Depression, heavy drinking, binge eating, insomnia, compulsive shopping — by her thirties, Kat Brown had accumulated a list of mental health problems. It was only when she began treatment for ADHD that life began to make sense.
Shortly before I turned 30, and while in a period of depression I seemed to cycle through every few years, I started seeing a new therapist who appeared only to wear cargo shorts. After one session, I wrote in my Notes app on my phone, “Today I suspect we got to the crux of the matter with Doctor Steve: ‘It sounds as though you think you are defective.’ " It was a testament to this man’s gentle competence that I minded neither the shorts nor his conclusions. I had spent my life trying to control how people perceived me and it was a relief to drop the act. But as much as I had started opening up about my constant sense of dread, and generally feeling more like an avatar in a meat suit than a person, I didn’t know how much time was still to go before I would get the answer to why I felt defective.
It started at school. Those years were confusing because I was seen as weird anyway. Not least because I had been moved up a year when I was 7 for being extremely tall. I was 6ft 1in by the time I was 13, in a non-model way, and I was a redhead, which in Nineties Britain meant repeated calls of “Ginga!” across the playground as though I had come to school via a slurry pit. I felt something more than sadness coming in when I was in my second year of school: negative self-talk amplified by being bullied by boys, girls and occasionally the teachers. I found sleep very difficult as my brain would explode into waking the minute I turned off the light. Still, I loved reading, acting and horses. I did well in my A-levels.
But I was suffering. It was all explained away by adjectives: oversensitive, sad, weird, odd, emotional, immature. Something thin and grey papered itself over my brain — depression — and I didn’t realise it shouldn’t be there. Nor did I realise that the way I blankly consumed packets of chocolate bars in a zombie state wasn’t greed or stealing (or not only that) but binge eating. I didn’t realise that my racing thoughts and constantly feeling on edge were anxiety. I didn’t realise anything. On the one hand, I thought I was perfectly fine and why were people so strange; on the other, I could see how some people responded to me — with disgust, disappointment, surprise and laughter — and it horrified me.
By my late teens, I was self-harming. I had no idea what I was feeling or why, only that everyone else must be feeling normal and it must only be me who felt appalling. (I was horribly wrong. In 2011, I went to the funeral of a school friend who took their own life.) And so after years of feeling awful, and making my family’s life a misery, at 18 I was finally treated for depression. But once at Durham University, where I was studying modern European languages, I started failing one of my courses and panicking about flunking out altogether. Things were bad. Really bad. I had terrible insomnia and struggled with the early mornings and bright lights of lecture theatres. I used drink, food and sociability to drown out the negativity and panic that were my brain’s constant companions. You’d never have known that I had started to think it would be easier if I disappeared altogether — or that I was planning how to make my exit — by the number of positions I held in college, the societies I belonged to: the theatre, sports, debates, everything.
I even met my husband at university although we didn’t date until 13 years later. He is supportive, kind and generally excellent — but I am so glad we didn’t date in my chaotic twenties as I very much doubt we would be married now.
When I started work, my feelings were transmuted into alcohol and big nights out to let off steam. I never had an intimate conversation with my friends about feelings — I had absolutely no idea how, and I was terrified about scaring off people I loved. Ironically, holding things back led to my losing friends. I’d been friend-dumped at 13 for being hard work (fair enough), and the same happened at 21 when I learnt that I was much worse at hiding my depression than I’d thought. Not talking about it just compressed it, also affecting the people around me through my moods and brittle exterior. When I became particularly overwhelmed, I would binge on ice cream and cookies and then hate myself because I was too scared to be bulimic.
For years I didn’t know that the way I felt had a name — names, even. I thought I just had awful habits that I couldn’t get rid of. In 2016, after going to the doctor about talking therapy for depression, I was also diagnosed with binge-eating disorder. I had no idea I had an eating disorder, just that I had certain rituals around particular foods when I was under pressure. What else didn’t I know? A lot, it turned out. In 2019, my husband and I endured failed IVF and were given the non-diagnosis of “unexplained infertility”. In 2020, we were told we would not have children. We looked into adoption but eventually let it go: I secretly worried that my brain wasn’t balanced enough to proceed any further.
I felt greedy for accumulating so many mental health conditions rather than growing up and becoming a fully developed human who understood pensions and did their tax return in advance. I did start doing well in my journalism career, but I felt always on edge. I was made redundant twice, which, to my mind, meant I had to work preternaturally hard to stay employed. It took two further redundancies — and those two rounds of failed IVF — for me to spontaneously leave 9-to-5 work altogether. This decision, it turns out, was classic ADHD impulsion. I reasoned that since I didn’t need maternity leave any more, I should resign. Six months later, lockdown came.
Having just gone freelance, I lost all my work during the pandemic. I was doing a vaccine trial at my local hospital when I scrolled through Twitter and spotted a thread in which adults shared how they had first realised they had ADHD: drinking endless cups of coffee; being overstimulated by open offices and office lighting; failing to manage their finances; multiple mental health diagnoses. I sat up straighter and went on: eating disorders, insomnia, depression, anxiety, epilepsy, addiction issues. I saw the past 30 years of my life. Is this what’s really been going on with me?
Some people deride self-diagnosis, but isn’t that, to an extent, what we all do before deciding to see our GP? I read and listened to everything I could find about ADHD. It was like doing a jigsaw puzzle without the box and finally seeing the picture — one you didn’t even know you were looking for. Armed with a folder of evidence, I asked my GP to refer me for an ADHD assessment. When I learnt the waiting list was a year, I used my tax savings to go private. I wasn’t called to book an NHS appointment until early 2023. It staggers me that the promised year-long wait would have taken three if I hadn’t gone private. As an illustration of how many assessments the UK has to catch up on, the cost of my assessment has more than doubled since I was diagnosed and the NHS waiting list averages four years, with a further wait before accessing medication.
And so I was diagnosed with ADHD in 2020, at 37 years old. Another thing to add to my embarrassing shopping list of conditions. I have spent most of my adult life and almost all my money trying to fix myself through exercise, weight-loss groups, hobbies, self-help books, therapies. Nothing stuck. Nothing except the gentle certainty that something was wrong — that I was wrong. When my psychiatrist released me into a shared care agreement with my GP in 2021, he said something that I think should be said to anyone diagnosed as an adult: “You have achieved so much without support, and you should be really proud of yourself.”
So why was I so bothered about a diagnosis? Because a diagnosis is an explanation, not an excuse. And a name matters. And now I wanted an explanation as to why I found things more difficult than my peers. So when I was diagnosed, I felt as though I were in a West End show and a red velvet curtain was about to drop. It was the closest I’ve felt to a happy ever after, and it lasted approximately a week before I realised I was going to have to get into research mode to find out how to live with it.
Researchers have found that ADHD is part heritable and part environmental. You might be more prone to it if relatives have experienced mental health problems of any kind, not just ADHD. I learnt that ADHD often comes with multiple comorbidities or co-occurring conditions, of which disordered eating, insomnia, depression and anxiety are common — all of which, I think we’ve established, I have experienced throughout my life.
When you read a piece like this, it’s nothing really: words read in a matter of moments. How can this person make such a fuss? What I need you to do is to imagine this terror stretching out through hours, days, years — a life. Imagine that your every move is accompanied by so much deafening mental chatter that you just can’t concentrate, and that your self-esteem is shattered by finding life so much harder than it seems to your peers, and that surely there must be something wrong in you. Add to this that you sleep badly, that you have low energy and a constant feeling of panic and that as a result you might abuse alcohol, caffeine, sugar and food either to calm yourself or gee yourself up and… well, it’s a lot.
If “almost everyone seeking a private diagnosis is getting one”, as a BBC Panorama programme suggested in May 2023, do we not also think it’s possible that only people who think very strongly that they have ADHD are going down the route of coughing up a lot of money to get one? Many people with undiagnosed ADHD will have already lost a lot. I had years of face time with NHS staff and nobody recognised that I had ADHD. While writing my book, It’s Not a Bloody Trend, I spoke to adults who have spent their lives feeling shame for not being able to navigate life “like normal people”.
It took me several months before I was on a structure of medication that worked, and I’m amazed by how the dosage varies from person to person. I was on a combination of slow and instant-release meds: atomoxetine, dexamfetamine and lisdexamfetamine, the latter known commonly as Elvanse. However, ADHD medicine supplies are currently in short supply — I haven’t been able to obtain Elvanse in months, but luckily my psychiatrist and GP worked to establish a replacement routine. Other people have not been so fortunate.
I’d always wondered why caffeine didn’t seem to affect me, and my initial trials with ADHD meds explained why. Rather than behaving like “uppers”, as they do on so many people, the amphetamines stimulate my neurotransmitters into behaving. They soothe my brain so that I can focus on one task rather than feeling pulled from one to another: speedy pills for a speedy brain, almost cancelling one another out.
Even on the meds, getting started can be a challenge. If I have a deadline or an appointment, that’s fine. If I have non-urgent work to do, however, I often end up briskly cleaning the kitchen or sorting out the laundry. But for once, it doesn’t feel like a big deal to prioritise tasks and keep track of everything. People make an analogy with having 1,000 tabs open on a browser and then closing them until just 1 remains. On meds, I feel as if the temperature reduces. Everything feels more balanced. They aren’t magic but, along with therapy, coaching and my ADHD friends, the drugs are helping.
Certainly, how I functioned before medication was in no way healthy. I constantly lived beyond my means. The type of ADHD that I share with 85 per cent of diagnosed adults shows up as both impulsivity and inattention. My bank statements were an insane mishmash of whatever I had decided was an urgent purchase. Candles, skincare and random gifts all gave me a hit of dopamine.
Often, these purchases came after weeks of research where I would hyperfocus on a product and decide I couldn’t afford it, only to have a bad day and hastily click to buy.
Much to my good fortune, and even more to my shame, my parents paid off my credit card endlessly in my twenties. I just didn’t understand how my friends could cope financially when to me it felt like water spilling through my fingers. From car fines to forgotten subscriptions and unintentional repurchases, my life has been soundtracked by the drip drip drip of the ADHD tax.
There is a meme that visualises the ADHD iceberg. Visible above the water is what people think ADHD is: trouble focusing and fidgeting. Under the water is what it actually is: executive dysfunction; losing items relentlessly; choice paralysis; trouble regulating emotions; problems focusing on things even if they are of interest; hyperfocusing on others.
I was disappointed that my life wasn’t instantly fixed when I started taking my tablets. But as Professor Susan Young, co-author of the 2008 National Institute for Health and Care Excellence guidelines on ADHD, explained to me, “Pills don’t teach skills.” Her co-author Professor Philip Asherson describes the ideal ADHD treatment as a “golden triangle” of medication, behavioural coaching and therapy.
I try not to regret what could have been. I have grieved my mistakes, from impulsive behaviour that lost me friendships to near-catastrophes from my binge drinking, and tried to make up for them through changed behaviour. But it can be easy to feel bereft for what could have been if you had only known 20 years earlier.
It’s Not a Bloody Trend: Understanding Life as an ADHD Adult by Kat Brown is available to buy now.
Written by: Kat Brown
© The Times of London