Fatigue in ASD/ADHD

Medical science cites 6 hours as the least amount of sleep in a 24 hours period. Autistics may well need 8/9 hours. Sleep affects medication and performance.

It is proven that autistics get more tired than the average person.
This is easily understandable since every task requires extra planning and decision making.
I need at least 8 hours of sleep to function, while 4-5 hours is the norm these hectic days.
People pretend to get used to it, despite evidence having long shown how lack of sleep weakens the Immune System and shortens life-expectancy, yet I often feel ‘lazy’ even if I put up long hours at work.

Fatigue is not laziness.
My cause of Fatigue is Anxiety, which in turn triggers Insomnia.
Insomnia is debilitating to me.
That leaves me with two options: double up my meds or call in sick. 
The former is the most likely, though not without consequences the likes of hypertension, encephalitis.
Thus far for ADHD meds.

Avoiding triggers and proper rest is paramount for all.
Regular sleep is crucial in Mood-stability.

Stimulants are the meds of choice for ADHD through enhancing dopamine, the main neurotransmitter involved in reward and motivation.
Reward and motivation have an antidepressant component.
People with ADHD must take them anyhow for studying or working.

Mood-stabilization is the ultimate goal.
We’re still far from it: antipsychotics remain the only option to date.

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Psychotropic Medication

Medications are surrounded by myth. The reality is that the same formula works differently in each patient. ‘Designer-drugs’ are the future of pharmaceuticals.

Medication is a very divisive topic.
Implications include religious beliefs, medical ethics, to mention the fact.
It is the igniting topic of unhealthy debates between Med-free, New Age Medicine, Spiritual Healing, Traditional Western Medicine s advocates.
I obviously support Western Medicine, henceforth in favour of the correct biological approach.

When I say “correct”, I do mean that Western Medicine is not infallible.
On the other hand, I see New Age practitioners as charlatans since there is no scientific evidence in their literature.
It’s a very controversial field, legally binding : these practices are not approved by the FDA, yet they are allowed to operate privately by law. Their fees are astronomic, they are not covered under Medical Insurance however, they thrive.
I don’t want to go into specifics, I just realise that they are a ‘last resort’ for disillusioned patients.
I accredit them for Placebo Effect, when successful.

People who take the Med-free route, are often very religious.
I believe in Spiritual Healing as a Christian, without excluding the doctor.

As you see, it is a multifaceted, arguably picture.

As a Western living in Asia, I must admit that Western Medicine has been imposed worldwide. Chinese Medicine dates back 5.000 years and most doctors offer either a Western or Oriental approach.
Although Western Medicine is now predominant, one can tell that Western therapies are not honored in the East, particularly in Mental Health. Most public hospitals don’t have a Psychiatric Ward and most Psychiatrists studied in EU/US whilst work in their private practices.
Psychiatry is still shunned.

I’m not arguing on what s better or worse, I am discerning how Western Medicine earned its reputation for Traditional.
Don’t think it’s solely based on scientific evidence, many meds’ mechanism of action is not fully understood, yet they are efficacious.
Doctors refer to them as ‘off-label drugs’. Ironically, they are oftentimes successful.
Timing is the winning strategy: the average kicking speed of Western meds is two weeks versus two months for Oriental herbal remedies.
Not to mention over the counter emergency painkillers: an Ibuprofen pill can abate a headache within minutes.
For these reasons, young Asian generations are reverting to Western Medicine.

Last but not least, Body Composition.
The same compound can work for one or being ineffective for another.
The future of pharmacology is headed towards the production of  ‘Designer drugs’ with regard to dosage, ingredients, symptoms.

Another myth is that Diagnoses and Personality are the same.
Personality is unique as it is the Immune System.

This theory is not new. It was first proposed in the 90s by leading psychiatrists the likes of Peter Kramer with the introduction of the first SSRI antidepressant Prozac in his book ‘Listening to Prozac’, still a blockbuster today.
The proposal was never taken into consideration by pharmaceuticals for lack of funding needed for this costly project.
I wish philanthropists would use their influence more wisely.

As of today, all medications are available in stock and none comes without a full array of side-effects.
This is the fallibility of Western Medicine.

The term ‘Cosmetic psychopharmacology’ was coined in the 90s by American psychiatrist and author Peter Kramer with regard to the introduction of the first SSRI antidepressant Prozac.
The name speaks for itself, who doesn’t know what Cosmetics are in our Image-Society?
Dr. Kramer compared indeed Prozac to a cosmetic.

What was a pioneering drug 30 years ago, countless SSRIs are available today.
Kramer questioned if it is ethical to ‘make-up’ personality.
Needless to say, he saw depression as a personality trait.
His bestseller book, ‘Listening to Prozac’, received either harsh or stellar reviews, though it remains a cult to date, praised by the Autistic community, understandably so.
Strongly criticized by patients suffering from Major Depression.

History repeating itself 30 years on in Autism: most autists support the Personality Trait.
Depressed individuals are convinced to be sick.

I refrain from commenting as to not trigger anyone, although I disagree with the popular definitions of ‘high-functioning/low-functioning’ Autism.
There is only one medical diagnosis of Autism.

Psychotropic Medications give us many answers on Illness or Personality.
In Medicine, this field is referred to as ‘Medication s adherence’ as in efficacy.

Adherence leaves little to imagination.
If medications work, we can talk of pathology no matter.
Surely, different compounds have different effects in individuals, from the assumption of ‘designer drugs’, though I believe in pharmacology.

My take is that finding the right med, can be very frustrating and time-consuming.
Off-label meds often turn out to be the most effective.
This leads many people to discouragement, henceforth go med-free.

It took me two decades to find the right combination.
Then again, no triggers wanted.
I will discuss my personal experience with dual ASD/ADHD avoiding preaching.

Methylphenidate extended-release is the med of choice  for ADHD and Narcolepsy, these days. Although adherence levels start diminishing after 8 hours, it stays in the system for up to 10/12 hours, this day and age’ average work-schedule.
At least, the most intense workday-time, 8 hours, is covered.
What used to be called ‘overtime’, is now called ‘wrap up’, hopefully requiring less energy.
So far so good.

I promised to talk in first person, nevertheless.
My adherence is about Timing.
I don’t wait for 8 hours to take action. I prepare my body at plasma-peak, within 3/4 hours, by taking Anticholinergics at intervals of 3 hours. Anticholinergics are neuromodulators and not drowsy.
I do feel tired at the end of the day, though I kill the Crash.

As of today, I identify 80% ADHD.
My Autism symptoms are hardly detectable as far as ADHD medication doesn’t wear off. Not a problem during workdays, I have early nights.
However, I skip methylphenidate on days off and I can do quite well for the first 3 days med-free, Humour is important in my line of work, actually all lines! No sense of humour=low serotonin=depression.
In fact, I believe humour is my lifesaver, it keeps me away from pills, temporarily.
I wish I could laugh no-stop for 5 days.
Nonetheless, I have gone weeks med-free during holidays at the sea experiencing Peace.

Consider I have been on methylphenidate for ten years, therefore I speculate that Stimulants build up in the long term.
I also learned that taken in a single dose, they maximize adherence: I take two 36mg capsules at 6 in the morning which work great for at least 8 hours.
On the contrary, I don’t get any benefit in two doses.
Could be tolerance?
What I learned so far, is that the initial response is stronger with the body at rest, while metabolized almost immediately under stress.

Cortisol levels make the difference.

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Self-identification vs Empathy and anticholinergic therapy in autism

Medications reach maximal adherence in synergy.

These two emotional states may look equal despite the mechanism of action being of different contexts.
Self-identifying is of hormonal origin, mainly adrenergic.
Empathy is of brain-circuitry origin, a kind of personality.

Autistics score high on self-identifying.

Endorphins overdrive is the most common reaction normally leading to meltdown in distressing situations.
It is established that adrenaline’s release through endorphins is contagious and autists have highlighted senses causing them to absorb it all.
Hormones play a pivotal role.

As for reward, we all crave for it: reward enhances dopamine and serotonin, the ‘feel good’ neurotransmitters.
These chemicals are often dysfunctional in autism.
Hormones affect neurotransmission to a varying degree.
In my experience, I don’t feel rewarded most of the time.

Off-label treatment is showing promising results, although the placebo effect cannot be ruled out.

Acetylcholine is the main neurotransmitter present at all body s nerve endings.
It plays a key-role in memory, motility, metabolism.
All neurotransmitters are somehow dependent to acetylcholine.

Anticholinergic therapy mimics the model of action of antidepressants by blocking neurotransmission at pre-synaptic level.

Latest research shows anticholinergic optimal response in combination with antihistamines and benzodiazepines.

In hot-humid climates, anticholinergics are widely employed in Motion-sickness by targeting Neuronal-displacement, coincidentally responsible for autistic meltdown.
In my experience, they have calming and non-sedating properties.
Specific categories of drugs peak efficacy in synergy. 

Meds’ info generally highlights Warnings of “potential interactions” or “no interactions reported”, thus far creating further apprehension among users. 

It is important to understand what the targets of drugs are.

  • Anticholinergics: acetylcholine 
  • Antidepressants: serotonin, dopamine, noradrenaline 
  • Benzodiazepines: G.A.B.A.
  • Antihistamines: mast cells’ histamine released in response to allergic reactions 

These compounds interact safely.

We know that most current medication cures symptoms, not the original disease.
We must identify where the symptoms originate in order to understand interactions, what meds-info will never tell you.
The Internet is all the more misleading and partial with countless medical ads.
Medical textbooks are mostly reliable.

Let’s start with Acetylcholine:
Acetylcholine is the final product of the Parasympathetic Nervous System.
That would explain the anticholinergics’ enhancement of anti-allergens like antihistamines.
For this reason, Acetylcholine is also referred to as neuromodulator.
Needless to say, the parasympathetic nervous system reverts allergic reactions triggered by the sympathetic nervous system.

Humoral neurotransmitters:
Serotonin, Dopamine and Noradrenaline are released by brain synapses following an electric impulse through neurons. 
Cerebral electric-activity determines functional neurotransmission and mood.
Antidepressants increase humoral neurotransmitters activity.

G.A.B.A.
Benzodiazepines enhance Antidepressants targeting the calming neurotransmitter GABA.
GABA in turn, is highly involved in the regulation of electrical nerve impulses.
See the interaction of benzodiazepines with electric-activity and anticonvulsants in the cure of epilepsy, an electric signals dysfunction.
Benzodiazepines increase GABA activity.

Histamine:
Histamine is released by mast cells present throughout the body.
Their function is to fight inflammation.
Inflammation is the response to allergens affecting mainly skin, airways and gastrointestinal tract.
The controversy of histamine is that it exacerbates inflammation.
Antihistamines block histamine release.
Their mechanism of action is not fully understood: they are potentially drowsy, sedating, enhancing all aforementioned compounds.
For this reason they are often used off-label in mental health.

Speculation that mental illness may be an allergic reaction is taken into consideration.


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Endorphins in Autism

Continuing the discussion on natural elements.

We all release Endorphins in response to stress and anxiety.

Endorphins produce what is commonly referred to as ‘body odor’, thus not of bacterial origin.
It is a pungent, chemical, triggering odor.
Speculation is that it stimulates adrenaline release.

Body odor is naturally produced by deteriorating skin bacteria.

Skin bacteria are a natural odorless protection from airborne pollutants.
They become foul smelly in contact with sweat as result of overheating.
Sweat alone is 100% odorless, we would never smell in the absence of bacteria.

We all sweat to a varying degree through physical activity.
Dermatologists recommend a shower ideally every 3 days in cold weather at physical rest, or daily rinsing for heavy laborers.

Endorphins related odor occurs under any distressing circumstance.
The odor is triggering for both the recipient and the receiving end.
Showering is useless if we don’t calm down.
Endorphins are not heat-dependent.

The sufferer goes in ‘fight or flight’ mode.
I could describe the experience as a long lasting panic attack.
Sedation is oftentimes indispensable.

Why are we affected by other’s endorphins?
I believe in autistic self-identify’s predisposition.

This is the worst scenario, like having two panic attacks simultaneously.
The odor becomes unbearable and Anger-triggering.

Avoiding confined spaces is the general rule for sensory overload’ s related conditions.



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Perceptual disturbances in Autism

Autistics are heavily influenced by natural and biological factors.

Autistics are particularly sensitive to anticipation.

I’m not talking of changes here, which are a long established feature.

A change happens in the present moment and it is commonly accompanied by a meltdown.

Anticipation is the dreading of an upcoming event, either planned or unexpected.

There are natural elements in the atmosphere easily perceived by autistics, like Barometric pressure: I always guess the morning-after’s weather.
I dread rain and humidity.

This kind of sensitivity is a pro to neurotypicals, while a major stressor to autistics.
Neuron-displacement remains the most accredited hypothesis.

What we don’t know for sure, is why neurotypicals are less affected.
Brain circuitry definitely plays a major role.

Autistics have strong perceptions.
Although they can come handy, they are a big trigger to me.

We’re living difficult times where the future is uncertain and gloomy.
The best approach is living to the day.
I wish I could.
I have an uncanny ability to predict circumstances instead.
And I’m almost right.

Circumstances are normally related to all the more dreadful dead ends.
Who likes dead ends?!
The ‘deadly’ reference alone is depressing enough to scare the hell out!
I question the legitimacy of linguists…
Why not ‘due dates’ ?
Not 100% harmonious, yet less macabre.

I wish I had no perceptions.

Antipsychotic therapy is the only option at present.
Not my thing, I want to be lucid all the time.
I dread sedation.
I can’t afford being sedated.
I’m a planner.

If only I could stop planning for a day, I could ease my perceptions.
Co-morbid ADHD doesn’t help, I can’t stop planning as an expat desperate to go home.

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Unrealistic predicaments in anxiety

Worst-Case Scenarios are virtually delusional.

I mentioned before the different chemistry of ‘Preparing for the worst’.

Although Readiness is shared in Preparedness, getting ready for a pleasant event is fueled by Motivation.
This doesn’t exclude a varying degree of apprehension, a mitigated form of anxiety.

“Looking forward” always accompanies Motivation. 
Some dictionaries give the expression as synonym of Motivation, altogether.
Whether Synonym or Definition, the genesis doesn’t change, grammar is no longer mandatory, these days.
AI will integrate all languages globally.

Nobody looks forward to the worst, but the better.
All humoral neurotransmitters are involved in motivation.
When the brain is depleted of humoral neurotransmitters, we inevitably envision Worst-Case Scenarios, the main cause of Worry-Paralysis.

Although medication helps to a big deal, Anticipation is a great complementary Mental Exercise.
By envisioning the Worst, our Parasympathetic Nervous System fights back Amplification.
Amplification is an irrational exuberance to dreadful events to come. 
Not to be mistaken for ‘Fear of the unknown’, a Chronic condition.

In Amplification, we know the time of the approaching storm, therefore we can stop the ‘build up’ of anxiety from progressing by amplifying the Worst, in so doing boosting the Parasympathetic response.
It is the same mechanism of vaccines, we introduce deactivated viruses into our body in order to boost the Immune System. 
An antianxiety vaccine is not available yet, therefore it is paramount to abate the build-up from scratch.

By Envisioning surreal scenarios, we lessen anxiety gradually.
The theory is keeping anxiety AT BAY however, with lots of practice, some subjects report facing the deadlines Anxiety-free.

Timing is the key.

Imagine this: there are hundreds meteorites potentially en-route to earth within decades, yet our fear is overtaken by reading how Space Agencies keep track of these annihilating objects while developing anti-impact technology.

Don’t wait to tackle your fears.


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Standpoints vs Defensiveness

Conflict-avoidance reverses Anger to Validation.

I’ve been talking a lot about Triggers and Defensiveness.

It is clear that Defensiveness is a byproduct of Anger. Some psychiatrists see Defensiveness and Anger as a single emotion.

Counter-validating is not giving up your standpoints, it’s a way of avoiding triggers as part of Anger management.
We can keep Anger at bay, but NOT erasing it.
We can turn Anger to our Wellbeing and Validation.

It is possible with time.

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Envy or Anger

Anger can take many forms, although it is oftentimes the result of trauma and abuse.

Anger is very individual.

To me, it s primarily Envy and Regret.

I regret growing up in the 80s when teachers didn’t have any mental-health training to recognise Autism and ADHD. 

I envy today’s children who are identified with learning disabilities in early life and put on special-needs education.

Back in the day, you were put on abuse….

I’ll never forget the trauma my entire life.


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Initiative / follow up

Gaining trust is challenging for neurodivergents. We are often misunderstood. It is vital setting boundaries and responsibilities in relationships between neurotypicals and neurodivergents.

My wife often tells me that I shout.
It’s not shouting for me but mirroring emotions.

I’ve been shouted at all my life.

I never get emotional with the purpose of offending.
Raising the voice is my means of protection.
My mother-in-law always shouts to my wife and I reply accordingly.

However, my wife doesn’t want me to get involved.

So here’s what happened today :
We go shopping-hate it but necessary- and I make the list as usual. 
I’m good at making lists.

Once we arrive at the mall and take the basket from the car, I spot my mother-in-law s basket and get emotional by saying “Why didn’t you tell me we have to do the shopping for your mother?!” 
Her mother loves shopping… 
“Because we were going!”

We spent an extra hour shopping, consequently.

Arrived home, I collect the laundry since it was threatening rain: “It s still wet!” Emotional again: “But it’ll rain soon! I want to dispose of the laundry! Why can’t I?!” 
“Because you shout!”

I meant “Hurry, it will rain soon!”

From today, I decided not to do things on my own initiative.

I’ll leave it to you to comment.
No offence will be taken. 

I feel downgraded for my diversity.

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Initiative

It’s best for neurodivergents to let trusted people do the first step. 

Yesterday I relaxed with my wife after an emotional weekend.

You’ll remember my resolution of avoiding to start tasks on my own.
→  ASD/ADHD vs Neurotypical Standards

The logic is, if my wife takes the initiative, I will comply without debates.
I’m anti-conflict by nature. 

I confess, it s not easy to keep the mouth shut.
Even more being passive.
After all, I am the neurodivergent.

I don’t suggest anymore what to eat, what to watch, etc.
I didn’t collect the laundry tonight like before, I ll help if she asks.
And most importantly, she won’t complain that it s still wet.

If marriage is compromising, even more so a neurodivergent one.


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