ASD and sensitivity to medications – my experiences (2023)

NOTE This is my personal experience, not medical advice. See my full disclaimer.

 

NOTE (December 2024): My perspective and understanding of psychiatric medication has evolved significantly since writing this post. I’ll be publishing a 2025/26 update soon that reflects where I am now. This post remains as a record of my journey and experiences during that time.

The TL;DR – From my experiences, neurodivergent brains react to medications/stimuli differently – usually either with less or more sensitivity.

In my experience, even a child’s dose or sub-therapeutic dose of a medication can have plenty of effects on my body and mind.

The Medications I’ve Tried

ADHD medications:

• Methylphenidate
• Lisdexamphetamine
• Concerta

Mood medications:

• Sertraline
• Escitalopram
• Fluoxetine
• Mirtazapine

Anxiety:

• Propranolol

Why I Think Children’s Doses Work for Me

I’ve noticed that children’s doses seem to work like adult doses on my body.

For example: The recommended starting dose for Citalopram is roughly 10mg. I started on 5mg and couldn’t tolerate 10mg due to side-effects.

The surprising part? I found therapeutic benefit in the 5mg dose anyway.

Same story with Lisdexamphetamine. I started at 20mg extended release and that was borderline too much. Side-effects were okay until it subsided, then I was left unable to have a full night’s sleep.

My Medication Journey (The Details)

CONCERTA 18mg

This was my first ever ADHD medication.

The 18mg dose translates to roughly 3 doses of ~5mg instant release Ritalin. It’s a capsule that uses an OROS system – basically an osmotic release system where the concentration gradient between your body and the pill allows the medication to effuse slowly.

The verdict: It worked well for 6.5 hours, but I felt super on-edge, irritable, anxious and overstimulated. I couldn’t justify the side-effects.

Note: All these ADHD medications affected my appetite.

METHYLPHENIDATE IR 5mg (Instant Release Ritalin)

My prescription was 5mg twice daily – “the child’s dose”.

When I started taking it, I realized the 5mg was just on the border of being too intense. It was quite uncomfortable to sustain long-term.

My experiments:

• 7.5mg in one dose = bearable, but creeping up in intensity with side-effects
• 5mg three times daily = felt strung out all day

What actually worked: After all that trialling, I decided to take 2.5mg of methylphenidate 3-4x daily (every 90 mins).

This greatly improved my symptoms with both less side-effects AND an improvement in my baseline concentration and performance.

DIAZEPAM 2mg

I have a prescription for 2mg tablets (six per prescription).

A standard diazepam tablet is 5mg, but I’m given 2mg because I’m very sensitive to medication – and it works.

I’ve used it for panic events and sometimes when my Ritalin becomes too overstimulating.

⚠️ WARNING: Diazepam is very habit forming and your body becomes reliant on it to deal with anxiety. I’m no longer using this medication as tolerance started creeping up on me.

FLUOXETINE 10mg

I tried this for about a week.

Edit (1 week later): This drug caused horrible anxiety, panic attacks, breathlessness, palpitations and low appetite around day 5. It became worse even after discontinuing.

It may be different for you, but I barely recovered. I’m now on day 2 of Escitalopram again.

MODAFINIL 100mg

I’ve tried Modafinil in the past but haven’t been prescribed it.

Last time it gave me an anxiety attack because I thought I was going to develop Stevens-Johnson Syndrome (an allergic reaction).

Why I’m still considering it: It’s a dopamine reuptake inhibitor with no adrenaline involved – which means lower likelihood of anxiety. Plus, its length of action is appealing.

PROPRANOLOL 5mg

I only tried this for one day.

What happened: I became paradoxically even more anxious because I was worried its beta-blocking effect might stop my heart (especially due to how calming it was).

Health anxiety caused chest pains, panic attacks, and I ended up self-admitting to A&E. Discontinued.

⚠️ Note: This is a risky drug if you have asthma.

SERTRALINE 25mg

This was my first ever psychiatric medication.

It seemed to take the edge off my anxiety, but it gave me unbearable tinnitus.

MIRTAZAPINE 15mg

This worked almost immediately with my sleep and mood.

The problem: It made me insatiably hungry. I ate 5000 calories in one day – almost double what I usually do.

ESCITALOPRAM 5mg ✓

This drug seems to be the one.

I’ve been on it for almost 8 months in the past. I tapered off because I thought I didn’t need it anymore (spoiler: I did).

What it does: Really helps my anxiety by letting me think through anxious thoughts. It helps physical symptoms too – palpitations, air hunger, etc.

Since Ritalin is a stimulant, it’s important to counteract any anxiety-inducing effects so it can be therapeutic.

The Science Behind It (My Theory)

(December 2024 commentary: Here’s what I thought was happening: if sensory hypersensitivity is about nerve signals, and medications affect nerves, maybe that’s connected?

Turns out, neuroscience is way more complex than that. But medication sensitivity in autism IS real, I just didn’t understand the mechanisms properly yet.)

[For a more accurate explanation of medication sensitivity in autism, see my 2025 update post.] (update coming soon)!

 

Here’s what I think is happening:

If you’re hypersensitive to sensory overload – touch, sound, taste, smell, hearing – that’s all based on nerve impulses.

You know what else affects nerves? Drugs.

So if you’re touched by someone and you feel that more sensitively than a neurotypical person would, then the logic follows that if you took a 5mg dose of methylphenidate, you’d feel that a lot more strongly than your neurotypical counterpart would.

“Trip Reports” (Unedited Notes)

Ritalin IR 5mg

Positives:

• Improves productivity (though can make me feel like I’ve done more than I have)
• Makes reading, comprehension, working memory and memory storage better
• Works for around 2-2.5hrs

Negatives:

• Attention to detail hasn’t improved much
• Unpleasant emotional side effects: dysphoria, depression, anxiety, apathy, anhedonia
• Instances of anxiety, paranoia, hallucination/illusion
• Doesn’t make unappealing tasks easier or less overwhelming

ELVANSE 20mg – Day 1

• T+1-1.5hr: Onset, very smooth
• T+4hr: Started feeling anxious (otherwise manageable)
• T+5.5hr: Anxiety completely disappeared
• T+7hr: Calm, positive, but not majorly focused
• T+9hr: Still calm, getting tired, didn’t study or blog (played games)
• T+12hr: Very smooth comedown, not ready for sleep yet

Side effects: Increased toilet frequency

ELVANSE 20mg – Day 2

Observations:

• T+6: Noticeable slump in effects
• Procrastination is more efficient (doing things I think I should be doing rather than what I’m drawn to)
• General dysphoria/lack of zest and colour to life
• Mood more stable than on Ritalin
• Perception quite normal – like I’ve had a coffee
• Productivity example: Wake 7am, by 10:15pm: breakfast, brushed teeth, 350 words for blog, 45mins of A-level Chemistry

Concerns:

1. Insomnia/broken/light sleep
2. Organization skills and structure issues remain
3. Motivation drastically diminishes after T+6
4. Same weird “hearing things” (infrequent but worrying)

Beyond the slump: Still feel mentally sharp, but without drive to do anything with it (especially uninteresting things)

ELVANSE 20mg – Attempt 3

• 5:15am: Taken on empty stomach
• 6:30am: Beginning to feel comeup
• 7:15am: Dressed, had breakfast, came downstairs, logged calories
• 9:00am: Took car to garage, walked back
• 10:15am: Beginning to tire, having a snack
• 10:30am: Lying in bed, very tired
• 12:03pm: Still in bed
• 10:00pm: Nauseated and depressed all day

Should I Read Medication Reviews?

Yes, but with a massive pinch of salt.

Reviews help give you an overall idea of how successful a medication is and which common side-effects it has. But they’re not “one size fits all”.

Example: I had awful experiences with Fluoxetine 10mg, yet my friend is on 20mg of the same drug and he’s having a perfectly fine experience.

My advice:

• Just try what your healthcare professional prescribes
• You can always stop if you need to
• Don’t be afraid to ask questions or mention alternatives you’ve researched
• You probably won’t find a perfect match at first try (or ever)
• But you’ll likely find something that helps ENOUGH

I thought my first psychiatric drug would fix all my problems. That couldn’t be further from the truth.

However, they have made my life easier to handle than it was before without medication.

What About Therapy?

I’ve had many types of therapy – mainly for depression and anxiety. Some ineffective, some very effective, some sort of effective.

Cognitive Behavioural Therapy (CBT) ✓

Most effective so far.

It’s helped reduce my social anxiety and health anxiety. CBT involves homework and behavioural experiments to “prove” to yourself that your beliefs aren’t as strong as you once thought.

Talk Therapy/Humanistic Approach

Mixed results.

It improves symptoms, but it’s much more subtle than CBT. You come away feeling positive, but without the “takeaway” that CBT gives you.

It’s more like a stress release and an indefinite method of relying on someone to vent to.

Alternative Therapies (EMDR, Hypnotism)

My opinion: Absolute waste of money.

I only went for one session of each, but for good reason – I took home zero value other than the strange experience.

A Note on the Therapist

This is MASSIVE.

It’s not just the type of therapy, but also the person practising it that matters.

I can’t tell you enough how important it is to “click” with a therapist. A good therapist vs. a subpar one is the difference between your best friend and a drinking acquaintance you see infrequently down the pub.

Yes, you like both and they ultimately serve the same purpose, but the best friend brings depth that makes you appreciate how much more that relationship brings to the table.

What About Meditation?

Meditation has helped me quite a lot.

I still consider myself a complete beginner, but I can testify to its usefulness and benefits.

MY CONCLUSION

As of today: I’m doing just fine on 2.5mg of Escitalopram daily and Methylphenidate 5mg 3x daily.

Note: We’re still trying to find the right dosage.

December 2025, what I’d tell past me: Make sure you have the basics down 100% before you jump to more complex solutions. Removing negative things is often more helpful than adding more positive in.