Adult ADHD Treatment and Memory Problems

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Reader’s Question

I am a 41-year-old male and was diagnosed approximately a year ago with adult ADHD and was prescribed Vyvanse (40 mg). The Vyvanse has helped tremendously with my memory, concentration and focus, but I still get anxious about things and am never able to fully relax. I also have a low libido and only feel sexual when I am completely at ease, so my sex life with my wife of 15 years is non-existent. I am very non-confrontational with my wife but have always had a reputation for being mean towards women even when I thought I was not, which may be attributed to growing up with a very domineering mother. When I was/am not on the Vyvanse I am very prone to getting defensive, with explosive anger, and I can be very verbally abusive (although never physically). My marriage is on the brink of divorce, and I do not want to lose it and need to find help in sorting out my issues. I am not averse to taking medication if there is one that will not interfere with the Vyvanse or hurt (hopefully help) my sex drive. Also, I am not good at “talking” in therapy as I have very poor recall. I need a therapist who can probe into my psyche and root out the answers that I cannot recall when sitting in a session. What kind of therapist should I be looking for who will be able to do this?

Psychologist’s Reply

This a very layered question. What appears to be happening is the current prescription is containing its target symptoms, allowing underlying symptoms and issues to surface. Some of those issues seem to be ego-syntonic — that is, they make sense to you (such as being mean) — where other behaviors cause you some distress. Finally, you are able to trace some of the problem to your relationship with you mother in childhood.

Your psychiatrist can work with you and your primary care doctor to balance your prescription and contain those symptoms that respond to meds. Not all symptoms respond to medication. Those symptoms which do not are the grist for the psychotherapeutic mill.

Because of the memory problems, you do not seem to be a candidate for insight-oriented therapy. That may change if your psychiatrist can fine-tune your prescription. If he can, then finding a therapist is a matter of finding one with whom you feel comfortable and safe, probably one with a psychodynamic orientation. However, if the memory problems persist, then it would be a better use of your time to take a behavioral approach to therapy. That is, do not take the time to analyze the root cause of the problem. Rather, deal with the behavior itself. Train yourself to use alternative responses to things that previously triggered you to be explosively angry and abusive. It is possible that, after mastering behavioral techniques, you could become available to insight-oriented therapy. But I would not consider that option for at least a year.

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If this makes sense to you, then I encourage you to let your wife know that you are taking responsibility for your behavior and your treatment. Ask her to give you a little time to sort this out. Then, get very aggressive about finding a behavioral therapist. Call the psychiatrist and consult with him about these myriad issues. Consult with the primary care doctor and confirm that you have no physical issues that the psychiatrist should consider when writing a prescription. In other words, make your mental health a top priority. It may consume much of your time, especially in the short term. The benefits of doing so, however, could last a lifetime.

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