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Question: I am 25 years old and have extreme difficulty concentrating and organizing my thoughts. I procrastinate and have anxiety and severe restless leg syndrome at night. In addition, at night it is difficult to get my mind to stop wandering and go to sleep at bedtime. I am currently studying law. With this condition it is very hard to focus on material that requires dedicated study. When I was younger I was diagnosed with ADD and was treated with Ritalin. I took this all the way through high school, but I stopped after graduation. I think I may now have adult ADD.
I was concerned about the anxiety and told my doctor about it, and he prescribed Lexapro, which helped marginally with the anxiety but did not help the concentration problems. A friend with ADD gave me a capsule of his Ritalin. I took it at 5:00 pm, and it seemed to calm me down. It even alleviated the restless leg syndrome, which my wife was pleased about. If I inform my physician about this do you think he will agree that it is adult ADD. I am becoming increasingly concerned because of the effects it is having on my studies
Dr. Schwartz's response: It is not a good idea to take medication without a doctor's supervision, but I can understand someone with your symptoms wanting to see whether a stimulant could help. A fair number of new patients I see have have tried stimulants of their friends (or children) and had a good response to it. (Those who had a bad effect probably don't call an ADD clinician even though in some cases they may actually have ADD but just took the wrong dose or the wrong medication.)
It is hard to be sure of what to make of your response to Ritalin. Some people have a good response to stimulants initially because of the placebo effect. But most who respond well to the medication with their first dose continue to do so. The fact that you were diagnosed with ADD and had responded well to Ritalin when you were younger makes it more likely your response was not just a placebo response.
Whether you should tell your physician or not about your recent experience with Ritalin depends on your judgment about the physician. Many doctors would view your experience with Ritalin as suggestive that you have ADD, but some might be critical of what you did. I don't know how your doctor will respond.
To help your doctor evaluate your ADD, you might want to print out the questionnaire on my web site, complete it, and bring it with you to your appointment with him. It might also help if you brought your wife along, and she reported her impressions of your symptoms and how they affect your life and functioning. As you may know, ADD does persist into adult life in over half the people who had it during childhood.
With regard to your anxiety: while the stimulants do not have usually a direct anti-anxiety effect (and can sometimes make people jittery), it is not uncommon for people with ADD to feel anxious about their memory and general level or mental functioning. These people often find that once the medication works and their mind begins working well, their anxiety disappears.