Citation: Karo. "The Tell-Tale Racing Heart: An Experience with Methylphenidate (exp66618)". Erowid.org. Jan 23, 2008. erowid.org/exp/66618
Abstract: This might be unusual, but with a long text like this an abstract may be helpful. Basically I write about my diagnosed ADD and myself, which you may find unnecessarily long and egocentric, so feel free to skip it. The main part then would be my experience with methylphenidate, a medication I overdosed over a span of four days, which surprisingly resulted in massive heart racing on the last day when I took the smallest dose. Finally I add some morales like in every good story. Who'd thought I would ever submit a text for this website? Certainly not me three months ago. Please bear with me if it sounds funny, I'm not a native English speaker. I am going through this for the umpteenth time and there are still far too many run-on sentences. Ah well.
I am living somewhere on the European continent, am 30 years old and suffer from a severe case of ADD. The symptoms of my attention deficit disorder have been painfully present all my life, but in the last ten years, during my prolonged and hardly successful education, it became harder and harder to ignore them. Just to name a few, I can sleep for 10 - 14 hours a day if I don't force myself out of bed. Also, due to 'daydreaming', it sometimes takes more than half an hour to get dressed after I return from the shower, and occasionally I let very stupid mistakes happen, like forgetting to use the shampoo when showering, so I have to jump in there again, etc. There are more and sometimes quite embarrassing blunders that can make me look like a total idiot in public. It doesn't help that I'm extremely sensitive to criticism like most people suffering from ADD that I know.
I frequently sustain little injuries too as I am rarely 'there', always stumbling through life, unless something really excites (read: stimulates) me, which is making this condition so elusive. Medication really helps as it 'activates' the brain and removes the need for outside stimulation. To give you an example, when not under medication I am a thrill-seeker, despite my hypoactivity. Under the influence of MPH the aggressive music, which otherwise 'get's me going' feels rather annoying to me, when I want to work.
I am the inconspicuous type who is often overlooked but easily makes a favorable impression on some strangers (or so I like to think) by her polite and unobtrusive appearance while consternating others that expect their interlocutor to be more open. Despite being rather shy, I sometimes surprise my surroundings with an unexpected idea, cynical remark or other activity they would not expect from someone they had classified as rather plain. This is actually part of my problem: I do not fit into any category. I act, look and talk rather sensible, but then I can't get anything done on my own.
Why is it that I am (was) often the most active and best in class, be it university or school, but when it comes to written assignments I get mediocre grades or I simply never finish an essay and fail class? This is not just laziness. It's not like I don't care either, it's important to me and I do not have anything else that would occupy my free time, nor am I leading a life style that excuses and legitimates my apparent lack of ambition (as far as lifestyles can do that).
In the last ten years my surroundings gradually changed: All my friends had finished 'uni' long ago, I couldn't appease my parents any longer and I could simply no longer keep up my image of the seemingly clever late-comer who just takes her time to finish things. Actually I lost contact to all but a few of my friends because I could not face them anymore. What should I tell them when they asked me why I still hadn't finished my studies yet? I couldn't answer this myself.
So pressure from outside and inside (a guilty conscience) was steadily increasing. I am sure I have gone through months or even years of depression, but was never diagnosed as depressive as I never went to a psychiatrist. I still believed myself what I told others: “Everything is okay, I just need to really start and get a grip on myself, then it'll all work out. I sure am intelligent enough, right? Just give me a little more time.” That never worked out.
Eventually I began searching for the cause of my failures. Where there psychic disorders that would fit my condition? Borderline, manic types, intellectual giftedness and anxiety disorders all had a number of matching symptoms, but neither really seemed to match my condition. For a week or so I was almost convinced to suffer from Asperger-syndrome – my elaborate (and often circumstantial as this text shows) diction and social isolation would speak in favour of this self-diagnosis. Thankfully I never told anyone. Then I eventually discovered ADD and finally found an answer.
However, an illness does not exist for the public if it is not diagnosed by a professional, right? There is lots of mockery on the internet where 'self-diagnosed' people are ridiculed, implying their self-diagnosis is just a cheap cop out for their failures and lack of socialisation - a stigma that also applies for diagnosed people, if to a lesser extend. Also, if I wanted to be treated adequately and possibly receive some benefits from 'uni', I needed an official document. So I went and looked up a doctor in my vicinity on the internet. That was not as easy as ADD is already a controversial enough condition as it is and even fewer doctors are treating people if you are beyond the age of 18 (“You're not a child anymore!”) Add the fact that in Europe even medical staff often has no more than a vague idea of what it is and how the medicine works (“Ritalin's a drug!”), I had a long way to go until I finally received my medicine.
To cut a long story short, I eventually found a doctor, had a very expensive positive(!) diagnosis and was prescribed 20mg methylphenidate after we increased the dose in steps of 5mg (the 20mg had to be taken 4 times a day or 2 times as a 'time-release' which has a longer effect, resulting in a daily dose of 80mg). That was four months ago, in April 2007.
Before I get into details about the methylphenidate, I should say that I had no experience with drugs of any kind whatsoever except a socially accepted amount of alcohol. I have been dead-drunk in my life only once and even that was intentional to “try it out” in my early twenties. Usually I hardly ever drink, and if I do, I keep a certain level that enhances the occasion instead of getting smashed. I have never smoked THC and never ever came into contact with anything else, avoiding even cigarettes and coffee. As unusual as it sounds, this dislike is not based on any personal philosophy or belief, I just happen not to like that stuff. Maybe because I'm too liable to depend on anything that provides me with instant-stimulation I unconsciously stay away from it. Maybe this is why I misjudged the effect of the prescribed Medikinet.
With 20mg and hardly any tolerance I was getting what you could all a 'high' every few days, when I was able to feel it and not too busy anyway. It was quite nice. I would just sit and think for an hour or two and let my mind roam freely. The MPH was slightly lifting up my mood and I finally experienced a clear head and more defined thoughts. I had some very elaborate daydreams while under the influence of the 20mg. Those were not hallucinations but rather more intense thoughts that would have crossed my mind anyway. I actually hardly noticed a change in my working patterns, except for one long text for uni that I wrote in one week, which probably would have taken forever to write without the meds. The important lesson here is that the medication is not a magic switch that makes me automatically more efficient. Self-control is much more important than the drug and if I am already in fear of the blank paper, the medication will not make that magically go away.
So I was still wasting lots of time, if more pleasantly than before. I thought of many interesting things totally irrelevant for my work or life: What would posters look like for a clever add-campaign? I devised stylish movie scenes, thought of art, products that would sell well and so on. I hardly wrote down any of that stuff, but what I still have sounds interesting enough. I can well imagine this chemical to be used in the advertising industry. Also my urge to communicate increased. I was muttering to myself when I was alone and sometimes I was talking to myself simply because I needed to talk. All the time I was very clear, never suffering from hallucinations.
Most importantly though I was experiencing a new kind of self-sufficiency, which means for once I did not feel that constant craving for stimulation that usually results in my indulgence in activities like surfing the internet, listening to music or doing everything other than boring work. So I feel I had (and still have) a great base to build on for automatisms and working patterns.
Why did my doctor not notice she prescribed too much? I guess it was my fault. I was afraid she would prescribe too little and my reports were more and more positive, so she hesitantly did prescribe this large daily doses of 80mg. “The more the better” is not the way to go here though as I eventually learned. I'm on 40mg daily now, which is much better. In all honesty, I did not realize my dose was set too high. I thought this was what I was supposed to feel. In retrospect that was pretty stupid. I guess the line between a state of mind where I reach self-sufficiency and what I could call a 'high' is very fuzzy.
The term 'high' might be misleading though. You could say it was simply a dose that was too high as well. While I usually resent the effect of mind-altering drugs, it was different with methylphenidate. Most drugs simply poison the brain and paralyse that part which keeps control. Once this happens, people will marvel at they’re newly (imagined) strength, delight in the illusions of their impaired perception or rejoice in their newly acquired deep understanding of the world and themselves.
But aren't all these impressions just the result of a intoxicated brain? When people slobber over their colourful hallucinations, aren't they simply talking about the convoluted input of their dysfunctional senses? Isn't this like feeding a computer wrong data while gazing happily at the garbled output it returns? Anyway, this is what kept me from other drugs. I was always suspicious of anything that would alter my state of mind and take control away from me. Methylphenidate however works the opposite way, it doesn't fog up my brain, in contrast it removes the fog and makes me think clearly.
On one fine day in August, three months after taking my first pill, I decided I could experience the pleasant feeling the meds provided exactly when I choose to. After a long day (getting up at seven, having had two regular pills of each 40mg (time release)), I decided that it would be the right opportunity to add another pill, simply to relax a bit. So I did. This time, to be on the safe side, not a time release but a 'regular' pill that is effective only half the time (3.5 hours). Then I waited. It was a bit better. Then I thought “What the hell” and took another. Then another. At one point I remember thinking: “I never had such a good life anyway, I deserve to enjoy it a bit more today”. It was nice.
All in all I had consumed a whole of 220mg that day instead of my prescribed dose of 80mg. Following my doctor's advise, I write down whenever I take a pill, so I am pretty sure this number is correct. I listened to music, watched some music videos and looked at a collection of artworks, a present which never interested me all that much before, taking pill after pill. That night those pictures hold my attention like they never did before. There were no hallucinations. At one point I closely looked at one picture, half expecting it to speak to me or something, but nothing out of the ordinary happened. Just imagine a picture with an interesting detail. Suddenly I could pay a lot more attention to that detail, and even while my attention was occupied with it, the image itself did not change.
I was listening to music too. All in all it was a very pleasant experience even though I could not increase the effect of heightened awareness with the later pills, which was slightly disappointing. But I wasn't going to be bored, far from it. Something else happened that kept me busy for the next few hours. All of a sudden, my heart begun pumping. I could see no obvious reason for that increase in heart rate. I was sitting at my desk like before and all of a sudden my pulse went up. I almost panicked but tried to remain calm.
What were my options? If I called an ambulance I had to tell them I had overdosed on my medicine. Also I would be the talk of my flat and lots of people who probably suspected me to take drugs because of my secluded lifestyle would knowingly nod their head and feel confirmed in their assumptions. Of course I would not be prescribed methylphenidate anymore and my relationship with my doctor would suffer. This was tricky.
So I decided I would only call an ambulance if I was in immediate danger, i.e. close to death or very panic stricken (big words, I know). I still had some extra strong cough syrup containing morphine I had received when I suffered from strong dry cough. I had taken the prescribed dose a couple of times before when I could absolutely not sleep to get at least two hours of slumber. I just noticed using this, even in a prescribed dose for something other than to treat my cold, proves my above statement wrong, where I said I had zero experience with drugs. Ah well, at least I did not use it for recreation, the stupor caused by it is rather unpleasant. I decided I'd take 25 instead of the 20 drops that I had to take usually. After a few minutes my vision blurred a little and I became sleepy, but my heart rate was not affected one bit. I guess methylphenidate beats morphine here.
As it turned out, it was not as bad as I feared it to be. The accelerated heartbeat lasted for about two hours during which I sat in my chair, motionless, controlling my breathing so as to not accelerate my pulse further. After a few hours my heart eventually slowed down. I was a bit shocked but also disappointed that my daring 'trip' had found such an unpleasant end and went to bed.
That was on a Friday. Saturday I spent a lot of time in bed in order to regenerate without taking my medicine. I did not feel any side-effects other than being rather exhausted. Then on Sunday I took my normal medication on the first half of the day, but then tried to 'enhance' the second half by taking double the amount of what was prescribed (80 instead of 40mg time release, resulting in a daily dose of 120mg instead of 80mg). I did not feel the expected pleasant rush, but still decided against taking more than that and eventually went to bed. Very well.
Then on Monday I immediately took double the amount at about 13.00, thinking I could estimate by now what effect the stuff would have on me. At that time I was ready to overdose occasionally without ever going as high as on Friday again. Since I took the medicaments irregularly anyway, I would always have some extra. The fact that my amount of methylphenidate was limited to what my doctor prescribed me in three months intervals would limit the risk of an addiction anyway. All that sounded like a reasonable and sound plan with a relatively low risk for my health or me getting addicted. All was settled at that point. I had little idea that the worst was yet to come. Actually just recalling what happened then is sending shivers down my spine, as cheesy as it sounds.
So I took 80mg that day in one dose (time release) on that Monday, hardly feeling anything. Slightly disappointed I went to bed at 14.00. After one hour or so I woke up, feeling a little unwell, a little nervous. I could not sleep for one hour after that. Then all of a sudden my heartbeat went up. “Oh no, not again!” were my thoughts. I only had 2x40mg time-release instead of 1x40mg as prescribed, so I did not expect anything but a little inconvenience. Yet my heart suddenly started racing like never before. This was preceded by a dull, threatening feeling. I could hardly believe how fast my pulse went up.
BAMM BAMM BAMM BAMM BAMM BAMM BAMM BAMM BAMM BAMM!
Within seconds my heart was racing like crazy. I was still in bed and there wasn't anything I could do to relax my body more than that. On Friday I was sitting at my desk, which is likely causing a slightly higher pulse than lying down. Now I could not get more comfortable even if I wanted to. Let me just say that it is quite an alarming and threatening experience. It concerns a vital body function, I feel it all over my body and I don't know how far it will go and when it will finally stop. A heart, racing as if it's trying to force its way out of my chest can not be ignored, rather I fear for my life. The events of two days ago made me a bit more calculating and sober though, so I decided to sit it out and rethink my strategy of overdosing later. The situation was highly inconvenient, but time was on my side, right? Boy was I wrong.
The heart racing did not go away. It stayed with me and I could not do anything about it. So what about calling an ambulance? “The stuff is effective about seven hours, so if I manage to lie down here, motionless, hopefully without sustaining any permanent damage to my heart, my brain, my kidneys or any other body part, it will hopefully be alright. I might have a stroke, but let's not go there, concentrate on breathing” I said to myself. This was difficult enough. I lay there, motionless, with a heart that beat like it wanted to burst. Any movement caused it to increase pulse a little more, so I could virtually not even lift a finger. All I could do was move my eyes freely. My concentration was fixed on breathing which had to be calm and through the stomach, not the chest. Breathing calmly while almost being in a state of panic is rather difficult as I found out, but I had no choice.
To top it off I had stomach trouble at that time. There was gas in my stomach which had to be released mostly through little burps. So whenever I was finally in a state of control, I had to release gas and my heart thanked me with another increase in pulse. Besides, lying there motionless caused my limbs to go to sleep, which made me very uncomfortable.
I stared at the clock and started counting. I counted almost every heartbeat during the first five hours. I went from one to ten and then repeated the process, sometimes replacing the ten with a single digit number so I would keep the decimals in mind.
“One two three four five six seven eight nine ten one two three four five six seven eight nine two one two three four five six seven eight nine three one two three four...”
At about 18.00 it was worst. My pulse was not constantly high, but rather irregular with episodes of extremely high frequency and times where I thought I could manage okay while I concentrated on my breathing. There had been episodes where I counted 44 beats in 20 seconds. These were the worst, as it was amongst the highest pulse I had ever experienced. Later on I looked up the numbers and found that a pulse of about 130 per minute is high but hardly life-threatening for a thirty years old. I did not know this at this time and I'm not fully convinced even now that my health was not at risk. I have an extremely low resting pulse rate (lower than 50bpm) and when I am running short distances with full speed on the racing-track, 130bpm is about the pulse I feel. Keeping this frequency up for 15 minutes and more multiple times within a few hours, without any real opportunity for the heart to rest must have been dangerous, I am sure.
While I was laying there, I called these episodes the 'bad times' and while things were drastic, but not catastrophic, I just hoped there would not be any more of those bad episodes. In fact I decided that if I felt the maximum pulse rate longer than 25 minutes, I would call an ambulance, regardless of the above mentioned consequences. Somehow I managed to make it through the first five hours without calling for help. But then what happened? It simply went on. Only 80mg as a time-release (which would be my prescribed daily dose, even though it should not to be taken all at once) and it simply did not stop! It must have had to do something with the overdose from two days ago that had not yet been completely depleted. This was getting more and more difficult!
I was feeling terrible but I told myself I was doing relatively well given the circumstances. Actually I recalled taking the pills at two, when I really took them at 13.00, so I estimated the effect to fade at nine (plus seven hours) latest. During those five long hours I constantly stared at the clock. Slowly but surely it reached nine. Still my feverishly racing heart showed no signs of stopping. Stopping to race like mad that is, not stopping altogether. Oh, do excuse me. I endured. This was no fun. Laying there, motionless, just moving occasionally when I absolutely had to. I was on the edge. All it took was a single 'bad time' to take longer than a quarter of an hour and my little plan of sitting this whole thing out was out of the window. But time was on my side... without any more complications this would work for sure.
At about midnight the pain in my sides grew more intense. I suspected the kidneys then but it was likely just cramps from me forcing myself to breath calmly for hours. By then I was feeling an overwhelming exhaustion both mentally and physically from the hours of concentration to lay still, count my heartbeats and control my breathing. I had light cramps. My mouth was unusually dry. But I had to remain still. What if I had to take a leak? Should I soil my bed? This was certainly not the most glorious day of my life.
The bad episodes of intense heart racing were less frequent by then (0.00). things were about to look better. But now the real fun started. Mix exhaustion and a body running a drug-induced emergency program and you're in for a real ride. At this point I experienced something strange: The more tired I grew, the higher my heartbeat became. The moment I closed my eyes, my body (subconsciousness, brain stem, whatever was responsible for this) picked up my fatigue and consequently increased heart rate as if to command me not to fall asleep under any circumstances. This was the worst part, as I was really tired and worn out by then. I could not move to stimulate me either and keep me from sleeping! All I could do was trying to think of something and keep my eyes open in order not to get too sleepy. That was a real torture. The first eight hours (from 16.00 to 0.00) hours were hard, but at least I was awake and still had my full mental reserves. With those nearly depleted I was cornered. Still I endured.
During the whole session I was able to think clearly. After midnight this was about to change when I was not getting the sleep I so urgently craved for. I never had hallucinations or anything like it. Until now.
You'd think calm breathing and sleepiness go well together, making it easier for me. But it didn't. If I gave in to my exhausted state, the heart frequency immediately rose. That was very painful, having sleep just within my reach without being able to obtain it. I read that doctors hesitate to inject tranquilizers for amphetamine addicts with this condition as their calming effect sometimes increase the symptoms. I now have a good idea why.
“Why am I not allowed to sleep? Please make it stop and just let me sleep!” For some reason I began visualizing my pain with bizarre images. The first image that came to my mind was my heart, trapped in a strange, many-legged mechanical device. In front of a pitch black background the apparatus took a step forward with each heartbeat, moving its long, spidery legs, striding from left to right in a jerking manner. I made an effort to banish this thought.
The second image that forced itself upon me was a soundless mechanical creature, looking like a robot that could have been part of a fantastic story early in the last century. It had a cone-shaped, legless body made of brass, metallic wings and a round head with simple rings for the mouth and eyes, looking very retro-style and inhuman. It did not move its wings and was totally motionless, yet it flew in an arch across the absolute darkness that provided the background for this image as well. The most frightening was the total silence that was emanating from this thought. Also, the creature's unknown power of locomotion (it did not flap its wings nor was it gliding) gave it an eerie, yet almost majestic dignity, I witnessed a motion that was performed without the effort to move. I banished this thought as well.
I did not want this to go on. I felt that if I did not fight it, I would have some horrifying nightmares, all expressions of my tortured mind. I had to get out of that undefined state between sleep and being awake. I still don't think these were actual hallucinations caused by the drug, but rather my brain reacting unsuspected to the extreme situation. I believe the correct term would be 'pseudo-hallucinations'. Note that I elaborated on fleeting impressions that were, thankfully, not quite as clear as you might think from reading my descriptions of them.
Pulse rate was getting slowly lower after midnight. If I just could manage not to fall asleep until the pulse rate went down further I had won. One side-effect of the lower pulse was a more flat pulse as well, creating further problems. While I could easily adjust my breathing while I felt my heart banging against my chest, with a flat heartbeat it was not so easy. So another stupid game started: My pulse getting lower and hardly palpable, my breathing getting out of sync with my heart-frequency and consequently pulse rising very high in turn. Amazingly I must have dozed off during 1.00 and 2.00 for a few minutes despite all the hardship (or because of it?). At 2.00 I even managed to go to the bathroom. Finally the effect of the amphetamines seemed to wear off.
Then at about 4.00 I was getting nervous again. It was the same threatening feeling I experienced at the start of this little ride (16.00). I tried to remain calm but I knew my panic was not gone unnoticed by my body. Then it came. For more than ten minutes my heart was beating like crazy. What did I do to deserve this? More than 12 hours after my intake it started again. Did I have to call the ambulance after all? I decided I would rather call a friend who would then drive me to the nearest hospital. I was pretty calculating by then, and my racing heart did not bother me like it did hours ago. I told myself that if this is what I could endure when running three or five kilometres then I would probably not die from it. I counted my heartbeats (about 130 per minute) and told myself that I would only act if it went over 135. This did not happen. After about 15 minutes the pulse went down again.
I dared not to sleep and grabbed an old history book of mine that was lying around. Reading about Prussia's rise and fall never kept me up all night before, but back then it was entertaining enough to prevent me from sleeping. I finally fell to sleep from about 10.00 to 13.00, when I woke up. I felt exhausted but not as terrible as I had expected. The whole episode seemed a bit unreal to me. My sides ached and I felt a pain in my chest but that was it. Still I was suspicious. The chemical had surprised me more than once and I would not take another risk. I decided to lay off the stuff for at least a week and after that I'd never overdose again.
Now, two days later, as I am sitting here, writing, I actually feel the effect of withdrawal. This is going on since yesterday with mood swings, headaches and a pain in my chest. It's not too hard, it's manageable, but I certainly don't want to up the antes and experience a more severe form of it. It simply would not be worth it. It's hard to say if I was in real danger of getting a stroke, as the dose wasn't all that high and only taken orally. But then again these things are very subjective and vary from individual to individual. Also the amount of methylphenidate was surely higher than just 80mg on Monday, as an unknown amount had to be still in my system from two days ago. The accelerated heart rate does not seem all that high either when you look up the numbers, but the strain on the heart was unusually long.
Update: It's been four days and I still feel a pain in my chest and experience sudden bouts of unmotivated palpitation. I have a feeling this defect will stay with me a bit longer than just a few days. I haven't taken a single pill since.
Last update: My stomach problems are finally gone after 6(!) weeks. I assume my stomach lining was severely affected by the high dose of methylphenidate and it took that long to regenerate. I still suffer from a light form of aerophagus that my docter can't explain. Secondly I have experienced that I can hardly lie down while under the influence of MPH, as for some reason it makes me uncomfortable, while I have hardly any problems while in the vertical position.
I asked my doctor for a lower dose and was prescribed 40mg. Instead of seeing this stuff as a welcome opportunity to have some fun, I will now use it the way I should – as a medicine – and take it regulary. I don't think I will ever develop an addiction as I begin to feel about methylphenidate the same way as about alcohol and THC. What I am trying to do now is to make good use of the passivity that comes with ADD. If something is potentially bad for me, I simply stay passive and do not actively attempt to put any more energy in acquiring it. Sounds crazy? Maybe, but this is how I dealt with all threats in the past and successfully so.
Frankly, knowing that I suffer from ADD with its specific symptoms was just as helpful as the prescription of amphetamines, as it provided me with an answer to my shortcomings and let me finally find strategies to deal with it effectively (even though I probably will never have the same output of work others have). It also reduced my guilty conscience and much of the stress and pressure associated with it, which is a great relief. I still take my dose of methylphenidate as I came out of this little adventure unscathed. It's a lower dose though – one that will only keep my from sleeping half the day and less urgently lets me crave the stimulation that makes me unproductive.
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