If you’ve read some of my other blog posts, then you already know that I have ADHD and my journey towards getting that diagnosis was not an easy one. To recap, when I was in first grade, my teacher identified me as being behind the rest of class. She was concerned and asked my parents if I could be “assessed”. My parents agreed, but to this day, I don’t know who that person was, what her credentials were, nor do I remember exactly what kind of assessments she conducted. What I do know is that, instead of identifying inattentive ADHD, she told my parents that I was fine. I just needed to “pay attention and try harder”. If you rolled your eyes or let out a frustrated groan, you’re probably another overachieving woman who should have been, but wasn’t, diagnosed with ADHD in childhood. That missed diagnosis led to an interesting set of coping strategies, masking strategies, and compensatory methods that I honed over the years to be academically successful and to appear at least somewhat socially normal.
If those are new terms to you, allow me to expand a bit. Obviously, learning was not my strong suit. I had a very difficult time learning to read and I was painfully slow at it for most of my life. I’m still a slow reader, especially if the content is technical, but I’m faster than I used to be. Math was always challenging for me, but when we started to do word problems—combining my difficulty with reading and my difficulty with abstract thought, differentiating what was important information from what was not, and deciding on the correct computation method to solve the problem—yeah, that was an outright disaster. In addition to reading and math, I had difficulty with retention of information. I would know something one day and be completely unaware of it the next. It wasn’t long before I realized that I was far below the academic levels of my classmates, but like most kids, I didn’t want to stand out in any way or be made fun of, so I adjusted.
Unfortunately, that adjustment was to pursue by studies obsessively. If repetition was what I needed for optimal retention, then I would just review concepts, vocabulary words, etc. non-stop. It got so bad that in seventh grade my parents had to put a time limit on my homework. I was allowed to do homework from 5:00 to 8:00 and then I had to stop. While most parents argue with their kids about doing homework, my parents were arguing with me about stopping. This stop time gave me a lot of anxiety, though. What if I hadn’t adequately memorized or reviewed something? I remember getting caught in my kitchen at 9:30 one night by my mom. I had snuck downstairs to review a history book because we were having a quiz on it the next day. Not a test, a quiz. My mom took my book away from me and I collapsed into tears, certain that I was going to fail the quiz. I didn’t fail—I got 100% on it, but that only reinforced my theory that my OCD-like approach (my psychologist’s words, not mine) to my studies was the right one. That’s one extreme example of a maladaptive compensatory strategy.
Now, looking back on that, my parents probably should have taken me to see a psychologist, or at least a doctor, but they didn’t recognize my behavior as anxiety any more than they realized that my anxiety sprouted out of my ADHD. I was just seen as a kiddo who tended toward perfectionism, worked hard, and wanted to do the best that she could. That was true—I observed friends and family members who had Type A personalities and tried to emulate them. Perfectionism isn’t my typical personality style, but to me, those individuals were seen as smart, successful, and were always complimented on their work. In other words, if I, too, wanted to be perceived as smart, successful, and destined for great things, then those were the people that I had to model myself after. I adapted a fake-it-till-you-make-it strategy. In other words, I masked the fact that I was naturally disorganized, not detail oriented, and had difficulty thinking ahead of the present moment. I pretended that I was detail oriented, particular and precise, and organized, and it was successful in fooling people around me. Generally, my classmates from middle school and high school would tell you that I was one of the good kids who got perfect grades. They would tell you that I was smart and that I had it all together. What they were not aware of was how exhausting it is to take an ADHD brain and force it into that mold. One of the reasons that I was so successful at it was because I got used to my teachers and the flow of my classes through middle school and high school. The environment was routine even as my classes changed, so I was able to keep over-arching strategies that I had developed, such as using an organizer to write down assignments and due dates, or the organization of my books, notebooks, and folders. Likewise, in those academic settings, you generally have the same teachers all school year, so after the initial first few weeks of seeing how that particular teacher approached things, I was able to develop the strategy that worked for me for that class and keep it all year.
Unfortunately, college was not the same environment as high school. It was the first time in a long time that I came face-to-face with my challenges and began to genially wonder if I had a learning disability. Leaving high school with a 3.98 GPA I was confident that college would go smoothly for me. I knew that I would have to work hard or that courses would be challenging, but I felt that I had adequately prepared myself for the experience. I was so, so, so very wrong. First, college classes are generally not 45-minutes long like my high school classes were and I hadn’t trained my brain to attend to a lecture for 60 to 90 minutes. If you’ve ever had to stretch your attention span, then you know how difficult and how exhausting it is. Second, teachers changed every semester, so I had to learn their style and adjust to it more quickly. That’s extra difficult in college because you might not have quizzes, homework assignments, or frequent exams that allow you to see how the teacher grades, what he/she is looking for from your work, or what their approach to exam questions is like. For classes that only had a midterm and a final exam, I would be an absolute wreck. I felt like I was always scrambling to get my bearings with each class, every semester. My anxiety hit an all-time high and I experienced my first bout of clinical depression. If I could go back and do it over, I would have made going to the campus counseling center a priority. They likely could have identified that I had a learning disability, if not which one specifically, and they definitely would have identified my anxiety and depression. Having gone through therapy many times over at this point in my life, I sincerely regret not utilizing that resource. My experience could have been so much better if I had. However, I wouldn’t seek out therapy until I started having debilitating panic attacks in graduate school and had my eyes open to how helpful therapy can be.
Ironically, this is the time that I met the boy who would eventually become my husband. I didn’t feel like I was in any sort of headspace to start a relationship, so that wasn’t on my radar, and I certainly didn’t think that six years later we’d be married. Thank goodness he was up front and persistent. What I did find was that I could share my learning difficulties with him, and he ever so patiently would work with me until I figured out a way to approach the material in a way that was both efficient and effective. Don’t get me wrong, my obsessive tendencies didn’t go away, if anything they worsened, but I was gearing my cognitive energy to the right things instead of spinning my wheels trying to figure out what was important and what wasn’t. My husband has a Ph.D. in biochemistry, so, needless to say, he was not having academic issues. He didn’t make me feel stupid, though, which was my initial fear in telling anyone just how much I was struggling. My family knew that I was having a rough time getting through my calculus class, but they were unaware of how poor my mental state really was. Honestly, I didn’t want them to know. I wanted to be able to handle things on my own and I was embarrassed to admit the I needed help. Now, I own the fact that I’m in therapy and I think that we should normalize going to mental health professionals. If you had a cough that lasted over two weeks, you wouldn’t hesitate to call your doctor to get it checked out, so why should this be any different? I will concede that access to mental healthcare is not the same as it is for medical issues. You could easily roll up to your closest urgent care to get that cough checked out, but mental health concerns are not so easily triaged. Despite that, I think the more that we talk about seeking out and getting mental health help the less stigmatized it will become. Now, I realize that my mental state impacts everyone around me and it’s my responsibility to address it so that I can be better for the people I love.
My sophomore year of college, I was doing some homework with the news on in the background when they advertised an upcoming feature story on ADHD. I perked up, not because I thought I had ADHD, but because as a psychology major I thought it might be interesting. So, I waited through the commercials and watched the segment. It was the first time researchers had developed a comprehensive list of what ADHD often looks like in girls—and that’s when it all clicked together for me. I looked at the list and I could check off almost all of the symptoms and behaviors they were talking about. Over the next week or so, I would consult all of my psych text books and resources at campus libraries and my research only confirmed my suspicion that my learning disability was ADHD. I remember a sense of relief washing over me as I realized that I finally had a name for my learning difficulties. I wasn’t a stupid person who was pretending to be smart. I just had a brain that worked differently. A brain that’s more interested in some things than others. The things that I’m interested in stick and the things I’m less interested in tend to fall away. I remember telling my boyfriend about it and him suggesting that I talk to a doctor about it—get a formal diagnosis and maybe even medication. Ultimately, I didn’t do that at the time, but man do I wish that I had.
Instead, I just moved on with my life, now knowing that my brain was indeed different, but I felt like I was coping with everything. I graduated from college with a solid GPA, I went to graduate school and earned a master’s degree in occupational therapy, and generally, I felt like my life was running smoothly. I never brought up my concerns with my primary care physician because I honestly didn’t think it would do me much good. Again, that’s something that I regret, but I can’t change it, so it is what it is. As life moved forward, I had three beautiful babies. Each postpartum period came with a postpartum depression. When I saw a psychologist for the first time for my first postpartum depression, I mentioned to her that I thought I had ADHD. She told me that I was likely correct about that, but our focus had to be on treating my depression as that was the biggest threat to my health and safety at the time. I would bring it up again in treatment for my subsequent two postpartum depressions, but, again, it wasn’t the focus of why I was there, so it wasn’t discussed let alone officially diagnosed.
As I approached my late 30’s, I began struggling with various issues. I was having trouble with my sleep patterns—difficulty falling asleep, staying asleep, and waking up in response to my alarm. Subsequently, I was tired all the damn time. With that level of tiredness, your brain isn’t working quite right, so I was short tempered with my family, easily overwhelmed, and then I would get mad at myself for lashing out. It really did a number on my self-esteem and my confidence in myself as a wife and a mother. In addition to the fatigue, I noticed that I was having more episodes of anxiety along with heart palpitations, and my depression no longer seemed to be regulated on my current dose of medication. My PCP had me do all kinds of tests from blood work to EKGs to sleep studies. Nothing out of the ordinary came up. We adjusted my anti-depressant, which did help with some of my symptoms, but I still just didn’t feel right. I was also craving sugar, sweets, and carbs like never before and I couldn’t seem to stop myself from seeking them out. My eating felt totally out of my control—like I was possessed by a refined sugar demon. One night, I was sitting in my bedroom, feeling sorry for myself and frustrated that all of the symptoms that I was experiencing appeared to be in my head. Then, I had a lightbulb moment—maybe all of the issues I was experiencing were related to my ADHD and maybe they were showing up now because my hormones were shifting as I aged. I opened my favorite ADHD website, ADDitude.com, and sure enough, it looked like I was on to something. After doing more research, I decided that I needed to get a formal ADHD diagnosis and treatment. I didn’t know that it would take me almost two years after making that decision to finally get that diagnosis.
First, it took me a little while to find a psychologist who was versed in ADHD treatment and who I got along with from a personality standpoint. Once I did that, she encouraged me to talk with my PCP and see what her thoughts were. That road led to two very discouraging and frustrating visits with two different psychiatrists. The first one that I saw was very nice and personable, which if you’ve ever met a psychiatrist, that’s really saying something. For what they do, they are stereotypically not the most socially adept individuals. We talked about what I was experiencing and what I thought was going on for her to tell me at the end of our discussion that she thought that I had bipolar disorder. To say that I was thrown for a loop is an understatement. I mean, I’ve had my fair share of depressive episodes, but never once in my life have I ever felt manic. Also, at 42 years old, I felt like someone would have caught onto episodic depressive and manic episodes, or even just episodes of uncontained impulsivity. I went back to my psychologist with the information, and she vehemently disagreed with the psychiatrist’s assessment. By that point, we had been working together long enough that she felt confident in saying that bipolar disorder was not my issue.
It took me a while to recover from that experience and to reach out to my PCP for a different psychiatrist. Not only did I have to emotionally recover, but I also didn’t want to have another psychiatric assessment and risk my insurance not paying for it (American healthcare system). So, I first had to figure out if I would be charged for another psychiatry visit before seeking one out and setting up a meeting. It took several months to go through that process. When I finally did meet with another psychiatrist, it was an awful experience. He was the stereotypical version of a psychiatrist for sure. He was curt, rude, and made me feel like he wasn’t listening to anything that I was saying. After an hour-long meeting, he told me that I couldn’t have ADHD. Why? Per his reasoning, it was because I have been in a long-term, stable relationship, achieved a high level of academic success, and never had a drug or alcohol dependency. Therefore, I couldn’t have a diagnosis of ADHD. Confused and frustrated, again, I went back to my psychologist. At that point she decided to do the diagnostic assessment herself. Turns out—mixed presentation ADHD! Even with the official diagnosis, my PCP refused to try me on any medications. She wanted me to establish a plan with a psychiatrist and then she would agree to take things over from there. She was firm on having a psychiatrist manage the trial-and-error phase that comes with any new medication. Having not had a good experience with either of the recommendations that came from my PCP’s office, I decided to take matters into my own hands. If you aren’t familiar, you can use the website Psychologytoday.com to search for mental health professionals in your area. You can read short bios about each practitioner, see what geographic areas they work in, and what insurances they accept. This was what I used to find my psychologist, so I decided to give it a try. Just as an FYI, I’m not affiliated with this website, or any website for that matter. These are just the resources that I have personally utilized. With Psychology Today, I was able to locate a new psychiatric practice to try. Honestly, I didn’t enter that appointment with much hope. I was feeling defeated by my past experiences, and I just didn’t think this one would be any different. To my absolute delight, I was wrong. This practitioner listened to me and then she engaged in conversation with me! She didn’t treat me as if I had no knowledge of the brain and body that I live with every day. This delight of a practitioner was able to talk things over with me while educating me on various treatment options. We came up with a plan! It was amazing. I left her office in tears, but, for once, not tears of frustration or disappointment. Someone listened to my story, listened to my struggles, and validated them. She didn’t fight me on my diagnosis or try to gas light me about it. It was amazing and went a long way in restoring my faith that good mental health practitioners still exist out there.
So, where am I now? Excellent question, I’d love to tell you! I am currently working weekly with my psychologist. I feel like this is a really important step in addressing any mental health issue. Medication is great and all, but that doesn’t necessarily address the underlying factors that contribute to who you are as a person. We all have something to work through at some point or another in our lives. You might be like me and have a lifetime of maladaptive practices to unravel. You might be someone who needs therapy after losing a loved one, losing a job, or undergoing some other major life change. Some of us will need long stints and therapy and others will feel better in a shorter time frame. The logistics of your therapeutic journey are less important than the reason for doing it in the first place. We are stunted here in the US in our thinking about mental health intervention. A lot of people out there continue to feel that if they’re depressed or struggling in some other way, well that’s their issue and they’ll work it out themselves. Let me tell you from first and experience, your depression, your anxiety, your overall mental state deeply impacts everyone close to you. I watched my mom go through several years of depression (ladies—beware of the hormonal changes that take place as you approach and go through menopause!) and not do anything about it because “it was her problem”. For something that was just her problem, it sure impacted how my dad and I, who lived with her, functioned on a daily basis. I tried talking her into at least mentioning depression to her PCP, but she wouldn’t do that, either. Honestly, I can’t say that I blame her. We’re often told as women that what we’re experiencing is “just part of being a woman”! Interesting, because if hormonal disruptions were “just part of being a man”, I think we’d have real treatment options in place. That’s another discussion for another article, though.
Here’s the thing, depression is not a feeling. It’s not just being a little sad, or a mental funk that will pass in due time. Depression is a medical condition where your brain is literally functioning differently than it does when you’re in a well state. Medical conditions should be addressed by healthcare professionals because the same treatment won’t necessarily work for everyone. I like to think about it like this: Julie and Tom both have cancer. Julie has breast cancer and Tom has lung cancer. Would we say, well just give them both chemo and radiation because both of them have cancer? Nope! Because we know that cancer is specific to an individual, therefore the treatment needs to be tailored to that patient’s particular case. The same applies to depression, anxiety, and a lot of other mental health conditions. If I have postpartum depression and Joe is depressed because his wife just died—those are not the same things. Each of us needs treatment that is tailored to our unique situations.
While watching my mom suffer with depression, I made myself a deal that if I ever felt my mental health going sideways, I would get treatment for it. If not for myself, then for the people around me because I wouldn’t want my husband or my kids to feel as helpless as I did. It’s not my fault that I have ADHD; it’s not my fault that I’ve experienced depression, but I do have a responsibility to myself and my family to deal with it appropriately. So, long story short, that’s why I continue to work weekly with a psychologist. As for my psychiatrist, we are checking in monthly as we trial a new medication. After a few weeks on the new medication, I noticed some positive changes, but we felt like we could maximize its impact by upping the dosage. While I did notice improvements in my executive function skills, I was also shaking like a leaf all day. It was like I pounded a pot of coffee and followed it up with energy drinks kind of shaky. So, we switched from one concentrated dose daily to one dose of a lower concentration twice a day. So far, I feel like it’s been a positive change.
I’m not quite sure how to explain the difference in my brain before and after this medicine, but I’ll give it a try. Typically, my brain was easily derailed. It was a very common occurrence that I would be doing something like folding laundry when one of my kids asked for a snack. I’d go to the kitchen, get the snack and remember that the dishwasher needed to be unloaded. While I was unloading the dishwasher I found my sauté pan and decided to start making dinner. When I went to set the kitchen timer, I noticed the time and realized that I needed to go pick up my son from practice. While we were in the car, I might as well head over to the pharmacy to pick up my prescription. The pharmacy is by Target, and I needed to return the pants I bought, so I should do that, too, but after picking up my prescription, I realized that I didn’t have the pants with me to return because that wasn’t something that I planned on doing when I left the house. So, we finally make it back home and I have to reorient myself to what I was doing—I was going to cook dinner. I get started with that and when I’m at a rest point, I take stock of what to do next and realize that the rest of the laundry still needs to be folded. Things like this would happen to me all day long. If I needed to focus on something for any length of time, like work, I typically need classical music and headphones to remind me to stay on task until the task is done. I will still set timers, as well, so that I know when to get up and take a break, because when I do get hyper-focused, I might forget to get up and eat or take a bathroom break. If it seems like a lot to you reading that, let me assure you, it is. Essentially, you end up feeling like your body is stuck in fight or flight all day long. It’s exhausting.
Now that I’ve started medication, I find less of the inner chatter. If I sit down to do something and another task pops into my head, I don’t feel the need to get up and do that other thing immediately. I can tell myself, “finish this first and then go do that.” I understand that to normal people, that might seem like a ridiculous mindset to be celebrating, but that rarely happened before. My system is less stressed because I don’t have a million fractured thoughts floating through my brain, so I no longer feel like I’m living in fight or flight. As a result, my temper is more regulated because I’m not chronically overwhelmed. I feel more rested and I find it easier to get out of bed in the morning. I also have less over-analysis paralysis. If that’s new to you, essentially it’s when you over-analyze every task and every possible situation or scenario until you become so overwhelmed by all of that thinking that you don’t do anything at all. If I am interrupted while I’m doing something, I have an easier time going back to that task once the interruption is addressed. The best analogy that I can think of is listening to AM radio while you’re driving—there are a few things getting through, but it’s mostly static. Then, suddenly, your car starts playing Sirius XM. Now, things are clear regardless of where you are. Medication might not be the answer for everyone. Some of us ADHD-ers get by just fine with regular exercise and dietary changes. I have already tried that, though, to no avail. I have also tried every possible over the counter and holistic method of treating ADHD that I could find. DHEA, EPA, ashwagandha, saffron extract, magnesium to help with sleep, bioidentical hormones to help with brain fog and forgetfulness, etc. I had researched and tried enough homeopathic ways of reducing ADHD symptoms that I felt confident that my brain needed medication.
It’s almost funny to me that we stigmatize psychoactive medications as if those are the only ones that impact how your brain functions. People become addicted to smoking, drugs (prescription and illicit), or alcohol because of the impact they have on your brain. Have you ever had a stressful day and your first instinct when you get home is to pour yourself a glass of wine or crack open a beer? Have you ever stopped to consider why that is? How did your brain learn that alcohol numbs your stress response? If you answered, “because of the effect it has on my brain”, you’d be right. While that answer is simplistic at best, it’s also correct. Now, imagine that your brain feels like a never-ending stressful day; I’d bet you’d want something to help with that, right?
I say this because we need to stop judging people for medication use. I often hear from parents how they were treated by family and friends when they decided to put their child on medication for behavioral or attentive issues and it isn’t nice. They’re trying to help their child. Unless you live with that child day in and day out, you have no idea what they’re experiencing and how it can impact the entire family. Listen and be supportive, not judgmental. They have enough to deal with. Likewise, we need to take the same initiative for ourselves as we would for our child, and you shouldn’t be made to feel bad about it. I think that a lot of people put the emphasis on medication when the real concern should be that person’s health and wellbeing. That’s why I share these stories. If reading about my journey helps even one person out there feel better about their own, then it’s a win. That might be trite to say, but it’s the truth. We need to take down the wall of stigma surrounding mental health conditions and treatment and I think that happens brick-by-brick, person-by-person as we each become brave enough to share our experiences. So, know that someone out there is rooting for you and wishing you the best on your journey. Be brave and be well–Lorie