Medication Anorexia

When your dosage makes you feel fat.

In the spirit of sharing resources I am going to keep this post free also. However, comments and questions will only be open to subscribers. Thank you for your interest and your continued support.

OK, first of all, please keep in mind that this is all purely anecdotal with a sample size of one. As in, me. The me who is not a physician or a clinical scientist.

Politically and spiritually I am into using whatever tools help. And it’s taken a long time to get here. It has also taken a long time for me to trust myself and believe myself when something is working and when it’s not.

I take Vyvanse every morning for my ADHD symptoms and I also take a very low dose of oral Minoxidil (1.25 grams; they give me a 2.5mg pill and I split it) for hair loss because after my dad died I could see the gleaming orb of my entire skull under certain lighting because so much of my hair had fallen out.

I will probably write about this at some point because it wasn’t just about going to a dermo and getting a scrip. I had a massive identity crisis as a Korean woman who’d had a ponytail thicker than her forearm her entire life. I also stayed in denial longer than was necessary because I had this heartbreaking thought underwriting all of it which was that it wasn’t “fair.” It wasn’t fair that my dad died and my hair fell out therefore did I really have to deal with it? Surely, someone would do that labor for me :(

Anyway, Vyvanse. Vyvanse is super expensive. Like, with insurance some people pay $100 for a month’s supply. I paid $50 a month and that felt insane. Without insurance it’s $340-$650.

…This is where I take a beat to Wim Hof breathe the ever-loving shit out of a moment not to fall into a tirade about the medical industrial complex and the fuckshit of late-stage capitalism…

Generic Vyvanse is incredible because for a month’s supply it’s now $10 for me with my insurance (also, fam, we just LOST health insurance with the writer’s guild because of this technicality and I will DEFFO be writing about that soon). But there are shortages of generic Vyvanse all the time as well as name-brand Vyvanse so I stockpile this shit whatever chance I get.

The way I stockpile this shit is that my actual dose was 10mg but there is no 10mg pill so I was getting 20mg pills of name brand Vyvanse and splitting them. Basically opening the gelcap and pouring it into a glass jar with measurements on the side, swirling it with water poured at a measurement that could easily be halved and drinking half of the water.

If you’ve ever made molly water in a Poland Spring bottle and eagle-eyed how many ‘grooves’ on the plastic water bottle your friend had, you’ve already done this before.

But because 20mg of Vyvanse is an unusual dose I now get 30mg pills because the 30s are available via generic much more readily. I halve those and am now on 15mg.

And let me tell you, going from 10mg to 15mg feels like I gained ten pounds. Like, spiritually and emotionally.

Upping my medication makes me feel (forgive me) fat.

OK, sorry, wait, some exposition that many of you know but others may not but I think it’s important for people to have a general sense of who the person is who is talking to them.

Also, content warning: bulimia.

I was diagnosed with ADHD during the pandemic and then Autism a few years after. I also identify as a person with bulimia and disordered eating, as well as a person with body dysmorphia. I also know that I had a childhood that did not necessarily agree with me.*

Everybody has different opinions on self-identifying. Like, I think it is riotously funny (but in a super respectful way) when people, especially European people are like, “But I already had therapy.” And what they mean is, like, for life. Like, they graduated because they’re cured. Not, like, it is Tuesday and for some reason I’m still in this weird part of town.

From the time I was around 11 or 12 I started starving + binging + purging.

Here is a thing I wrote about it a long time ago but below is also an excerpt.

When I was born, I weighed 11 pounds and had a full head of hair. I also bore the tiniest hint of a butt chin, like my dad. My mother’s chin, on the other hand, is smooth and small. Her slight, elegant alleles were no match for my father’s. After all was said and done, her body snapped back to a Size 2 with an alacrity that could testify only to how alien a parasite I’d been. Lugging my enormous swaddled body around with her on buses and trains and to church must’ve looked like a kind of punishment, as though a royal race of fatsos had risen to power and made wet nurses of the bantam class. The primal chemistry that compels one to breastfeed a burden only so it will grow heavier is just one way that babies are scary...

…My preoccupation with food and dissatisfaction with my size has been with me since infancy. One of my earliest memories is despising the number 8 because it resembled a fatty in a too-tight belt. I abhorred Cindydolls—not just because they were off-brand (like the Gobots to Barbie’s Transformers) but because Cindy’s face was comparatively bloated. Carrying a portly little Cabbage Patch doll only drew attention to my own physique, so I gave her away before anyone could make fun of me.

Eventually, I became bulimic because it suited my needs. (I lacked the type-A conviction to be anorexic.) I binged and purged, sometimes while reading eating-disorder books, taking strange satisfaction in the dwindling lists of foods the girls obsessively logged before they were whisked away to hospital. Each suffered the same second-act problems, and the treatment chapters were dull, but I read it all and learned so much.

There is so much literature linking ADHD with binge-eating and bulimia and Autism has her own links to eating disorders. And I chose the above paragraphs because they particularly highlight how much masking raised to the power of “special interest” that can go into the thinking behind it.

I have not purged in over a decade. But I will always be bulimic. I will always have an eating disorder and body dysmorphia. Some may find this pathologizing or defeatist but the framing is helpful for me. It is helpful for me to know that I have a baseline attitude that a lower dose of anything is more pious or in “control.”

It’s a smaller serving of pie. It is the big-ass vein in the lanugo-fuzzed forehead of the girl doing cardio 7 hours a day instead of eating food from three different restaurants and getting all the plastic-wrapped cutlery so that it is credible as many people’s orders and eating it all solo, in one go, and wanting to throw it up.

For me anorexia > bulimia. I am not saying this is healthy or aspirational. But I am probably saying something that one hundred percent of bulimics have thought at least once if not an infinite number of times.

I have romantic, ableist, neurotypical-coded attachments as well as scarcity mentality around getting as much of something as I need. Even when it’s medication.

I am obsessed with numbers for a person who sucks at math and has time blindness. Numbers hold magical qualities. Numbers feel like facts and facts will keep me safe and facts are also a moral issue. There are good numbers and unwieldy grotesque numbers. Anything that you do for yourself is correct and interrogated, anything that I do for myself is tawdry and bloated.

There are moments that I get caught up in how this is sad. It is sad. It’s also the harsh thinking that has gotten me this far. It is the harsh thinking to which I owe my life and every success I have ever had up to a point. Sometimes I grieve all the former versions of myself that have only known this kind of screaming and thrashing and believed it to be intuition or god.

The reason why I will always have an eating disorder is because I don’t want to vilify it or moralize it. If I can’t catch a break on extreme auto-pilot/hyperfocus, lip-synching for life days/weeks/months then chances are my food will get messy in one direction or another.

When I am edging on some form of AuDHD burnout I will skip meals and then eat a very big one. Or I will eat hasty, tiny meals and then many, many snacks. Or my sugar will be the only source of joy and diversion at my desk. Sometimes the sugar is sunflower seeds. Or all the gum in a pack despite having TMJ. And this is when it’s really bad.

Sometimes it gets really bad.

Once I get below a certain threshold of resources, the seductive thought will always jangle into my head wearing a full-sequin jumpsuit with the urgency of a billion dollar idea and be like: Biiiiiiiiiiitch, I know what we should do next.

And I can be like: Babe! I knooooooooooooow! You’re so funny you always say the same thing. Here, eat a string cheese and take 45 minutes with it; no judgement.

This thought is not the enemy. This thought is not a surprise. She is "helping.” And believing that I haven’t beat her into submission forever helps me remember. This way I’ll also remember that when shit gets bad my first good idea is to lose 10 pounds.

Lose health insurance? Lose 10 pounds! Have a fight with your partner? Step on a scale! Encounter a terrible work-related disappointment? Put on your punishment pants that are too small and feel worse all day!

Once you’ve had these first good ideas one billion times, you kinda get used to them. Enough that you can not do them. And also keep it moving instead of ruminating on why you still think that way. Or how to stop thinking that way.

The other kinda Autistic/masky thing about my ADHD medication is that there’s also this hideous status layer around it. Like, I love that I’m on Vyvanse because to me it’s the Hermes of ADHD medication.

This is not NOT gross. But if I get into too much judgment around the thinking around this (stay with me here) I second-guess whether the Vyvanse is working or if I just want to be on Vyvanse because it’s rare and elite. If it’s ONLY a status thing maybe I should just be on something else? Maybe I don’t have to be on Vyvanse at all! That would be kinda great because Vyvanse is a pain in the ass. On and on etc.

But the truth is Vyvanse works for me. I’ve been on regular-degular Adderall, Adderall extended release, as well as Ritalin. I have not been on non-stimulants and cannot speak to those. But I do strongly recommend changing medications from dose to kind, from instant release to extended release if what you are taking is not working for you.

“What’s not working for you” will take many forms.

What will work is determined by many factors and chemistries that are personal to you. You are the authority on you.

Also, people-pleasing is not for your psychiatrist. You are not bothering them or being annoying. If your doctor makes you feel like a pill or questions your questioning, get rid of them and get a new one. If you cannot get rid of them just force them to do their jobs and cry about it to your friends afterwards because it sucks. This place sucks.

In any case, the TL;DR on the mechanisms of Vyvanse is that it’s hard to abuse because it remains inactive in the body until it’s metabolized. Basically, Lisdexamfetamine dimesylate has to go through the intestines and liver before converting to dextroamphetamine and L- lysine.

For me that means it takes an hour to hit and then lasts until around 4 or 5PM.

Instant release adderall (IR) hit way quicker and was in and out within three or four hours. And extended release adderall (XR) hit just as quick but tended to last forever for me to where I couldn’t sleep.

I was on Adderall for two years and it made me irritable but also delusional? I felt like I was really “on my shit” and everyone else better get out of my way. I’ve never done coke but from what others have told me this might be a similar vibe of asshole-maker. It also reminded me of the careening, screechier aspects of a manic high but there was one thing that made me stay on Adderall despite the rage and the meltdowns which was that when I made a decision it felt as though it stayed made. It was like a soft-close drawer to the end of a thought rather than having every tab open in the browser forever. It felt like there was a matching up of thought and action as it related to my executive functioning that I had never experienced before.

Ritalin was less spiky than adderall. But it made me strangely fearful. I carry a lot of fear in life already but with Ritalin I was scared and worried. Maybe it was the exactitude of Adderall but without the confidence. I don’t know. All I know is that I felt the most mentally ill on Ritalin out of all of them. And once I took Ritalin and ate dark chocolate and something really strange happened. I can only describe this as “hating myself to a suspicious degree even for me.”

But here’s the thing that was scary about all of it. I couldn’t write on Adderall or Ritalin. Some will argue that I cannot write on Vyvanse either but as controls and experiments go, I would say they probably don’t like my writing period.

I once had coffee with a writer friend who told me that a particular seizure medication she was prescribed gave her aphasia. I think about that all the time. I also think about this thing that Choire Sicha once wrote.

All that focusing really does something to your syntax. Something bad!

And this was true for me. I wrote a whole book twice on Adderall and burned myself out writing nonsense. It was the craziest experience and I’m still digging my way out of it now. I could not make the sentences sound like me. And I never knew when a sentence ended (like way worse than usual).

To this day I am still questioning my voice after that experience and I have to be careful not to get into romanticism about “raw dogging a book because that shit will be more pure.”

Which is to say that this post was inspired by the question of: what do you like about Vyvanse?

And for me the answer is complicated. And I don’t think I’m alone in this. It’s kinda like how back in the 80s and 90s and everyone’s parents were getting divorced almost to the point of like, is it boring to feel totally gutted and betrayed and horrified and scandalized about my own parent’s divorce?

No, dude. It’s still wild and destabilizing and harrowing.

Whatever comes up for you whether or not everyone you know is medicated or abusing medications can be surprising and unflattering and not even yours sometimes. Like, my Mom still thinks I haven’t gone hard enough on prayer as a solution. Which is to also say EVERYONE has an opinion on medication so take even my shit with a big mess of salt. It’s all ongoing and nonlinear.

Much like this post.

*Sidebar: I have a very spicy take that most children of immigrants who come from a collectivist, patriarchal society and then move to a late-stage capitalistic, white supremacist country where those parents are infantilized, have childhoods that may not have agreed with them. Bonus points if you had to translate everything for those parents and it was mutual alienation, frustration and resentment on both sides.