Work has been especially taxing - we are in the midst of a high visibility technical audit from one of the big audit firms, and I am playing a key role in wrangling up the information that the auditor needs. On top of that several team members have been having rather difficult weeks amongst one another, and on their own. I have been needing to keep on top of this set of situations, plus my own regular work - managing the group and managing my own set of overwhelmesque-flavoured projects.
Correspondingly, my inattentive symptoms have decided to show some attention to me and shake me about like a rag doll. My living space in my office at home is slowly becoming cluttered - like a swamp infested with kudzu vine on radioactive fertilizer. You may remember a scene in one of the Aliens movie where humans have been incorporated into a larger organism and they are moaning and enveloped by some great special-effects slime against a strange wall of warped body parts. I fear this may happen to me if I don't declutter quickly and diligently.
I am trying hard to take into account the mindfulness exercises in "The Mindful Way through Depression - Freeing Yourself from Chronic Unhappiness". Now, I'm not depressed, but the psychiatrist who gave me my diagnosis suggested I look into mindfulness exercises as a way to developing effective coping skills for ADHD.
(Preview this book).
The bottom line is that I feel in the grips of strong perseverative paralysis. At home in the evenings I just stay on the web reading news feeds, drinking no-caffeine, no-sugar Coke, and feel like a zombie. I am an absolute pleasure to be around.
In the background of this is my doctor's appointment scheduled for this Thursday afternoon - where I expect I will finally get a prescription for Strattera. I have had some terrific e-mail feedback (which I'll respond personally to - as soon as I get around to it...) about my previous posts about Strattera. While I didn't question the psychiatrist in great detail about why he prescribed Strattera, I did ask a fair bit about the medication and how it would work for me. Because of my comorbid anxiety (which sounds so wonderfully dark), and because of a close family member diagnosed with a tic disorder, and for a few other reasons, the doctor decided on Strattera. It generally takes 4 to 6 weeks for full effects to kick in (much like the SSRIs have done for me in the past). If there is something ADHD has taught me, paradoxically, it is to be patient. And I can wait for a couple of months, as long as I know I'm doing something to help.
I'm not too worried about side effects that sound like those of SSRIs. Been there, experienced that, expecting that, can cope with that. I figure it is part of the deal.
As I've read (in one of my books), it is possible that the longer time of action the NRIs take versus the stimulants is related to the homeostatis feedback loops of normal neurotransmitter communications between the limbic and the cortical system - the prefrontal cortex where the executive functions mostly reside are re-adjusted, or brought back into harmony by using a Norepinephrine Reuptake Inhibitor (NRI) - and that this simply takes some time:
"A norepinephrine reuptake inhibitor (NRI, NERI) or adrenergic reuptake inhibitor (ARI), is a type of drug which acts as a reuptake inhibitor for the neurotransmitters norepinephrine (noradrenaline) and epinephrine (adrenaline) by blocking the action of the norepinephrine transporter (NET). This in turn leads to increased extracellular concentrations of norepinephrine and epinephrine and therefore an increase in adrenergic neurotransmission."Dr. Kenny Handelman has a page about Strattera where he explains in simple language how Strattera works:
The publication Canadian ADHD Practice Guidelines from CADDRA contains policies & approaches to treating ADHD. It seems to support Strattera in my case. In fact, my psychiatrist was (before his untimely passing) the chair of this group:"Strattera selectively blocks the reuptake of norepinephrine (or noradrenaline) in the brain. This, in and of itself, can increase the ability to pay attention and improve hyperactivity. The interesting thing is that Strattera gradually has a downstream effect on the dopamine in the brain, specifically in the frontal lobe. Now, I am throwing around a lot of medical terms very quickly here. Allow me to explain:
The frontal lobe is the ‘command center’ of the brain. This is the area that new brain imaging studies show is most affected in individuals with ADHD. This command center allows people to use their ‘executive functions’, which are the thinking skills which allow for: sustained concentration, impulse control, delayed gratification, etc.
Norepinephrine and Dopamine are called ‘neurotransmitters’. These are little brain chemicals which jump from one nerve cell to the next in the brain to carry a message through the brain.
In individuals with ADHD, research shows that they have ‘under-activity’ of the dopamine and norepinephrine in the frontal lobes.
ADHD medication generally increases the activity of the brain chemicals dopamine and norepinephrine in the frontal lobe, and in so doing, they increase the attention, and decrease hyperactivity and impulsivity (i.e. they increase these ‘executive functions’)."
Well, I think I've been rambling a little - so I'll boil it down:"The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA) is a national independent not-for-profit association whose members are drawn from Family Practice, Pediatrics, Psychiatry and Child Psychiatry. We support individuals with Attention Deficit Hyperactivity Disorder (ADHD) and their families.
The Canadian ADHD Practice Guidelines (CAP-G) were constructed to help Canadian physicians diagnose and treat ADHD. The CAP-G Committee is part of CADDRA and is composed of experts selected to represent different specialties from across Canada based on their contributions to treatment, education and research in the area of ADHD.
These guidelines are unique in that they:
a) have been produced by a multidisciplinary team
b) are specific to Canadian practice
c) include the entire lifespan of this disorder
d) speak to diagnosis and treatment in real life conditions of practice where resources are limited (Section 1)
e) recognize that ADHD is a disorder which will require treatment using a shared care model between specialists and primary care practitioners. For this reason the guidelines stipulate both what can be handled in primary care as well as guidelines for referral to specialists."
- Tough week - feeling especially paralyzed and unfocused and unable to take the initiative, despite a few wins (mowing the lawns at home, being quite productive in short spurts at work around this audit process).
- Reading about and using Mindfulness exercises to help me move away from ruminative and perseverative thinking and behaviours. This seems to help.
- Finally going to the medical appointment where I expect I will get a prescription for Strattera. It seems to have been a long time and I am anxious to get started on it. I want to see focus and attention and motivation return.
Cheers,
Mungo
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Ouch man, that week does sound terrible! Isn't it always the times that we need them to show up the least that our symptoms make themselves known? Drives me up the wall. I'm cheering you on and sending positive, soothing vibes your way. :)
ReplyDeleteI've seen that book in stores. I may snap it up after all.