What are the issues involved in taking stimulant medications for ADHD from early elementary school onward? And what happens when someone who has done this decides to quit the drugs in college – only to find her motivation and academic capabilities diminish without the meds, and to suffer a crisis of identity and mood problems upon resuming them?
Two recent guest posts from a reader raised these questions and prompted ample discussion and comments from readers. In those posts, I let the young woman in question speak for herself. Now, I’d like to highlight some of the larger issues her story illustrates.
How to know if you still need meds?
In retrospect, this young woman admits that when a given drug would stop working back in high school, she fared poorly. But the desire to prove to herself and her parents that she could perform well in school without pharmaceutical assistance was powerful enough to raise the question, just before she started college, of whether she might be able to achieve at a high level sans prescriptions.
Of young people I’ve interviewed with similar histories, I’ve found that this impulse to strike out without the “crutch” of medication is a powerful one, and prompts many to quit their meds.
How to know if you ever needed meds?
For many people who began treatment at a young age, this is an unanswerable question. They can scarcely remember themselves without the drugs.
In the case of this young woman, three semesters in college during which she was scarcely able to do any work suggested to her that even if she didn’t “really” have ADHD or perhaps could have learned to function without drugs if she’d never taken them, she had become psychologically dependent on them for her academic performance.
In addition, the person they helped her be – on-track, focused, high-achieving – had become an essential part of her identity, one that was painful to lose. Regardless of whether she ever needed them, she had come to rely on the effects they produced.
After so many years, how to know what are side-effects of the meds, what are new symptoms, and what is psychological habituation?
Going back on ADHD meds, the young woman found she got her focus and drive back, but also began to suffer from anxiety and depression and to be tormented by the idea of what constituted her authentic self.
But it’s hard to say what might be driving these troubling mood symptoms.
As one commenter put it, “Are the medicines causing her OCD and depressive symptoms? Or is it her anxiety/crisis of identity that is causing the OCD and depressive symptoms? Or is it just the fact that many adults with ADHD have co-existing OCD and depressive symptoms?”
What to do now?
These questions of identity, comorbid conditions, medication side effects and the like are fascinating to ponder in the abstract – but when you are suffering from anxiety and depression and rampant self-doubt, as this young woman is, contemplating the complexity and myriad variables involved is unlikely to provide much immediate relief from troubling symptoms.
A potential problem with long-term medication use, especially from a young age, is that you don’t learn coping strategies for when things aren’t going well. As long as the medication works, that’s terrific. But when it stops working, when you stop taking it, or when new symptoms or stressors crop up – you find yourself without the tools to dig yourself out of a hole.
Some readers speculated whether this young woman might fare better if she had other options – either for managing her ADHD symptoms off the medication, or for dealing with her recent anxiety and depression now that she is taking the meds again. Coping strategies don’t solve existential angst, but they can help get you through rough patches in the here and now. Here are some from a psychologist blogger with a particular knack for recommending practical strategies.