Advice from the Trenches: Over Dosed

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 the 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 doctor 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 wellness 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 lifestyle 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 misleading or tricky. Fatigue can look like ADD, or recreational drugs and self sabotaging behavior such as not studying for exams can look like ADD, along with a myriad of other symptoms. But taking psychiatric medications doesn’t solve the problem, and over time, it can make things much worse.

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

C says: 

I agree wholeheartedly with Dr. B’s comments about Adderall, but his final recommendation begs the question: do you know how hard it is for anyone to find a job they love?

ACDC, before you decide to follow your heart and toss your meds, 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 you may need? Could you live a life of deprivation in order to do something you love? 

Most of us stick with jobs we aren’t ultimately fulfilled by because the security it gives us is essential to sustainability. It relieves the stress of having a place to live, it provides income to support a family, and coverage for medical bills. The job is not everyone’s whole life; the pluses equal the minuses.

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

Right now, many people are questioning their work choices because the whole world is in flux. It is during such times that change is in motion. The ruts we were in have been pulled out from under us by a global pandemic. New possibilities abound.

But beware: people are also vulnerable during flux. Scams search for floundering souls. Your whole way of thinking was swayed by one podcast. Doesn’t that tell you something?

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? No. Just no.

– Cathren Housley 

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