by John Testore
Medication is a very divisive topic.
Implications include religious beliefs, medical ethics, to mention the fact.
It is the igniting topic of unhealthy debates between Med-free, New Age Medicine, Spiritual Healing, Traditional Western Medicine s advocates.
I obviously support Western Medicine, henceforth in favour of the correct biological approach.
When I say “correct”, I do mean that Western Medicine is not infallible.
On the other hand, I see New Age practitioners as charlatans since there is no scientific evidence in their literature.
It’s a very controversial field, legally binding : these practices are not approved by the FDA, yet they are allowed to operate privately by law. Their fees are astronomic, they are not covered under Medical Insurance however, they thrive.
I don’t want to go into specifics, I just realise that they are a ‘last resort’ for disillusioned patients.
I accredit them for Placebo Effect, when successful.
People who take the Med-free route, are often very religious.
I believe in Spiritual Healing as a Christian, without excluding the doctor.
As you see, it is a multifaceted, arguably picture.
As a Western healthcare worker living in Asia, I must admit that Western Medicine has been imposed worldwide. Chinese Medicine dates back 5.000 years and most doctors offer either a Western or Oriental approach.
Although Western Medicine is now predominant, one can tell that Western therapies are not honored in the East, particularly in Mental Health. Most public hospitals don’t have a Psychiatric Ward and most Psychiatrists studied in EU/US whilst work in their private practices.
Psychiatry is still shunned.
I’m not arguing on what s better or worse, I am discerning how Western Medicine earned its reputation for Traditional.
Don’t think it’s solely based on scientific evidence, many meds’ mechanism of action is not fully understood, yet they are efficacious.
Doctors refer to them as ‘off-label drugs’. Ironically, they are oftentimes successful.
Timing is the winning strategy: the average kicking speed of Western meds is two weeks versus two months for Oriental herbal remedies.
Not to mention over the counter emergency painkillers: an Ibuprofen pill can abate a headache within minutes.
For these reasons, young Asian generations are reverting to Western Medicine.
Last but not least, Body Composition.
The same compound can work for one or being ineffective for another.
The future of pharmacology is headed towards the production of ‘Designer drugs’ with regard to dosage, ingredients, symptoms.
Another myth is that Diagnoses and Personality are the same.
Personality is unique as it is the Immune System.
This theory is not new. It was first proposed in the 90s by leading psychiatrists the likes of Peter Kramer with the introduction of the first SSRI antidepressant Prozac in his book ‘Listening to Prozac’, still a blockbuster today.
The proposal was never taken into consideration by pharmaceuticals for lack of funding needed for this costly project.
I wish philanthropists like Bill Gates would use their influence more wisely.
As of today, all medications are available in stock and none comes without a full array of side-effects.
This is the fallibility of Western Medicine.
The term ‘Cosmetic psychopharmacology’ was coined in the 90s by American psychiatrist and author Peter Kramer with regard to the introduction of the first SSRI antidepressant Prozac.
The name speaks for itself, who doesn’t know what Cosmetics are in our Image-Society?
Dr Kramer compared indeed Prozac to a cosmetic.
What was a pioneering drug 30 years ago, countless SSRIs are available today.
Kramer questioned if it is ethical to ‘make-up’ personality.
Needless to say, he saw depression as a personality trait.
His bestseller book, ‘Listening to Prozac’, received either harsh or stellar reviews, though it remains a cult to date, praised by the Autistic community, understandably so.
Strongly criticized by patients suffering from Major Depression.
History repeating itself 30 years on in Autism: most autists support the Personality Trait.
Depressed individuals are convinced to be sick.
I refrain from commenting as to not trigger anyone, although I disagree with the popular definitions of ‘high-functioning/low-functioning’ Autism.
There is only one medical diagnosis of Autism.
Psychotropic Medications give us many answers on Illness or Personality.
In Medicine, this field is referred to as ‘Medication s adherence’ as in efficacy.
Adherence leaves little to imagination.
If medications work, we can talk of pathology no matter.
Surely, different compounds have different effects in individuals, from the assumption of ‘designer drugs’, though I believe in pharmacology.
My take is that finding the right med, can be very frustrating and time-consuming.
Off-label meds often turn out to be the most effective.
This leads many people to discouragement, henceforth go med-free.
It took me two decades to find the right combination.
Then again, no triggers wanted.
I will discuss my personal experience with dual ASD/ADHD avoiding preaching.
After experimenting virtually every antidepressant and antipsychotic for ten years, my psychiatrist decided to take the traditional ADHD approach only.
Adult-ADHD is typically an underestimated, underlying disorder. It is thought to pave the way for extra pathologies.
Doctors prescribe ADHD medication in adults as last resort since these combinations leave the system after 6/8 hours average, followed by unpleasant rebound symptoms.
However, there are antidotes to stimulant’s Crash, nowadays.
Let’s look at one symptom at the time, starting with the benefits.
Methylphenidate extended-release is the med of choice for ADHD and Narcolepsy, these days. Although adherence levels start diminishing after 8 hours, it stays in the system for up to 10/12 hours, this day and age’ average work-schedule.
At least, the most intense workday-time, 8 hours, is covered.
What used to be called ‘overtime’, is now called ‘wrap up’, hopefully requiring less energy.
So far so good.
Now, on to the side-effects.
All ADHD sufferers know all too well what the Crash is: Depression, Exhaustion, Anxiety… but they also know how to counterfeit it.
Recognizing the onset is crucial.
When we are highly motivated, it is easy to forget that the stimulant is wearing off after 8 hours. We continue to ‘wrap up’ until the Crash has subconsciously begun.
I promised to talk in first person, nevertheless.
My adherence is about Timing.
I don’t wait for 8 hours to take action. I prepare my body at plasma-peak, within 3/4 hours, by taking Anticholinergics at intervals of 3 hours. I m an EMT, the dreaded last minute-call is always round the corner…
Anticholinergics are neuromodulators and not drowsy.
I do feel tired at the end of the day, though I kill the Crash.
As of today, I identify 80% ADHD.
My Autism symptoms are hardly detectable as far as ADHD medication doesn’t wear off. Not a problem during workdays, I have early nights.
However, I skip methylphenidate on days off and I can do quite well for the first 3 days med-free, I work shifts as a First Responder. I happen to be on call 24/7 for weeks in a row relying on naps in between calls, hence making up for it with 4/5 days off thereafter. On a side note, never pursue a career as First Responder if you are a 9 to 5 regular, better warned than sorry.
Forgive the diversion, humour is important in my line of work, actually all lines! No sense of humour=low serotonin=depression.
In fact, I believe humour is my lifesaver, it keeps me away from pills, temporarily.
I wish I could laugh no-stop for 5 days.
Nonetheless, I have gone weeks med-free during holidays at the sea experiencing Peace.
Consider I have been on methylphenidate for ten years, therefore I speculate that Stimulants build up in the long term.
I also learned that taken in a single dose, they maximize adherence: I take two 36mg capsules at 6 in the morning which work great for at least 8 hours.
On the contrary, I don’t get any benefit in two doses.
Could be tolerance?
What I learned so far, is that the initial response is stronger with the body at rest, while metabolized almost immediately under stress.
My take is that keeping Cortisol at bay makes the difference.
I would like to hear from fellow ADHD patients.
And may God’s love be with you ⚡
My name is John Testore and I m a British-Italian man married to a Japanese lady in Japan. I m a former Medical student. I was diagnosed with Autism and ADHD in Med-school causing me to drop after my third year and join the Ambulance Service as paramedic.
