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When your psychiatrist and therapist disagree

My psychiatrist prescribes me medication for ADHD, and my therapist doesn’t believe in it. Confusing? Yes, but also no.


My name is Sonia and I have struggled with distractability, fatigue, and memory problems for as long as I can remember. Inside my head can feel a bit like owning a car with broken windshield wipers. Even when I really want to drive, depending on the weather that day, I can have a hard time seeing the road.


Photo by Symeon Gouriou

So, when I was diagnosed with ADHD last year at age 27, at first I felt relieved. It felt good to have an explanation for something that I had always assumed was a personal failing. More recently, though, researching ADHD started to do more harm than good for me. Reading I had done, such as on social energy limits, made me over-aware in social and work situations. I felt like I was reducing myself to a diagnosis, rather than using it as a reference for well-being.


In Berlin, Germany where I live, I now see both a psychiatrist, who prescribes me stimulant medication for ADHD, and a therapist, who does not believe in medication for ADHD, but rather that my symptoms come from a faulty coping mechanism that can be unlearned over time.


Navigating two differing medical opinions may be overly confusing for some, but I find that for me, it has provided a balance of ideology that feels appropriate for the moment. Although I don’t feel quite ready to give up on medication yet—there are still times when I feel a jumpstart is

necessary for me to have the day I need to have—I also believe that there is nothing fundamentally wrong with me, and that with time and healing, there may be a point in the future where I’ll be able to comfortably live medication-free.


What the research says

I am just one of many women in recent years who has received an ADHD diagnosis as an adult. Between 2020 to 2022, the percentage of women newly diagnosed between 23-29 and 30-49 nearly doubled. One reason, experts say, is there has been a deepened medical understanding of symptoms and how they may differ between genders. In men and boys, ADHD often presents as externalised symptoms such as hyperactivity, disruptive behaviour and physical aggression, whereas in women and girls, the signs may be more subtly exhibited in symptoms such as inattention, feeling overwhelmed, and emotional dysregulation.



As a result, many women later diagnosed with ADHD report masking symptoms until, once seeking help, receiving diagnoses of conditions like depression and anxiety. While they may feel symptoms synonymous with these conditions, they may in fact be factors of living with unaddressed ADHD symptoms, such as feeling depressed about not meeting set goals.


While current research suggests that ADHD is caused by the dysfunctional conduct of neurotransmitters, including dopamine, the “feel-good” hormone, the root origin of this deficiency is not fully known. While many studies point towards a significant genetic component, including an observed trend of ADHD running in families, environmental factors such as adverse prenatal conditions and psychological trauma have also been shown to be viable causes.


What happened to me

Up until middle school, I did not struggle with my grades, but I did struggle with feeling like I was the odd one out, socially. Once I switched schools in 7th grade, to a rigorous exam school, these feelings suddenly switched. I had friends that I felt accepted me for who I was, but I began to struggle with my grades. From what I can tell now, this was because of two things: school got harder (more obviously), and (less obviously) my time- and memory-related tasks increased. It was suddenly solely my responsibility to get to class on time, remember assignments, and study on my own schedule, which eventually became unmanageable. Although my parents did what they could to help me, I began missing school on a regular basis, and barely graduated my senior year due to accumulated absences.


During my undergraduate and master’s programs I performed better than I expected, mainly because I had created compensatory strategies in high school that helped me hustle to the finish line (such as letting the adrenaline rush help me stay up late into the night before a deadline). But life has changed since then. When I started trying to juggle a new freelancing career, writing fiction, and learning two languages, I kept finding myself on the couch watching Gilmore Girls

on repeat instead of working. Why? Because I was not facing an external threat, which used to be my main driver.


It was only when I saw a TikTok (I’ve since deleted the app) about ADHD that I considered getting a medical opinion. I found a psychiatrist in Berlin who diagnosed me, but only tentatively, after I reported that my grades were not an issue as a young child. I then started seeing my current psychiatrist, who prescribed me medication, and my current therapist, who also has recently introduced deep-tissue massage into her practice.


The presence and clarity I feel one-hour post-massage is deeper than anything that I have ever experienced on my medication. But not every day can start with a massage, and I am not at the point yet at which I can get to this feeling on my own. So, for now, here’s what works for me in moments when the windshield is foggy.


 

What helps when the windshield is foggy

  • This is one I am not so good at yet, but I am working on doing it first and foremost. That is, asking myself: “What inside me feels stuck?” to check in with my body. I try to focus on those physical parts (for me, it’s usually chest and shoulders), and take deep breaths to give the feeling space, allowing myself to move on from it.

  • I also use FreeCBT, a psychotherapy app which allows you to write down your thoughts, check for cognitive distortions, and write an alternative thought in its place.

  • If I’m struggling to start a task, I will sometimes use a “mousetrap” action, which gets me from zero to a point of starting. For example, if I’m dreading writing an email, I will, with as little thinking as humanly possible, quickly address the email and write the subject line.

  • I recently started using an online planner. I find it especially helpful for organizing my day, breaking down big projects, and goal setting. (I use Evernote which annoyingly requires a monthly subscription, but I find the customisable features are worth it for me. Trello has a free version).

  • I try to integrate “anchor points,” or times when my routine involves another person, into traditionally more challenging parts of my day. For example, I struggle to wake up in the mornings, so I recently joined an online writing group that starts at 9am.

  • I also try to regularly exercise, whether that is at-home yoga, a 20-minute run, or going bouldering with friends.

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