Why write this?

This August / September, I had a lot of life changes in one go:

  1. Moving from an apartment i disliked to one I absolutely love, and maybe even feel at home in, for the first time in my life
  2. Officially switch jobs, becoming an employee of a non-profit I had co-founded
  3. Catch COVID for the first time and recover from it, with appropriate MH breakdowns from the isolation
  4. Get on Guanfacine as a non-stimulant medication for ADHD

While I can not fully separate the effects of these changes, the overall effect has been very good for me. The ADHD meds form an important and specific component, and I think I am primarily writing this to understand what that is. Many years ago, I had started on bipolar 2 meds and anti anxiety meds at the same time, and attributed some positive changes to the bipolar 2 meds that were not true - it was almost exclusively the anti anxiety meds. This contributed to me living with a misdiagnosis for many years, and taking meds I just didn’t need. So I don’t want to unconditionally say all the good positives in my life are from this, but recognize that some are, especially this time we did not mix it with another pharmacological intervention. Writing it down now should also allow me to come back to it a year or two later to see how that has evolved

Dosage & Side Effects

I currently take 2mg a day in the morning, after starting at 1mg. No plans to increase dose further. I had some dry mouth for a week or so when starting, but it has mostly subsided.

I had been on Ritalin for a few months when I was first diagnosed (happened when I was 20). It was an important marker in my life (my first thought when it kicked in was “Wow, is this how normal people feel?”). I did not enjoy the “crash” in the evening, but now i suspect increased dosage or an extended release would have helped fix that. But I was still in Chennai at that time, and due to various socioeconomic factors + how hard it was to access, I gave up after 2 months. While I got back on other psych meds later, due to various other mental health comorbidities, I’ve been wary of trying stimulants for myself. I’m extremely happy that there are now non-stimulant options for ADHD, and one of them is working for me.

Productive capacity

The first, and most noticeable difference is that doing “work” (broadly defined as ’thing that pays my salary’) is easier. Specifically,

  1. I can focus on a single problem for a longer stretch before I lose energy and hence focus. My work sessions now seem to be closer to an hour before a break rather than 20minutes before a break. This also means the total amount of time I can bring to bear on a problem per day has increased, as much as by 50%.
  2. I seem to have more control over what I am actually interested in. I know I do great work when I focus on something, but I never felt fully in control over what things I could choose to put my attention on. We have to evaluate this more long term, but so far, this atrophied muscle seems to be slowly growing.
  3. I am able to actually plan my day and do the things I have planned, and say ’not now’ to other things I may want to do during the middle of the day. I have never managed to stick with any kind of personal planning system. What I had planned and what I would actually do would often not match up, causing some amount of emotional pain (“Why am I so incompetent?” usually). After a while, I’ll give up said system because the pain is just too much, instead chasing the ephemeral joy of just doing things.

So my overall capacity has increased (1), and so has my ability to apply it in a particular direction. This is awesome. It’s now up to me to work on building systems that allow using these gains, building organizational muscle that was just not possible before (3). I’m excited to build this muscle, re-trying things that I had tried before and failed at. One specific hope I have is that it’ll help me go from someone who gets something to 80% completion to someone who gets things to 100% completion more times.

A side-note here here about my ADHD Tax, which has been primarily paid as shame and emotional turmoil (ask anyone who has been around me whenever I have had to apply for a Visa), although of course there has been a financial and opportunity cost. This has gotten so much better. I just got a ton of pending paperwork finished, without the usual attached emotional turmoil. For the first time in my life, I think I will be able to get on top of this and stay on top of it.

Emotional capacity

Between the stimulus and response, there is a space. And in that space lies our freedom and power to choose our responses.

This quote from Victor Frankl has always stuck with me, and I think Guanfacine has just increased the amount of this space I have to do this.

I have been in therapy for a long time, and will probably continue to be forever. I have learnt many skills I can bring to bear, particularly at times of extreme (and often disproportionate) emotional distress (something that seems to happen far too frequently for my taste). However, often when you are emotionally distressed, you just don’t have the capacity to use those tools! The best you can do is to avoid causing harm, to yourself or others, and retreat for your body to recover.

Guanfacine has definitely made this situation better. I have more capacity now to actually use the tools I have learnt, and iterate on them. Insight is often useless without action, and Guanfacine has given me far more scope for action than I had before. This isn’t something that ‘heals’ everything (no such thing, unfortunately) - but it has vastly increased my ability to ‘do’ rather than just ‘know’ or ‘feel’. Very grateful to have it.

What now?

My overall goal has been to find ways to heal and lead a less miserable, more joyful life than I have in the past. I understand this is probably a years, decades-long process, and I’m much closer to the start than to the middle Guanfacine feels like a significant boost along the way here. I’ll check back-in in a year and see how the things in this post have aged :)

If you think you may have ADHD, consider getting evaluated and trying some medication. This may be a fucked up process that you may not be able to afford for economic, social or even just ADHD reasons (may need a lot of follow through ugh). But, I think it is absolutely worth it, so if it is available to you and you have been putting it off, consider this a sign to re-prioritize that.

You can reach out to me by emailing yuvipanda@gmail.com if you wanna say hi.