The Myth of Milligrams

The mental health system in Australia promises structure and consistency, yet for many people struggling with ADHD, it delivers something akin to uncontrolled chance.

As more individuals are diagnosed with ADHD and related spectrum disorders, I worry for them. As a neuro divergent community, we deal with stigma and shame from all corners of the societal pressure cooker. We're biologically prone to addiction, self-destructive behavior, and securing sessions with the right psychiatrist is a maddening journey - yet it should be simple and practical.

I can only speak in detail about my lived experience as a "patient" in my home country. Attending expensive psychiatric appointments year after year was fraught with misinformation, confusion, and a textbook one-size-fits-all mantra from countless "healthcare professionals."

I imagine the same problems outlined in this reflective piece are mirrored globally.

Firstly, the wording in the ADHD acronym is misleading. Attention Deficit Hyperactivity Disorder does not match my set of symptoms, even though I am accurately diagnosed as having ADHD.

I don’t experience classic hyperactivity. My attention difficulties are less about a lack of focus and more about the nuanced challenge of regulating it, something that may surprise anyone familiar with my maximal, outlandish poetry and fiction.

Or not, LOL! 🤪

On a serious note, my symptoms are best explained by dysregulation of the norepinephrine network; it's a key neurotransmitter in the brain AND body. It orchestrates alertness, wakefulness, energy, limbic drive, thermoregulation, blood pressure, and heart rate. Norepinephrine is loosely linked to dopamine and serotonin, its famous neurochemical cousins.

They've snared much of the mental health spotlight, even though seldom-touted norepinephrine is vital for wellness.

Serotonin is a key messenger for mood, happiness, contentment, sleep regulation, and a multitude of warm and fuzzy feelings. Dopamine is akin to a bulldozer in the brain - supercharging focus, reward signaling, attention, memory, and learning.

In my early 20s, anxiety and panic attacks were my first clues that something was awry. It didn't feel like classic fear; I had no phobias in the traditional sense. Anxiety dogged me on a physiological level, and running my head under cold water from the kitchen tap or drinking anything caffeinated would alleviate my symptoms.

Let's go over this again. Drinking a stimulating beverage calmed me down?! Paradoxical, perhaps. Not uncommon for my as-yet undiagnosed ADHD phenotype.

Antidepressants, or Selective Serotonin Reuptake Inhibitors (SSRIs), didn't help. Anti-anxiety medications plugged a proverbial hole in the problem, yet their band-aid effect wore off. I was running out of options, a carousel of mental health clinicians couldn't offer sustained solutions, and my life was careening to a crippling standstill.

After more than a year (yep, how absurd) on the waiting list for one of Melbourne's most renowned psychiatrists, I walked into his office with little hope, yet he surprised me. After our initial session, he swiftly enunciated this sentence:

"I'm 99% confident that you have adult-onset ADHD."

This came as somewhat of a relief. After I had completed the written checklist and passed with flying, no-doubt-in-his-mind colors, I was trialed on a "first line" short-acting dextroamphetamine medication.

It was a fucking disaster.

For the record, pharmaceutical dextroamphetamine is very different from the mixed levoamphetamine/racemic compounds commonly sold as illicit “speed.” The actual isomer of dextroamphetamine wasn't the issue, more on that later...

The tablets gave me two or three hours of clarity and control over my mind, followed by a horrendous physical and emotional crash. My sleep, diet, and energy levels suffered. I ended up losing eight kilograms and ceased the medication after two months.

I was put on another short-acting stimulant medication, although this one wasn't in the dextroamphetamine class. It was from the methylphenidate "family" of medicines. Nonetheless, I failed to tolerate it.

I'd researched long-acting stimulant medications for ADHD and brought up the possibility of trialing one of those. My psychiatrist's response was as blunt as can be:

"Nope, they won't work. If you can't tolerate short-acting, there's no possibility that any long-acting agent will be clinically sound or safe."

I spent the next few years in dysphoric limbo. Trialing non-stimulant medicines (SPOILER ALERT: the side effects were even worse) and natural therapies. I was already an avid gym junkie and jogged daily. Exercise helped, for a time, but it was never enough for full-blown relief.

I craved professional guidance with panache.

So, I booked a maiden appointment with a new psychiatrist and even scored an early appointment the following week due to one of her existing patients' late cancellation.

I was chuffed! I couldn't shake the feeling that long-acting stimulants might work, and even though the thought of having drug levels in my body for a longer period per day worried me, I was fed up with living a shitty shell of a life.

As soon as I'd cozied into the chair and exchanged pleasantries during our first session, I raised the issue of long-acting stimulant medicines whilst holding my breath. She stated it was "common" for many people to experience negative effects from a multitude of short-acting ADHD treatments.

She had zero hesitation in offering several promising options.

Wait, what? Common? So, my new psychiatrist had a completely different ethos than my previous one?! How could one ADHD expert dismiss the possibility that long-acting stimulants could be curative, outright denying me a chance, whilst another seemed more than happy to prescribe them to me?

Right there and then, I realized the divide between professional acumen, firsthand clinical practice experience, and bias-leaning opinion (they're all human at the end of the day) varied GREATLY among psychiatrists.

How could this be the case? How can vulnerable people with mental health conditions be at the mercy of one clinician's personal opinion? It's a fundamental flaw in the system at best, and at worst?

A tokenistic lottery masquerading as healthcare.

To cut a long story, well, less long, the first long-acting (pun unintended) stimulant worked like a fucking charm. Titrating to the correct dose was a trial-and-error baptism by fire, but I got there. It erased my agoraphobic tendencies, improving my instinctual sense of control over mind and body for the better.

Ironically, my current daily dosage consists of a *higher* amount of dextroamphetamine than any of the short-acting stimulants I failed to tolerate. Why? Because ADHD is a complex condition. Every affected person requires tailored care.

In my case, it was less about the raw number of milligrams, and ALL about the shape of the pharmacokinetic duration curve. Short bursts of dextroamphetamine exposure were akin to up-and-down whiplash for me, whereas longer peaks resulted in sublime nervous system stability. It allowed my brain and body to adjust to a smoother decline in plasma levels once the medication wore off.

This is a classic therapeutic response for someone with suspected norepinephrine-deficient ADHD.

I'm highly aware of internal physiological changes, thus I conducted my own research. I accumulated a cavalcade of clues from medicated peers and mental health forums, and I ultimately stood corrected because I soldiered on and found a new psychiatrist in the hopes that the "right" miracle stimulant might be prescribed.

I got my wish, though not every newly diagnosed ADHD person will seek a second, third, or even fourth opinion.

Many will (and do) take the word of their first psychiatrist for a multitude of reasons; notwithstanding the waiting period to seek out a new health professional is unjustifiably lengthy, coupled with the belief that *every* ADHD specialist is equally committed and competent.

The tragedy is not that ADHD is difficult to treat.

Effective medicines exist, yet access to these life savers often depends on luck, persistence, or the willingness to challenge professional opinion and seek greener pastures. Furthermore, "cleaner" short-acting stimulants don't necessarily equate to better therapeutic outcomes.

I'm living proof.

Long-acting formulations can produce fewer side effects in certain individuals (like me) because they prevent rapid highs and lows yo-yoing across the blood-brain barrier. It took four exhausting years to obtain the correct medication after my initial diagnosis... and I'm no outlier.

My odyssey is, unfortunately, not uncommon. Many friends in my peer support network continue to search for ADHD clinicians who'll respect them and their lengthy plights. Some have turned to illegal substances for recreational solace, and who can fucking blame them?!

The system is irrevocably misaligned, as patient navigation skill matters more than dire need.

(c) Edward Swafford 2026.

Author's Note: My article is in no way a "blueprint" replacement for professional medical advice and/or guidance.

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