Please suggest pharmacological and time management solutions for adult ADHD.

Question

Hi doctor,

Last winter, at the age of 48, I found that I have adult ADHD. I have a very high IQ, and I somehow managed to graduate at university. Still, I have never found a decent job anywhere, despite changing the country several times and being fluent in four languages (while unemployed). My main limitations are very unreliable energy levels, inability to follow very boring materials, struggle to assess priorities, and general low motivation for most things that I keep adding to my hundreds of to-do lists.

I finally obtained my first prescriptions last summer:

Concerta - which made me though ridiculously tired and dumb, so I discontinued it after a few weeks. The good part was that I found it was the "paradoxical effect," which confirms ADHD.

Now I am currently in the third week on Atomoxetine, which stopped my mental chatter and unexpectedly reduced my chronic foot pain and hand tingling. I have found that fibromyalgia may be due to lack of noradrenaline, and I might have some of both.

I am happy about these changes, but I feel somewhat exhausted and with minimal motivation to do things most of the week, except for writing to friends and attending new dance classes twice a week, where I go hoping to find a dateable woman. Social isolation was hard on me.

My next appointment with the psychiatrist is next week, and he only dedicates me 15 minutes per month, so I need to be prepared to make up for his haste. I have been considering asking him to increase the dosage (now 18 mg at 9 and 18) because of the first couple of days on the pills, and I felt great when it was new.

But I have also tried taking both daily drugs together, and I did not notice any difference. Now I also need to take coffee in the morning, which I never used in my life because it was making me agitated. I suppose it is an improvement, but I want more motivation to do things, even the most boring things, which was why I asked for the treatment, so I can be less dysfunctional daily.

I enjoy not feeling restless, but I need to get things done in my day, and perhaps a job or getting around, starting my own company, and several other projects, including several online courses that I paid for and have only begun.

Please help.

In conclusion, I need both pharmacological opinion and time management solutions for (high IQ) ADHD brain.

Answer 1

Hello,

Welcome to icliniq.com.

It is good that the drug Atomoxetine suits you. Still, I tell you any medication in the early stage leads to more relief than resistance or tolerance develops. A person gets used to it, so it is better to let the psychiatrist decide whether to increase the dose. Instead, we should work on the ways in which the amount can be reduced or maintained.

I suggest you read about behavior therapy and follow these instructions:

Walk or work out for 30 to 40 minutes per day, leading to an increase in endorphins and serotonin (anti-stress hormone or relaxing hormones).
Take things more lightly. I know it is easy to advise and difficult to follow, but think about why we do anything. I guess for happiness or pleasure, and no one, either me or you, can find joy in being impulsive or negative. Please do not mind my words; it is my duty as a friend or doctor to advise.
Kindly focus on positive things in life; they might be little things like being thankful for having food, water, cell phone, and having job ability to express. Make it a habit to say thanks to almighty atleast 40 to 50 times a day; it will bring positivity in you even if you say it without feeling initially. You will feel good. Later, it will become your habit.
For time management, make small goals or schedules and motivate yourself to complete them and reward yourself by being happy or confident.
After this COVID-19, engage yourself in pursuing your hobbies as you told you are going to a great dance class you can include in your daily exercise schedule to enjoy and work out simultaneously.

Take care.