Base level of dopamine

The base level of dopamine is stochastic, for me at least. And so the effectiveness of ADHD medication on me can also be stochastic.

Generated using OpenAI Dall-E 3.

I’ve had an on and off relationship with Methylphenidate (Ritalin in the US, Inspiral in India). Right now I’m in the “off” state, but for the previous three years I was “on”. In the decade that preceded I have again been very on and off about it.

This is not a problem - unlike antidepressants, Methylphenidate doesn’t cause any withdrawal symptoms. So you can simply use it when you need it (this is NOT medical advice). The common analogy given is that it’s like wearing prescription spectacles - that I take them off when I sleep doesn’t mean that my eyes start “withdrawing” in any form.

So it was interesting to find this post here yesterday by David Epstein (whose Range I rather liked - maybe it was because it confirmed too many of my biases). Ignoring all the faff, what this post essentially says is that there is an “optimal level of dopamine” for functioning.

The scientist explained that some people are naturally very easily stimulated; when they take a test, give a speech, or engage in competition, their challenge is to stay relaxed so that they don’t get over-stimulated and anxious, resulting in diminished performance. Other people, he explained, are not easily aroused; their challenge is getting stimulated enough to reach peak performance.

If your dopamine levels are too low (like mine are a lot of the time), then you crave unnecessary stimulation all the time, and so cannot focus on most tasks. If your dopamine levels are too high, then you can “run around like headless chicken”, seemingly achieving a lot but actually not doing much.

The problem with me (and with a lot of others, I would imagine) is that my base level of dopamine is stochastic. The average is much lower than the average for neurotypical people, because of which I have been prescribed stimulants, but the variability is also significant.

So there are days when “I don’t need no drugs to calm me”, and I can peacefully function in my ground state. There are days when I’m jittery, but after taking my medication, I relax considerably, and then can function rather peacefully. And then there are days when it doesn’t really matter how much drugs I’ve taken, I simply cannot get myself to focus and do any work.

These are just three sample points from the distribution - basically my normal state of dopamine is not constant, and because of that, the prescribed dosage of the drug (for me) can either feel too stimulating, or not enough.

In the past I’ve had psychiatrists prescribe the same drug (Methylphenidate) to me, and saying “take it when you think you need it”. While that is a good advice for someone whose dopamine levels are stochastic, the issue with that is that deciding whether you need the drug requires executive functioning, and that is in short supply when your dopamine levels are too low!

So it is a sort of catch 22 situation here, where on some days I need the drug and on some days I don’t. Medically it is possible to take the drug only on days I need it. Just that I’m not able to make that decision (on whether to take it or not) on a lot of the days!

And so I go through these on and off periods, when as a rule I either take the drug every day or not at all. And right now I’m in the latter camp.

Your mileage might vary.