Advice from the Trenches: Adderall or subtract

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Welcome to Advice From the Trenches, a monthly feature on NRI NOW.

Advice From The Trenches combines the clinical experience of a double boarded psychiatrist, with a slap-in-the-face dose of reality from an artist and writer who has gathered her wisdom from the school of hard-knocks.

Do you having a burning question for the duo? Send your thoughts, ideas and woes to [email protected]. Don’t forget to mention that you’re an NRI NOW reader so we can be sure to publish the answer here!

Dear C and Dr. B.; 

I saw a psychiatrist because my work performance was suffering. I had a lack of focus, poor concentration and my short term memory was shot. He prescribed Adderall. I’ve been on medication for a year and my performance at work is a lot better. 

I never questioned my diagnosis, but recently I heard a podcast on the subject of burn out and when they described the symptoms, I felt like they were talking about me – exhaustion, lack of interest in my job, and declining work output. I have hated my job for years – I dread going back every Monday. My psychiatrist had told me this was from being overwhelmed and distracted by ADD (attention deficit disorder), but I think that burn out is my real problem.

Now I am confused as to what I should do. After a year on Adderall my performance at work is a lot better, but it is still the same meaningless sucky job. I am treated like I’m expendable and I’m overworked and underpaid. I still dread Monday mornings. Was my doctor right to treat me with Adderall? Do I have ADD or not?             

ACDC

Dr. B says:

Symptoms without etiology – the cause or set of causes for a disease or condition – are entirely meaningless. Yet symptoms alone are the criteria upon which psychiatric diagnoses and treatment are based.

Just about everyone these days has the symptoms of ADD, yet these symptoms can also be caused by burnout, anxiety, depression, substance abuse, fatigue, and many other sources. Should every one of these people get Adderall, simply because Adderall initially makes everything seem better? 

The DSM5, which is the psychiatric diagnostic manual, considers only your symptoms. It doesn’t ask “why” or seek to find out what is causing your problem. The DSM5 doesn’t care why you feel like you do, only that you do feel that way. It pays no attention to etiology.

I feel this makes no sense whatsoever, but that’s the system we have. We end up diagnosing everyone with something – in fact if you go see a psychiatrist they can’t get paid for a well visit, insurance doesn’t allow it, so you have to leave with a diagnosis. It all becomes about pushing products that make you feel better immediately. There is no investment in solving problems long term with behavioral and life style change. 

Treating a patient for ADD when they really have burnout is like giving steroids to athletes. They may perform a lot better today, but in the long run their health falls apart. – it just isn’t sustainable. 

Diagnosis can be tricky. Fatigue can look like many things – ADD, recreational drugs, self sabotaging behavior, and a myriad of other symptoms. Psychiatric medications don’t solve the problem, they treat symptoms, and over time, that can make things much worse.

Find a job that you love, and if you still have a focus issue, you might have ADD. But that would be a different story than the one you have told here.  

C says: 

I agree wholeheartedly with Dr. B’s comments about Adderall; but a job that you love isn’t something you can just walk out and get. It’s pretty damn hard for anyone to find a job that they love.

So before you decide to follow your heart, ask yourself this: are you prepared to accept the fact that it is entirely possible to throw away a sure thing, look for a job you love, yet never find it? And that even if you truly desire a job, you may not be qualified for it? Are you ready to get the additional training or education may need? Would you be willing to wait years for your dream to come true? If not, then don’t jump without looking.

Most people stick with jobs they aren’t ultimately fulfilled by because the security it gives them is essential for sustainability in real life. It means having a place to live, income to support a family, and coverage for medical bills. The job is not their whole life and the pluses equal the minuses. There is absolutely nothing wrong with that.

But there’s a big difference between being vaguely unfulfilled at work and wanting to kill yourself at the thought of going in.

If you want to change your life, more power to you. But understand who you are and what is really important to you before you make your move. Life is not a Nike ad. There are some things you can’t just DO.

But as to the Adderall? Just no.

– Cathren Housley 

You can visit Dr. B’s blog at drbrilliantcliche.wordpress.com.

As originally published in Motif Magazine.

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