More thoughts on ADHD medication, specifically amphetamine, after a year.

Like lots of people, I started them and BANG! Neo waking in his pod in The Matrix. Life changing. The scales fell from my eyes. I suddenly understood. It all made sense. The stuff I found so incredibly difficult for half a century and other people could just ... do it?

I wept.

"Don't chase the high", they all warn. What does that mean?

About 4-6 weeks later I had an argument with Zoe. I felt some of the old behaviours creeping back in. What? Why is that happening?

Then I started to go to bed late again, and procrastinate, and some of the other stuff. Not all though, I kept the place clean. The piles of clothes never came back. I was still getting relief from sensory issues.

And each new titration dose brought it all back.

Until titration stopped, and I was on my final dose.

And it slipped, slowly, it slipped.

Why did it slip? "Tolerance! You have become tolerant to amphetamine! Take a meds holiday!", they all chant.

I tried. I got as far as 3pm before I couldn't stand the bullshit.

Thing is, the evidence that drugs tolerance to therapeutic doses of amphetamine in ADHD even develops is ... dubious. There's a great video by Russell Barkly on this, here: youtu.be/RbZjL7czIy0?si=6xHaoY…

It's not though. I worked out what has happened, and it's fine.

Unmedicated, undiagnosed ADHD is marked by horrible disregulated emotions (more severe in the combined (me) and hyperactive forms I believe), non existent executive functioning, difficulty focusing, and yada yada.

It is, in a nutshell, "really bloody awful".

If you think you have ADHD but are undiagnosed, you possibly just read that and felt like a fraud, didn't you? "But I don't feel that awful!"

How do you KNOW? You have never known any different.

Because here's the thing. You grow up with this crap and you start to mask it, because you HAVE to.

But masking and coping strategies are profoundly psychologically expensive. They destroy us with burnout run the long run.

So we mask to the point where we can more or less make it through the day, and no more.

And it's a pretty sodding miserable existence (Yes, it really is, yes, for you, person reading this wth "some traits". Lots of stuff you accept as a normal part of being human simply is not. I know you don't believe me, even if you think you do. I wouldn't have believed me either).

And then we get diagnosed.

And medicated.

It. Goes. Away.

It all goes away.

Annnnnnnnd breathe!

You are suddenly Mr Spock. You are impervious to your emotions. You can just DO STUFF! You CAN clean the house and you DO and you ENJOY IT! What witchcraft is this?

"I'm cured! Why did nobody tell me about this?" (We did. You ignored us)

You also aren't cured. You still have ADHD.

Your emotions are still there.

You still have executive dysfunction,.

You still struggle to focus.

All of it. It didn't go away.

You just can't hear it.

Why? Because ... well, you are outside and it's stupid sodding bright, and loud. Insanely loud.

And you've been out there for hours.

Then you come into a dim room which is quiet. You can't see anything, you can't hear anything. It's all there though, just below your level of sensitivity.

A few month later when stuff starts coming back and you conclude the meds are failing? They aren't. Your eyes are adjusting to the dark.

Here's another metaphor: A shelled of water has been dumped on a landscape, continually, over thousands of years. It carves out a basin. It finds its level. Water always finds its level.

Move it to the side and it will flow back into the basin it carved. And so it is with us. We start meds and the level of effort we have always applied to make it through the day, which was borderline killing us, suddenly makes it STUPIDLY EASY.

Borderline killing us. Still is.

So you start to dismantle your big expensive coping strategies, because they were hurting you.

You dismantle them until ... well, you start to approach the level of functionality, or rather disfunctionality that you are used to. And then you stop.

Because water finds its level.

You conclude they aren't working, so you take a meds break and OH MY GOD IT'S HORRIBLE.

What the hell is going on? You turned the bloody difficulty knob up to max again. That's what the hell is going on.

After a week you start meds again, and they magically work! IT WAS TOLERANCE ALL ALONG!

No it wasn't, you muppet. You just started to match your effort to the difficulty level again.

You can get trapped in this cycle.

Or you can realise that you deserve a rest, you've had a rest, and that's nice. Now get up and do your goddam laundry, which is a thing you can do, and is still far easier than it ever was.

That is all.

Having one of those “oh god, the meds don’t work any more. I’m still time blind and distractible and have executive dysfunction. Everything is fucked” drops.

And then I go into my room to get ready for bed past the washing machine that’s running and the dishwasher that has run twice today, been emptied twice, and refilled, under the clean and clutter-free work surface.

The sink does not have a three week old pile of teabags in it.

The bedroom floor when I get there has no clothes on it. My chair has no clothes on it. I know where all my meds are. I have cleaned my teeth twice in the last 24 hours. I take my clothes off and put them away; laundry basket or hung up for reuse.

I stopped doomscrolling to do all that. Consciously. Wilfully.

Also I don’t hate myself. Better even; I like who I am. I’m a good person. And I’m funny, even if my sense of humour is somewhat niche. That just makes it a delicacy.

I haven’t impulse bought stupid shit on Amazon in ages.

And I ate vegetables today. Lots of them.

My total alcohol consumption for 2026 is: 2 units. At no point in the last 12 months have I ever been illegal to drive.

And when someone gets upset, I don’t assume it’s about me.

So yeah. Don’t forget where you came from. Sometimes it’s too easy to do that.

They still work.

OK, gonna preface this by asking you to read to th end before judging.

It's been more than a year now and initially my experience of diagnosis was very much, "I hate this thing and would love it to go away".

And to be fair, I still hate this thing and would love it to go away. But it isn't going to.

However, this did colour my views of the terms "neurodivergent" and "neurodiverse", because while I saw the former as simply descriptive, and largely value neutral: my neurology is an outlier, the latter seemed to normalise what I very definitely experience as pathology and sometimes even want to celebrate it.

And I don't want to celebrate the way my own nervous system torments me constantly, nor do I seek to regard that as "just another equally valid way of being that's no worse than any other", because it is objectively worse.

My nervous system torments me. That's not a good thing.

BUT:

I find my position evolving quite a lot more nuance. One of the things I've been doing for the last year is therapy. I had loads of therapy before but this time I had specific requirements.

I wanted a therapist who was: female, late diagnosed ADHD, LGBT positive, and on stimulant medication.

And there are reasons for all of these, but the ones that may not be immediately obvious are why she needed to be late diagnosed and on stimulants.

It's because I didn't want to have a recurring expense while I talked to someone weekly for an hour a time during which I spent large fractions of that hour having stuff pushed at me that I KNOW DOES NOT WORK, and having to argue the toss.

I needed commonality of reference.

Let me give you an example: mindfulness meditation. I can't. Don't reply to this saying that I just have to practice, or I haven't found my thing. I can't do it. Any form of metacognition while I'm in the unmedicated state results in setting off an ADHD thought chain that starts ruminating on metacognition, which ruminates on rumination on metacognition, which ruminates on ruminates on STACK OVERFLOW! CORE DUMPED!

Or in common parlance, "it gives me a right fucker of a migraine".

That's the unmedicated state (in case it's not clear, stimulant meds aren't like, say, antidepressants where you aim for a constant effect. What you get instead is two modes: medicated and unmedicated, and you will switch from one to the other sometimes as abruptly as under a minute. You can seem to be two different people). I can do mindfulness meditation in the medicated state.

There's just no point that I've discovered to doing that. Useless activity. "Find inner calm!" Um, got it. That's why I am able to count my breaths or some shit. So what?

"Well it's like exercising a muscle, and eventually you'll be able to do it unmedicated"

No I won't, because that MAKES MY SYNAPSES CRASH MY BRAIN, and if it didn't I wouldn't be in the unmedicated state, knobhead.

My therapist asked me, "can you meditate?"

"No"

"Ok, cool. Me neither. Let's do something else"

Easy. "Something else" was reparenting my inner child and it's been crazy effective.

And yesterday I watched this video: youtube.com/watch?v=zL_s6dKitH…

And it helped crystallise something I've been thinking more and more because YouTube has been increasingly pushing pop psychology videos at me and something most of them have in common is this: They present common neurodivergent behaviours as "trauma response", and never once mention neurodivergence.

And yeah, that's exactly why I'm starting to feel that "neurodiversity" is something that I can identify with. Yes, my neurology results in things that are objectively pathological and they never won't be.

But the fact that I'm playing with a Whacky Tracks fidget stim whilst typing this is not one of them. That's harmless, and it doesn't mean "I'm stressed", or that "mummy didn't love me". It just means that I enjoy having something in my hand to fiddle with.

The Fediverse to Bluesky crossposter is gonna have a field day with this one. I wish it the best of luck. If you want to see it unadulterated, try here: thegoatery.dyndns.org/profile/…

ASRS is a screening test for adults to see if it's worth pursuing an ADHD diagnosis. It is 18 questions, written by neurotypical people who assume their external observations of ADHD are accurate representations of what it's like to have it, so needs to be translated into "actual person with ADHD" before you fill it in.

That's why it includes stupid shit like, "do you feel driven by a motor?" No, I do not. Things driven by a motor spin round and round and I do not spin.

And, "Do you have problems remembering appointments" to which everyone responds, "It's 2026 and I have a fucking SMARTPHONE".

So that being the case, I have often thought one written BY ADHDers, FOR ADHDers would be better.

It would include questions like:
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"Do you think your friends all dislike you and that you annoy them?"
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"Is there a song on repeat in your head? Is it the same 3 bars over and over? It is, isn't it?"
.
"Your partner says, 'we need to talk'. Do you flee to Antarctica? If not, is that because you got distracted by TVTropes when trying to find out how to flee to Antarctica?"
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"Do you do the thing with candles? You know the one. Yes you do, stop playing dumb."
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"'Right, but you need to show your working' - how much homicide do you want to commit when you read this?"
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"How many bottles of ketchup are there in your fridge? Did you have to get up to count?"
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"How many are expired?"
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"By more than a year?"
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"You left the fridge open, didn't you?"
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"Which leg is bouncing and why is it always the same one?"
.
"Do you rehearse conversations in your head before having them?"
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"And then get annoyed when the other person doesn't say their correct lines?"
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"How long have you managed to lie in bed desperate for a pee without getting up to pee and why is it six hours?"
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"Cleaning your teeth twice a day is easy|common|aspirational|not happening|I own a toothbrush?|I own five toothbrushes?|And don't know where any of them are? (delete as applicable)"
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"You notice a scab on an easily accessible body part. How many seconds is its life expectancy?"
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"Where did you get those bruises? The ones on your legs? You don't know, do you?"
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"Rock climbing, knitting, or both?"
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"How long have the clothes in the washing machine been there?"
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"And is Indiana Jones getting excited about the early Mesopotamian sock layer at the bottom of the pile on your chair?"
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"Ikea Skadis. I know, right?"

April 16, 2025. One year ago today. Zoe and I took speed (Elvanse) for the first time.

Less than an hour later - “oh”.

The profundity of that one word; when everything changed. Everything.

Because suddenly you KNOW.

The thing that was there your entire life. The thing that trapped you. Hurt you. Turned you into an alien amongst your own species. The thing you could never understand. Could never know WHY.

Suddenly you know.

All of it.

The force of the revelation was like a supernova.

Fifty one years after they formed, for the first time ever my synapses worked properly.

And they did what they should have done all along.

I’m still processing the grief.

But it’s not just grief. I’m also furious about the revolting way people treat us. The advantage they have over us and neurological power imbalance is immense.

And most of them use that imbalance to use us as convenient receptacles for their own frustration, knowing somehow that we are incapable of fighting back, and apparently revelling in the ease with which we can be made to experience unbearable emotional distress.

One thing that really seems to confuse people is when it just … stops working.

And for the first time in your life you assert boundaries.

Every day now I take four times the amount of amphetamine than was in that starting dose.

And I hope I will for the rest of my life.

Because if I ever stop, I will be what I was again, within days. I will KNOW, all of it, and I will know WHY; and I will know what’s coming, and I will be utterly powerless to stop it.

It’s not something I like to contemplate.

Knowing is a cursed gift.

But it’s still a gift.

Amphetamine not only saved my life; it started it. I woke up for the first time ever a year ago today, at the age of 51.