The Challenges Associated With Travelling & Being Medicated - The Rebuild Week 14

Why I swapped out Dexamphetamine for Ritalin and how it affected me.

I know what absolutely none of you are thinking… Why is Sam’s blog a couple of days late?

The short answer is that (in some ways) I’ve had a fucked week.

But let me give you some background.

We are flying to Thailand on Monday next week to watch my best mate get married. It’s not your typical destination wedding. These two have been together for 15 years, they have three kids ranging from six years old to 11. They run a business and a household together and have done for a long time. They’re more married than most married couples.

They wanted to have a chilled wedding here on the News South Wales South Coast. Hire a paddock of a farmer somewhere, self-serve buffet-style food and some light entertainment. Essentially a party with a short pause for a quick, informal wedding.

Once they started trying to organise such an event, they soon realised that even when you try to call the wedding a party and play it down as such, all the services required still throw the dreaded “wedding tax” on top of their prices.

After getting past the halfway point of organising the wedding, they were already looking at a bill of over $20,000.

That’s when my mate said fuck this shit, I’m going to take my family to Thailand for a two-week holiday, spend half the amount of money and just get married on some random day while we are there.

Not wanting to be one of the self-important arseholes, he said, “Look, we’re going to go on a holiday to Thailand. While we are there, we’re going to get married. We’re not inviting anybody because we don’t want people to make unnecessary or unfeasible financial sacrifices just to come to our wedding, but for anyone who wants to come, we’ll be getting married at some point in this two-week window.” You might be starting to understand why I like the bloke. 100% practicality, 0% bullshit.

It was at this stage we, too, thought, fuck this shit, and booked flights to Thailand with money we weren’t sure we should be spending. But the last 18 months have been the toughest (and best) of our lives (there’s something in that). We needed a break, so we thought we’d buy the flights and have to find a way to make the rest work, and we did.

Fast forward to a few weeks ago, and I thought I’d better double-check that I’m allowed to take my medication with me. Dexamphetamine is a tightly controlled medication here in Australia, and I knew that in some parts of Asia, they do not fuck around with people importing or exporting controlled or illegal drugs. Shout out, Chappelle Corby.

Luckily I checked because I thought that, at worst, I would need a letter from my psychiatrist stating what I take and why I take it. Turns out dexamphetamine is completely illegal in Thailand. Not controlled, not allowed with a prescription, just flat-out illegal. You cannot have it.

By now, we had booked some nice accommodation, and I had no interest whatsoever in downgrading that accommodation to The Bangkok Hilton. I could do without the whipping and stretched ears.

I started to stress out because I knew what I was like when I didn’t take my dex. Years ago, I stopped taking them over the Christmas holidays to give my brain a break. It was ugly. I got angry, irritable, inconsiderate and depressed.

Because It does a better job than me, I asked ChatGTP to explain why this happens.

Dexamphetamine stimulates the release and blocks the reuptake of dopamine and norepinephrine, two important neurotransmitters in the brain. This results in higher levels of these chemicals in the brain, which can improve focus and attention in people with ADHD.

When a person stops taking dexamphetamine abruptly, the brain may struggle to adjust to the sudden decrease in neurotransmitter levels. The brain has adapted to the heightened presence of these chemicals, and a rapid withdrawal can create an imbalance, leading to what's often referred to as a "crash".

This can result in symptoms that are the opposite of the stimulant effects, including fatigue, irritability, and depression. This depressive "dive" can be particularly severe because dopamine, one of the neurotransmitters affected by dexamphetamine, plays a crucial role in regulating mood.

It's important to avoid stopping any medication, including dexamphetamine, abruptly without consulting a healthcare professional. They can guide you through a safe and gradual tapering process to minimize withdrawal symptoms and potential risks.

I wasn’t advised by any health professional to do this, and although these days my psychiatrist tells me that it should be ok to have a short break, it’s not something I want to risk, especially given how hard I have worked on my sobriety over the last 15 months.

So here I was, pondering what the fuck I was going to do. I’ve been looking forward to this trip for a long time. I feel like I need this break more than ever, but because the country I’m going to has a blanket ban on my medication, I am now at risk of spending my time over there in a depressive crash when I was meant to be relaxing and unwinding after the most challenging and transformative 18 months period of my life. But now I was going to be without my medication, surrounded by loose unit holidaying Aussies, celebrating a wedding and/or the simple fact that they don’t have to go to work tomorrow, most likely with plenty of very cheap alcohol. Each of those things is dangerous enough on its own, but when added together, it could be a recipe for disaster for a bloke with my history.

Thailand is a country that will allow you to use cocaine if you have a prescription for it. A country where ten years ago, being caught with a gram of marijuana could see you locked up for years has completely legalised marijuana. The mind boggles, but the empath in me reminds me that I need to respect this country’s laws even if I don’t understand or agree with them. I’m sure they have their reasons, none of which are my business, and if I want the privilege of holidaying there, I should probably just shut the fuck up and toe the line.

For a moment, I even considered pulling out of the entire trip. Maybe we could get flight credits, miss the wedding and go somewhere else. Even go and see a part of Australia we hadn’t seen before. It seems drastic, but I was genuinely worried about protecting my sobriety. Almost anyone in active recovery will tell you that their number one priority, above all things, is their sobriety. It sounds selfish, but that’s not the case. If we don’t maintain our sobriety, then the people we care about the most aren’t receiving the version of us that they deserve.

I’ve realised on reflection that I’ve never truly enjoyed holidays, largely due to my own limiting beliefs or actions. The uncertainty of being unfamiliar with my surroundings gives me anxiety, and I would drink my way through it to numb that anxiety enough to enjoy myself a little. Going on a holiday can be stressful for someone who relies so heavily on routine and familiar environments. So when you consider what happened last time, I stopped taking my medication, coupled with literally not being allowed to have it over there, I started to panic. It would be another element of my now concrete routine that I would have to do without, and I felt like with each element of that routine taken away from me, the higher my risk of drinking again.

Luckily, I found out that Ritalin, although tightly controlled, is allowed to be taken in Thailand with a prescription and a letter from your psychiatrist. So I rang my Psychiatrist and spoke to him about my options. He gave me a script for Ritalin and some instructions on how to take it. He suggested that I start taking it a week before we were to leave. Start on a weekend and adjust over the week so that by the time I arrive in Thailand, I will have had that time to adjust to it.

Ritalin works differently from dexamphetamine. I’m not a chemist, so I have used my old mate ChatGTP again to help me explain the difference.

Dexamphetamine and Ritalin (methylphenidate) are both stimulant medications used to treat attention deficit hyperactivity disorder (ADHD). Despite their similar uses, they have different chemical structures and slightly different mechanisms of action.

Dexamphetamine, an amphetamine, works by increasing the concentration of dopamine and norepinephrine in the brain's synaptic cleft. It promotes the release of these neurotransmitters from storage sites in nerve endings and inhibits their reuptake. This enhances neurotransmission, resulting in increased alertness, attention, and focus.

Ritalin, on the other hand, mainly acts as a norepinephrine-dopamine reuptake inhibitor. It blocks the transporters that remove dopamine and norepinephrine from the synaptic cleft, leaving more of these neurotransmitters available in the brain. This also leads to increased focus and attention.

The choice between these medications is generally based on individual response and tolerance to side effects. Some people may respond better to one drug over the other. Both medications have the potential for abuse and can lead to dependence, so they should only be used under medical supervision.

I took Ritalin for the first time last Saturday. I was a little concerned that it would affect my sleep the same way dex did when I started it many years ago. So I started with 75% of the recommended dose. To my surprise, it made me tired. Like, really, fucking tired. The upside was that I wouldn’t get insomnia that night. The downside was that it was nowhere near as effective as dex in cognitive function, and I felt some mild anxiety for the first time since I started using CBD oil five weeks ago.

I reached out to a few Facebook support groups to see how other people found the difference between the two medications. Some people said they’d had the exact same experience as me, whereas others said they had experienced the opposite. To me, this speaks to the notion that there is no one fix-all approach to the treatment of ADHD.

I had the longest sleep I had had in a long time that night, The sleep quality left a bit to be desired. However, I was just grateful that on my first day of this new medication, I was able to sleep for that amount of time. The following day was an improvement. I was much less tired, my cognitive function was a little better, and while I was still a little bit anxious, it was less severe than the day before. The following night I slept for the same amount of time (8h45m), but this time the quality of sleep was much better. The following day was a slight improvement again. Although I was still more anxious and less alert than I was on dex, I felt things were improving.

I was starting to think that maybe if I can keep on adjusting to the Ritalin, that combined with the improved sleep might end up being a better combination than the old combination of dex and slightly less sleep. Sure, dex was better for my cognitive function, but nothing rivals sleep quality when it comes to overall health benefits. It was a trade-off I was willing to consider.

On Tuesday afternoon, I had to travel for work four hours away from home. The plan was to stay away on Tuesday night, complete a training course for work on Wednesday and travel home on Wednesday afternoon. I got to the motel around 4 pm, ran for an hour, returned to the room, and started to unpack all of my things.

Usually, when I pack for any trip, I sit down and write a list of all the things I need to take and then cross them off as I pack them. That may seem over the top to some, but I know what I’m like. We’re talking about a guy who writes the same shopping list every week, walks the same route through the grocery store crossing things off as he goes, and still manages to forget something. It’s kinda funny but also a pain in the fucking ass.

I don’t know if it was anything to do with the change in medication, but for this trip, I didn’t write my list. I thought I’d packed everything I needed. In fact, I had way more socks and undies than I needed (not a bad thing), but I’d forgotten to pack one slightly important thing. The melatonin that I get is made up on a prescription by the chemist.

Melatonin is a naturally occurring chemical in the brain released in time with circadian rhythms. Around sundown, your brain will release melatonin to tell your body it’s time to start unwinding. Like a lot of neurodiverse people, I’ve struggled to drift off to sleep for my entire life, but I have always tried to avoid sedative medications because they make me feel like dog shit the following day, and I didn’t want to fall into a trap where I then overuse stimulants the following day to lift me out of the funk from the sedative, then rely on the sedative again that night because I had overused the stimulant earlier in the day. So when my doctor prescribed me compounding melatonin and explained that it was a naturally produced chemical in our brain, I was happy to try it.

I’ve been using melatonin for a couple of years now, maybe more. Although I have been able to reduce the amounts of medication I use since I have been sober, it has helped me find a nice balance where I am able to perform well during the day and get better sleep than ever before.

On Tuesday night, I was very tired. When I FaceTimed my family, my partner mentioned how tired I looked and told me I should go to sleep because I couldn’t stop yawning. She was right. I was fucked and keen for a night where I didn’t have to share a bed with a wriggly 11-month-old boy, but in the back of my mind, I was worried about how I would go without my melatonin.

As I lay down to sleep, I knew I was tired, but it was almost as though the moment I closed my eye, my mind woke up. A feeling that is all too familiar to me. I struggled with this a lot as a child. It also reminded me of when, back in January, I thought I had a repeat left on my melatonin script, which was kept at my local chemist. Because it takes a week or so to have the capsules made up and sent to the chemist, I knew I had to get to the chemist a week or so before I ran out.

When I got to the chemist, they told me I had no repeats left. This meant I would have to get an appointment with my GP, usually booked for two weeks. Then I would have to wait another week for the capsules to be made up. So I was looking at two weeks between running out of my medication and getting more. A week or so later, I ran out. I had spent my first sober Christmas Holidays focusing on my health and fitness in an effort to protect my sobriety. So I felt I was in a good place to try maybe to stop taking the melatonin.

I barely slept for the first couple of nights without melatonin, so after a couple of shitty sleep, I went down to the chemist and asked for some doxylamine, better known as restavit. It’s a dirty, chemical-based sleeping medication that makes me feel like shit the next day. But when desperate, you can get it from the chemist over the counter. My chemist knew I was waiting on my melatonin, so they were happy to give it to me. On other occasions, I have just said that I have been on the night shift and struggling to sleep, and they usually hand it over.

I used restavit for the next 14 days. I hated it, but I’d rather feel a bit shitty in the morning than struggle to sleep. What I didn’t know is that after ten days of taking restavit, you build a dependency on it. So when I finally got my melatonin again 14 days later, the damage had been done. The first night I didn’t take restart, I took melatonin, heaps of it, and still didn’t sleep a wink. This little mishap resulted in probably four to six weeks of shitty sleep, and my mental and physical health deteriorated accordingly.

So yeah, laying in the motel bed, feeling absolutely fucked yet wide awake at the same time, I started to panic a little. It’s an all too familiar cycle where worrying about not sleeping makes it harder to sleep. Then you lie to yourself and say, “Well fuck it, I’ll just not sleep, and I’ll be ok”, or “fuck this training course tomorrow. I’m not going to set an alarm, and I’ll sleep when I sleep. If I don’t do the training, so be it.” I even tried my favourite childhood trick, where I would put on some warm clothes. Trackies and a jumper, and grab an extra blanket. Something to provide me with that slight feeling of physical comfort. Nothing worked.

After trying unsuccessfully to sleep for a couple of hours, I contemplated driving home seriously. If I wasn’t going to be able to sleep, there was no point sitting in on this training tomorrow. And if I weren’t going to sleep, I’d be better off driving now, not tomorrow when I’m even more tired. I thought better of it and kept trying to sleep. I tried breathwork, reading some stuff on my phone, speaking to my partner on the phone for an hour, and watching some TV, but nothing worked. So at 1 am, after 5 hours of trying, I got the shits, packed my car and drove through the night to get home at 5 am.

Look, maybe this was a bad idea. Maybe it was unsafe. But in that state, I found a way to justify it to myself. I got home, took my melatonin, played with my son, and I was asleep within half an hour and didn’t feel like I moved for the next six hours.

Even though I slept until 11 am that day, the following night, I fell straight back into my routine of falling asleep around 8 pm and waking up around 4 am, which, in my opinion, speaks to the amount of work I have put into my sleep hygiene over the last 12 months.

I believe all of our well-being starts and finishes with sleep hygiene, and after the week's rollercoaster, I decided to go back to my normal combination of medication for the last couple of days. After the week that has been, I just needed that comfort of feeling like myself again before going out and trying something new again. Kind of like a reset back to normal.

So far, it’s working really well. I didn’t need to be at work super early this morning, so I decided to stay up and watch a little bit of The Ashes Cricket, only to be woken up at 1:30 am by a screaming, sick 11-month-old. I struggled to get back to sleep, so I decided to go out to the lounge room and look after him so my partner could have a much-deserved rest. I thought he would settle within an hour or so… he didn’t. When he finally settled at 4 am, I thought I might as well come to work and write this shit. Luckily I’m going on leave today and get a long-haul flight and a different timezone to finger me right in the sleep routine.

I’m not blaming the Ritalin for my forgetting to pack my melatonin. Yes, I did feel less sharp on Ritalin. I haven’t forgotten to pack something that important for as long as I can remember. I haven’t even been too lazy to write myself a checklist when packing in a very long time. But I still knew that I was likely to forget something if I didn’t follow my process, and I needed to be accountable for that.

I guess the point of all of this is that if you have or are currently experiencing similar, try not to stress about it. I’ve been actively trying to repair my sleep hygiene for nearly 12 months now. And although I have come a long way, shit happens to all of us.

I was on a 27-day exercise streak and tracked my food for over 20 days. I haven’t exercised in the last two days now, nor have I stacked my calorie intake. I didn’t have the energy. This is fine, of course. I don’t need to do these things every day. But this is an example of the potential knock-on effect of not prioritising your well-being, something that gives me the energy to continue looking after myself. I didn’t prioritise writing my list, which means I forgot my medication, which has resulted in all of the above.

I know that when we are in this headspace, struggling to sleep, it can seem like your world is caving in and nothing will ever be ok again but try to remember that everything will be just fine. There are help and solutions out there. Try not to panic, and seek some help if you need it. There’s no shame in admitting you might’ve made a mistake and need help to fix it. That’s how we learn.

As I sit here now, I have half a day left of work, and then I’m on annual leave for a fortnight. Going to another country where I can’t be hassled by work. I won’t have the daily stresses of maintaining a household and doing chores. The world isn’t ending like I started to believe it was only a few nights ago. Everything is, was always going to be, and always will be ok.

If I feel the need to write blogs for myself while I’m away, I will. If not, look after yourselves, and I’ll catch ya’s in a fortnight.

Cheers Wankers.

X.

---

Click here to check my other blogs. Follow me on Instagram and Twitter @sbrngthghts.

Make sure you check out my Writing 4 Resilience friends. They’re all legends.

Running for Resilience Ben Alexander Brent Ford Running Rare The Milkbar Reflections of a Clare Bear

If anyone is struggling in any way, make someone aware of it. Speak to a friend, family, loved one, stranger, postman, uber eats driver, or me; talk to someone.

Lifeline Ph: 13 11 14

Alcoholics Anonymous Ph: 1300 222 222

NSW Mental Health Line Ph: 1800 011 511

Suicide Call Back Service Ph: 1300 659 467

Mensline Australia Ph: 1300 78 99 78

Kids Helpline Ph: 1800 55 1800