On to the second medication I was ever prescribed! Equasym XL.
Equasym belongs to a class of drugs called Stimulants, and a specific group of stimulants known as methylphenidate, the most commonly known of which is Ritalin. Methylphenidate is one type of medication used to treat those with ADHD, and the ‘XL’ part of the name in Equasym refers to extended released, meaning that the treatment works for longer throughout the day. No one is quite sure how or why stimulants work for ADHD but they are very effective. There is a potential to abuse methylphenidate and so it is a controlled substance. They cannot be prescribed (in the UK) by a GP and need to be given to you directly from a psychiatrist. I once lost a packet of mine and was instructed to inform the police as they are also sold as street drugs.
I was given medication for my ADHD when I was around 14/15. It was intended to help with extreme inattentiveness and some impulsivity I was showing around that age. I was diagnosed with the “inattentive” subtype of ADHD. At first the starting dose (10mg) seemed to be working a bit, but not much, and so we increased the dose under guidance from my psychiatrist to 20mg. This changed my whole life. I could suddenly concentrate at school and was more motivated to do so, my parents remarked that I could focus better one conversations and not drift off in the middle of them, I stopped getting in trouble for “not listening/paying attention”. It was like a miracle drug! Except for the downsides…
Methylphenidate makes you focus, but doesn’t decide what to let you focus on. That meant if I took it and then focused on something other than my homework, I would get that thing done at my homework’s expense. I was also a very anxious child and when I focused on that, it led to lots of overthinking and rumination. It also made my heart beat considerably faster and at times would give me palpitations, which weren’t fun.
I kept taking methylphenidate on and off for years. Finally it was time to transition out of child and adolescent mental health services and into the adult mental health team. It was not a smooth transition. I went off to university and used up the last of my meds to good effect. Now I had to wait months to be seen by a new psychiatrist to get a new prescription. The consultation was a nightmare, the new psychiatrist was extremely eccentric and anti-drug. He informed me that he would not prescribe without being reassessed for ADHD at the local ADHD clinic, despite having ample evidence of my diagnosis, and compared me to a drug addict. I gritted my teeth and went, with my diagnosis being confirmed. The psychiatrist now lamented to me about how experiments had been done on rats and their ventricles had shrank so as he ‘reluctantly’ handed me my prescription, he told me “I’ll see you in a few years when you have psychosis”. I want to make one thing really clear, yes I did end up having psychosis (MANY years later) but it was in no way linked to a drug I took sparingly as a child, a drug that thousands of people take with no problems. I have a family history.
After my first episode of mania and psychosis, I tried to go back to university and found my concentration issues really pronounced. Some of this may have been due to recovery after the trauma my brain had experienced, but I had a feeling some of it was ADHD related. My new (very nice) psychiatrist explained to me that she didn’t want to prescribe it currently because it is contra-indicated in people with mania and/or psychosis but it wasn’t a closed conversation. Unfortunately my mental health continued to be unstable for the next year and my new, new psychiatrist, after telling me she would look into it, will not prescribe it for the same reasons. So I’m left a little stuck. I understand the rationale behind these decisions but I also would like, if I could, to start on a low dose and just see if I could handle it. I am, after all, on an antipsychotic and mood stabiliser. For now, all I can do is wait for my health to be stable and see if anyone will revisit it with me in the future.