Productivity Issues

Tags

bipolar, hypomania, productivity, work

I feel terribly guilty if I’m not somehow being productive. Most of the time, I’m beyond driven to just get things done. It doesn’t even matter what things. I just have to feel like I’m doing something useful. It’s satisfying.

But my “issues” often get in the way of working productively. Either I’m too distracted, miserable, or hyper to get much done. At other times, I’m whipping out 7 things at a time, with highly variable success (but mostly pretty good). It’s a little bewildering. Jorge Cham, author of Piled Higher & Deeper, totally gets this state of mind:

I <3 PhD Comics! “Wishful Thinking” – originally published 5/18/2012

This rings very true for me. Of course, I did manage to get through the PhD in a mere five years. Despite knowing that it’s utterly unrealistic, I still feel inadequate when I can’t keep up hypomanic productivity all the time. I get constant pressure from peers who only see the high productivity, and have never seen the months and months where the only thing I accomplished was endless worrying.

But I set the bar pretty high, didn’t I? No wonder I’m always disappointed in myself!

Distracted, Distressed, Disabled

Tags

Adderall, ADHD, adult ADD, Concerta, dx, meds, symptoms

This is a long-overdue post on what it’s like to have adult ADHD/ADD. I was presumed “precocious” as a child, so my smartypants ADHD behaviors really went unnoticed. When I got to the adult grind of office work, I started having panic attacks, in part because I was massively overstimulated and unable to function appropriately (I still work best home alone.)

Is this my brain on stimulants, or is it an anemone that’s been manipulated beyond recognition with Photoshop?

I was diagnosed with adult ADD at age 23 or thereabouts. I started off with Concerta and it was a huge improvement. About 10 years later, as a PhD student, I switched from Concerta to Adderall (and then to Adderall XR.) Where I saw a 100% improvement in symptoms with Concerta (methylphenidate), I had a 1000% improvement on Adderall (dextroamphetamine-amphetamine salts), and even slightly better on the extended release formulation.

Yes, everyone has attention deficits, and ADHD is way overdiagnosed. It’s taken quite some time to figure out how to best express what the difference is, but the bottom line is this:
not everyone has attention deficits that are disabling.

By disabling, I mean that ADD can make it impossible to function at a normal level due to executive dysfunction in addition to problems with inattention, hyperactivity, and impulsivity. It permeates every part of my life, making everyday activities more difficult, and can cause great personal distress. That’s how I interpret “disruptive and inappropriate for developmental level” in the DSM definition of ADHD, slightly modified below to show only the symptoms that I exhibit. All symptoms must have been present for at least 6 months, but adults going for diagnosis need to present evidence from childhood as well.

Six or more of the following (9) symptoms of inattention:

Inattention (7)

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks.
3. Often has trouble organizing activities.
4. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time.
5. Often loses things needed for tasks and activities.
6. Is often easily distracted.
7. Is often forgetful in daily activities.

Six or more of the following (9) symptoms of hyperactivity-impulsivity:

Hyperactivity (6)

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Is often “on the go” or often acts as if “driven by a motor”.
4. Often talks excessively.

Impulsivity (3)

1. Often has trouble waiting one’s turn.
2. Often interrupts or intrudes on others (e.g., butts into conversations).

In addition to the symptoms…

1. Some symptoms that cause impairment were present before age 7 years.
2. Some impairment from the symptoms is present in two or more settings (e.g. at work and at home).
3. There must be clear evidence of significant impairment in social, school, or work functioning.
4. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

I have the majority of symptoms from all categories and the severity is basically disabling for me. A more specific diagnosis would be ADHD, Combined Type. In addition to several diagnostic interviews (which all yielded positive dx’s), I’ve also taken the CPT II computer-based test. The results further substantiated the claim that my brain is simply screwed up in the departments that control attention, impulsivity, and (to a much lesser degree) hyperactivity. To make it all the more interesting, some of my bipolar symptoms overlap with the ADD symptoms, which made bipolar harder to detect for a long time.

To the symptoms above, I’d add inconsistent academic performance, low self-confidence and self-image, generalized anxiety due to cognitive deficits, executive dysfunction problems, underemployment, memory issues stemming from inattention, chronic insomnia, “noise” in my head, and delays in learning social norms of behavior. Almost all of these issues faded away almost as soon as I started taking stimulants. The symptoms that overlap with bipolar also improved substantially.

The meds made an enormous and unquestionably positive difference in my life. I only realized how unnecessarily difficult my life had been when I started meds. The drugs don’t just help with attention; there’s really so much more to it due to the pervasive effects of ADD symptoms. Being medicated solves a lot of problems for me and my quality of life is much better as a result.

People who don’t have AD(H)D typically cannot fathom how hard I work just to appear normal, suppress blatantly inappropriate behavior, and do certain everyday tasks that most people take for granted. It takes 5 times as much work for me to do anything when I’m off meds. Throw a bipolar episode on top of that, and I can barely function enough to get by. Fortunately, I’m pretty tenacious. Strategies I use to deal with ADD on a daily basis is the subject of another post, over on A Canvas of the Minds.

Dr. Chickadee Goes on Vacation

Tags

backpacking, bipolar, hypomania, mood chart, moods, Moodscope, vacation

I never take vacations. All my trips are business trips, except for the annual trip to see family. Which is not a vacation.

But the second half of May has been a vacation for me – officially unemployed (for two weeks) and really trying to kick back. Yes, I’m writing a conference paper too, because the deadline is June 1, but I’m doing it slowly and leisurely. Yes, I overhauled my personal website, migrated my IRL blog to a self-hosted WordPress instance, and did a bunch of other minor around-the-house work as well. I also spent two mornings at the local wildlife management area stalking warblers and other birds, and added three life birds to my list (I’m up to 307 species!) This is the kind of stuff I like to do with my “time off” when it’s completely unconstrained.

A “deluxe” privy is a welcome sight during wilderness backpacking. This, however, is one of the grossest outhouses I’ve ever seen.

Today I’m leaving for a backpacking trip. Mr. Chickadee, me, and our dog will take a 6-day 50-mile walk around a lake in the Five Ponds Wilderness of the Adirondacks. I can’t wait! I have been dehydrating food for weeks, and can think of practically nothing else at this point. This is the real vacation part for me; the rest has been just catching up.

But what I’ve been noticing lately is that I’m feeling great. Since the start of May, my mood charts show stable, positive moods in the mid-60′s to high 70′s, which is exceptional for me. This morning (not shown on the graph below) my daily Moodscope score topped out at 80. I have only hit 80 a couple of times in the last year, and was very clearly hypomanic each time. Of course, the start of May was basically when my break began, and coincided with the whole-hearted return of the sun. I’ve been productive, happy, and having a good time. I’m hardly worrying about the many things I could be fretting over.

Feeling fine, or hypomanic?

And yet, it’s not hypomania. I don’t think.

Yes, I did get an overwhelming urge to make a quilt the other day. Which led to sewing together all of the cut pieces of T-shirts that have been sitting around the house since sometime last year. And deciding that it’s not going to be a lap blanket, it’s going to be a queen-sized quilt for our bed, because why do anything small when you can go full size? Plus the purchase of batting, a king-size flat sheet for backing, and an embroidery frame for hand-quilting. I’ve actually made good progress, with the top nearly done except for the borders. But I now realize how much work is left to complete this quilt that I’ve started: borders, batting, hand-quilting, and binding. That’s a lot of work. Oops. Did I mention that I’ve never made a quilt before?

But I still think it’s not hypomania. There are no racing thoughts or brilliant insights and I’m sleeping fine.  I think it’s just the way I relax, inasmuch as I ever relax. I’m just feeling good and working on whatever suits me. I think that’s the way a vacation ought to be.

Still Drinking

Tags

alcohol, bipolar, cannabis, drinking, drugs, interactions

I was completely clean and sober for a little over 3 months. It wasn’t bad at all, but I didn’t stick with it. I basically only drink socially these days. On the very rare occasion that I open a bottle of wine at home for personal consumption, it’s usually just one glass per evening.

Still Drinking! Thanks – a napkin note to protect a fresh cup of coffee from overly attentive staff.

But I do still drink, and social drinking has been in season recently with graduation and various other celebratory events. I also decided that the causes for celebration were such that I could permit myself a bit of cannabis on occasion.

This is how I came to realize that I simply can’t handle intoxicants, either singly or in combination, the way I once did back when I relied upon them to keep me from flipping out (i.e., self-medicating.) My tolerance is now way, way down, especially for cannabis.

I can usually manage just fine even after the equivalent of a bottle of wine, providing it was consumed over an entire evening rather than in a sitting. Until a little pot gets thrown into the mix. Or too much nicotine with pot. Or too much pot. At that point, my brain shuts down. I become one with the couch. I can’t even muster the will to knit. And the next morning, I’m groggy and it’s very hard to get up. I forgot how bad the pot hangover really was!

Not to mention the ill effects of mixing intoxicants on my stomach. Under normal circumstances, I rarely throw up, but in the last month I’ve lost my dinner a few times – twice from mixing alcohol with cannabis. After the second time I told Mr. Chickadee that I’m not to be permitted to mix drinking and pot. It’s clearly a very bad idea. The alcohol impairs my judgment regarding how much pot I can handle, and pretty soon I’ve emptied my stomach quite abruptly. The other time I just lost my cookies after having too much pot, and subsequently required a good hour’s nap before I could even function enough to watch TV.

Now that obviously wasn’t fun nor very smart at all. And yet, I keep drinking. I keep smoking pot. It is just enough pleasure in the moment to outweigh good sense. But I do want to keep a lid on it, so at least now I’m strictly avoiding mixing intoxicants, and I’m smoking only a very small amount of pot at any sitting. Two lungfulls and I’m done. Any more than that and I become nonfunctional. Add in a cigarette or two and the world starts spinning; nausea ensues. These things must be carefully managed.

I don’t attribute all of this to medication interactions, although some degree of interaction is certainly possible. I took all of the same meds while smoking a lot of pot and drinking every day with no noticeable impact from the combination of chemicals. The difference is that after cleaning out my system, it doesn’t take much for me to get wasted. I’m trying to keep things well enough in check to keep it that way.

Weekly Photo Challenge: Hands

Tags

meds, photography, bipolar, medications, vitamins, ADD, ADHD, postaday, hands

This week’s photo challenge is hands. Most of my shots of hands involve holding something, usually wild berries. But this week, instead of picking a photo from my archives, I made a new image.

The focus of this blog is mental health, and I write about my life with bipolar disorder and ADD. For me, as for many others with mental illnesses, taking my mental health into my own hands means taking a handful of medications and supplements.

Swallowing a handful of sanity each day keeps the crazy away.

My morning cocktail currently consists of high doses of fish oil, Vitamin B Complex, Folic acid, Vitamin D-3, and Biotin. The prescriptions include Wellbutrin XL (bupropion), Lamictal (lamotrigine), and Adderall XR (amphetamine salts).

Both bipolar disorder and attention deficit disorder are chronic conditions. To stay stable and prevent cognitive decline, I will have to swallow a handful of pills every day for the rest of my life. If I neglect to take my meds, I just can’t function. I am so easily distracted that I can’t work, my anxiety levels are disabling, and I have wild mood swings that can include severe depression, excessive irritability, explosive anger, and euphoric highs.

Once these pills make their way into my system, I’m a fairly normal human being. I’m a functional, contributing member of society and very good at what I do, just like many other people with mental illnesses. You would never guess that anything is remotely wrong.

DBT Week 4

Tags

DBT, group, distress, doodling, self-soothing, distraction

This week’s DBT continued with the distress tolerance module. We started off by reviewing last week’s homework, which was practicing distraction techniques. I mentioned a lousy haircut experience and the group leader pointed out that graduation ceremonies are also sort of distressing, so I had used some distraction skills with that too. Good enough.

DBT doodling: keeping my hands busy is an ADD management strategy to help me avoid speaking out of turn and being disruptive.

Then we moved on to the next skill set: self-soothing. This is using your five senses to make yourself feel better. It’s framed as taking care of yourself, but my first question was, “where is the line between self-soothing and self indulgence?” The answer is that most of us know it when we see it. It’s when that short break turns into a full afternoon of getting nothing done and suddenly you’re more distressed than when you started because you got nothing done. I can certainly identify with that situation, and in fact, that’s one of the reasons I generally don’t use these skills. I have a hard time walking that line. I do pretty much everything to an extreme. That’s one of the reasons I’m in therapy, after all.

So we discussed things that we like seeing, hearing, smelling, tasting, and touching. Easy enough. Actually practicing using those skills when they are needed is something else entirely. It’s hard for me to take a break and do something to make myself feel better without feeling guilty about it instead. It’s hard for me to take a break and do something other than work without getting carried away with it. I have to work so hard to keep myself on track that deliberately distracting myself seems like the most absurd notion ever.

After that, we went over skills for improving the moment; the acronym “IMPROVE” stands for imagery, meaning, prayer, relaxation, one thing in the moment, vacation, and encouragement. Most of these I find hokey or flat-out stupid. I crossed prayer off my handout because that simply isn’t part of my life (and I don’t want to hear any judging about that, thankyouverymuch.) Going to a “happy place” with positive imagery isn’t something I’ve ever been keen on (delusions, anyone?) and finding meaning in shitty situations is really kinda horrible. Relaxation and doing one thing in the moment are good techniques, not that I’m good at doing them. Vacation is another one that never occurs to me; time is a-wasting if I’m not working. And encouragement, well, don’t get me started. I understand that affirmations actually do work, but I freaking hate them.

I figure that anything that I resist so immediately and so strongly is probably something I actually need to work on. I’ll try to cooperate as best I can. It’s just really hard to have these super-basic and semi-obvious things presented as skills, find that I violently dislike them, and realize that I’m probably reacting this way because I don’t actually have these skills.