I started getting foggy again I took one more pill, and managed to sit down and write pretty much this whole post in one sitting. It’s not quite as comparable as putting on glasses for the first time but I noticed that apparently my anxiety is mostly tied to my brain’s inability to start and finish a project all at once, and my brain creating roadblocks that I can’t always seem to force my way around. I feel totally calm and at peace, and I honestly can’t remember the last time I felt like that for an entire day.
It took me until I was almost 33 years old to get my shit together. After just one day on Ritalin after not being on it for 20 years, I feel really optimistic. Like I can take on the world and don’t feel an impending crash back to reality sneaking up on me. I spent most of my life trying to treat one thing or the other, but never really realizing just how much they really went hand in hand for me and that the effective approach wasn’t to try and fix one and let the other fall in line, it was to take a calculated approach to attacking all the issues at once that would require more than one solution. One method wasn’t going to fix everything for me, and I can’t believe it only just occurred to me that I could put a second patch on the dam for extra stability.
I know it’s only been one day, but I’m incredibly optimistic for what this holds for my future. I may know myself well, but I am by no means an expert on any of these conditions, or writing this for any reason other than to share my own personal experiences. If you’re having trouble making it through the day, you don’t need to do it alone, and you don’t need to do more than you can handle. The internet has some great resources, and you can always call your insurance provider if applicable to help you find the care you need.
If you’re having a hard time opening a search engine and taking the first step, please check out Mental Health First Aid and the National Institute of Mental Health as a jumping point for your search.
Your feelings are valid. You matter. I love you.