Middle aged ADHD diagnosis be like, you’re in this escape room, and the window is small and locked and you’ve been yanking at it for years.

And your friend calls to you: “just turn round and follow me”

But you don’t because yanking on this window is exhausting and you need all your strength for it.

“Turn round. There’s a better way”

“Can’t. Busy”

And so it goes.

Until eventually you’re exhausted and you think, “FINE! I’ll turn round”

And your friend is standing outside the door. Which is open. It’s always been open.

And they’re holding a bottle. It has something like “Elvanse” or maybe “Concerta” written on it.

And they explain they were stuck in an identical room until recently and then they realised the door was open too.

And you walk out and half your social circle is there. They are all holding bottles with “Elvanse” or “Concerta” on them, and one hands you one.

And you take a pill.

And realise you’re in a hallway.

And it was obvious. It was all so very very very obvious the whole time.

But you never saw it.

And then you realise only half your social circle is there, but you can hear the rest of them making exhausted noises.

So you walk along the hall and every few steps there’s an open door and one of your friends is inside yanking hard on a window, just like you were.

“Come and join me!”

“Can’t. Window is stuck”

A weird thing. When I was young and did not choose my own peer group, I was a fish out of water, a closeted queer visibly neurodivergent kid (tic disorders are hard to hide) in a mostly neurotypical setting and it was basically a running joke that I was “unfuckable”. People would use the idea of a relationship with me as the butt of a joke. The absurdity was, apparently, self-evident.

I believed this. Internalised this. Assumed I would die alone.

And over time, I subconsciously chose my social circle. I guess I gravitated towards people who didn’t require so much masking nor cause so much stress via what is now called the Double Empathy Problem.

These days, my interactions with neurotypical people tend to consist of whether I want milk in that, or how much ketchup I’d like.

And meanwhile, it appears a queue has formed because, as I am told, I am “fucking hot” (even in my 50s and middle aged lesbians are the filthiest fuckers alive. We do, as they say, the weird stuff. It’s great!)

That was … unexpected.

The neurotypical response to speed (amphetamine) is still confusing me.

So the base mechanism is the same for everyone: amphetamine (alpha methyl phenethylamine) is a monoamine releasing agent. It displaces the monoamine neurotransmitters dopamine (3, 4 dihydroxy phenethylamine) and noradrenaline (beta hydroxy 3, 4 dihydroxy phenethylamine - these are all really similar molecules) from the synapses, forcing them to circulate. It then acts as a reuptake inhibitor for both, and weakly agonises both.

So suddenly lots of dopamine and noradrenaline available. Right. Simple enough. That's how it treats ADHD, a condition marked by pathologically low circulation of both to the point that certain neural activity that's supposed to happen ... doesn't.

Now noradrenaline controls alertness, and too much in the peripheral nervous system cab cause tachycardia and anxiety. This is why we titrate up. The peripheral nervous system gets tolerant to it but the therapeutic effects in the central nervous system continue.

Dopamine is the interesting one here. It does lots of things, including acing as a neural "damper" (which is why we're hyperactive), but more significantly it controls the human motivation system. If something is worth doing, completion of that something is marked by a release of dopamine. This tends to be muted or doesn't happen in ADHD which is why emptying the dishwasher feels like a five thousand mile deathmarch across broken glass.

But you add amphetamine and circulating dopamine increases, which starts the reward system functioning.

Here's where I get confused. Keep going, and you spam the system with dopamine.

Which means you don't NEED to do anything to get the "reward".

Which is why, when my meds are peaking, I can occasionally just sit there and stare into space, feeling perfectly content. Keep going and I'll fall asleep.

In a neurotypical it will also flood the CNS with dopamine.

So why do they then get wired when they too are getting constantly rewarded for doing literally nothing?

IDGI