Notes on Managing ADHD
The first-line treatment for ADHD is stimulants. Everything else in this post works best as a complement to, rather than as an alternative to, stimulant medication. In fact most of the strategies described here, I was only able to execute after starting stimulants. For me, chemistry is the critical node in the tech tree: the todo list, the pomodoro timers, etc., all of that was unlocked by the medication.
This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.
It was the equivalent of running a marathon carrying an 80 pound backback. Yeah, with enough work you can do it, but you're not going to be setting any records.
Stimulant meds have been lifechanging for me. I'm not magically doing more than I was before. Those coping mechanisms took me pretty far. It's that I'm doing it all without delaying them until they became emergencies, which is what it use to take before I could even get started. My life is so much easier and less stressful now.
I took that backpack off and how I can run the same race as everyone else. And you know what? When you've been practicing your whole life with an extra weight on your back, and you take it off, sometimes it's surprising how fast you can go.
In before "of course it's easy, you're on meth!" Yeah, that sounds reasonable if you know nothing about ADHD. I've talked about this here before, but Aderrall has no noticeable stimulant effect for me at all. I feel a good cup of coffee much more than my daily meds, which is to say, not a lot. It doesn't give me extra energy or alertness or anything else. It just tells my brain, hey, did you know you're allowed to get started on things before they become emergencies?
Now that I’m medicated (methylphenidate), I still lean on those systems but they serve me very very well. I remember details much better than I did, but don’t always remember them long-term. The note taking system and habit that I developed years ago is now… supercharged because I am so much better about keeping good notes.
On the coffee/meds thing, I agree. I don’t get a buzz from the medication the way I do from coffee, but before my diagnosis I was drinking a ridiculous amount of coffee every day just to stay focused, with the associated buzz and jitters. I still have a cup or two of coffee in the morning, but drinking anywhere near as much as I used to is pretty much unbearable.
It's hard to reconcile with how difficult it was previously. Life on hard mode is a term ived used too. I try to think that it was all to make me stronger for the second half of my life, but I still regularly wonder what could have been.
One time I realized I hadn't gone to my intro chemistry class yet that semester and had a test that day. I went, bluffed my way through based on what I remembered from high school chemistry, figured out mid-test how to calculate rate-limiting reactions, and aced it. My then-girlfriend, now-wife was so incredibly annoyed with me about every bit of that. "What do you mean, you hadn't gone to class, ever? And that you still aced the test?!"
And I also failed a comparatively easy general ed class because I just couldn't convince my brain to care, even though I know I needed it and certainly didn't want to take it a second time.
Had a midterm for a class I did actually like that went sort of how you described. I prepared for it a bit and was sitting around with some friends killing time before the 2pm exam. It’s about 1:40pm, I figure it’s time to head over. Go to the course website to find which room the exam is in and discover that the exam started at 1pm. Run over there, get there at 1:50pm, and finish the exam before the 2:30pm end time. Hand it in, the professor knew I’d been really late and had a weird look on his face as I give it to him. He looks it over, smiles, and says “I was going to offer some extra time for you because of the mix-up but… looking at your answers here… I don’t think you need it! See you on Thursday!”
Almost failed a history class because I couldn't do essays more than a day before they were due
I can do anything if it's urgent or interesting, but that's it
I try not to look/think back too much - I had (sort of still have) a very successful career but the costs associated with getting there were and are still being paid for.
Getting treatment and therapy has really helped improve my ability to be present, though still such a battle.
I took that backpack off and how I can run the same race as everyone else. And you know what? When you've been practicing your whole life with an extra weight on your back, and you take it off, sometimes it's surprising how fast you can go.
The way I've always described this to people is that before, in order to get started on anything I first had to bang my way head first through a solid brick wall. It was painful and unpleasant and an absolutely absurd amount of effort. It didn't matter if the thing I was trying to do was "a load of laundry" or "build a shed"... same brick wall. That's pretty crippling in day-to-day life.
And then once I get through it I wasn't in the clear. The first interruption, the first unexpected thing that came up... was another brick wall I had to bash my head through.
The medication doesn't take away the walls, but what it has done is turn them all into drywall. I still have to bang my head through a lot of walls, but after decades of going head first through brick walls everything just seems _comically easy_.
I really wish someone had identified this sooner so I could have gotten treatment earlier. I'm grateful my life has gone as well as it has. I don't have nearly as many things to look back on with regret as other people that were diagnosed late in life. It does suck to realize that everything really didn't need to be so difficult. And some habits and coping mechanisms that allowed me to function aren't exactly healthy for me or those around me, and those are hard to unlearn.
Well, huh.
(Similar story with asthma. I was training for a marathon relay. My doc asked how that was going, and I said it was fine, except you know how after a mile or so, you get cotton mouth and tunnel vision? No. No, they did not know. And that’s how I ended up with a pre-run inhaler, and immediately shaved a minute off my mile pace. Holy crap. Not everyone feels like they’re dying mid-run? Why did no one tell me?)
Hell, caffeine barely does anything for me if I'm not taking my meds - I could pound energy drinks and go to bed 30 minutes later. Meanwhile, unless I have built up a tolerance, nicotine would give me a legitimate rush, and I unknowingly self-medicated that way for years (though it was substantially less effective).
The human brain is funny, it doesn't matter if you're ND or not, different stimulants affect people in wildly varying ways.
This does nothing long-term for ADHD, and in fact creates a dependency on drugs which in many cases are not necessary because ADHD and other Spectrum Disorders fall into catchalls. It treats symptoms not the cause.
Sure you can manage so long as you get your SOMA, but the moment its gone you are back to square one, and the risk is not zero.
The best thing for managing this is meditation, and a disciplined lifestyle regiment.
Meditation being the intentional practice of stilling ones thoughts, which anyone can do with a little practice.
In my opinion, not a lot of people actually have ADD/ADHD, but the rhetoric gaslights towards this label because the diagnostic criteria are catchalls and ambiguous. Additionally, it has no cure, and treatments may have side-effects and other risk factors.
Fun fact, you can actually induce ADHD temporarily with a bit of hypnosis, its just a heightened state of awareness.
Most literature on ADHD, and other spectrum disorders doesn't pass muster, and they are just looking to sell you on an incurable ailment where you have to keep coming back for more.
The best thing for managing this is meditation, and a disciplined lifestyle regiment.
Wrong.
First you reveal your wellness nonsense with "creates a dependency on drugs"
Drugs that cure/alleviate your symptoms are good things. We like curing diseases.
It treats symptoms
Good. This is a good thing. Treating symptoms is a good thing and we like good things.
The best thing for managing this is meditation, and a disciplined lifestyle regiment.
Bollocks. The best thing are the easy, dependable, reliable medications.
rhetoric gaslights towards this label because the diagnostic criteria are catchalls and ambiguous.
The gaslighting is pushing shitty wellness cures, and ultimately the shame of their failure when there are tested dependable drugs available.
Most literature on ADHD, and other spectrum disorders doesn't pass muster, and they are just looking to sell you on an incurable ailment where you have to keep coming back for more.
I literally had to fight to get access to my ADHD meds, and I my only regret is not ramming a bulldozer in the side of a pharmacy a decade earlier.
Good. This is a good thing. Treating symptoms is a good thing and we like good things.
You frame this in fallacy, false dichotomy circularly. For a refutation, is treating poisoning with something that masks the symptoms of poisoning without resolving the cause a good thing?
The poisoning is still there its having a detrimental effect leading to harmful outcomes, and you don't know its happening because you masked the symptoms thinking its something else.
A concrete example? Chronic low-level exposure to heavy metal poisoning was quite common 20 years ago. It came largely from silver fillings which were in-fact 50% b/w, mercury amalagam. It was claimed stable and thus fit for us in dental fillings, but later found in the presence of acidic beverages to leach into your systems, and this is not the only exposure. Mercury has also been used in the efficient production and manufacture of Soda beverages, you have to dive quite deep in industry literature to find these facts such as they remove those chemicals after production, and label them as contaminants. No chemistry is ever perfect at removing things. They have been found present in many cases, and not all processes use this but the cost effective ones do. Similar environmental issues are neglected, such as lead paint and other products, arsenic from the water; you get the drift.
Ironically, these can easily fall into the same diagnostic criteria as ADHD/ADD and blood tests aren't sensitive enough because those substances binds so easily to remove it from the bloodstream rapidly (into tissue) to protect you. It bio-accumulates. You literally have to cause induced acute poisoning through medication (chelator) before taking the blood to get an appropriate test result.
The gaslighting is pushing shitty wellness cures.
Ad Hominem, and lacking in facts.
I literally had to fight to get access to my ADHD meds...
Ancedotal.
I've met quite a lot of people who initially thought they had ADD/ADHD because that is what the doctors decided. Once you have a label, there is no need to look at anything else that suggests otherwise, a common bias of your average doctor.
These people found that they actually had low-level poisoning, and half the battle was finding a doctor willing to order the chelation tests to prove it. Upon completion of rigorous chelation therapy and removal of exposure sources, and related lifestyle changes they were medication free without the symptoms. They, in effect, cured their ADHD/ADD, and some of them had been to hundreds of psychologists/psychiatrists, all being told they had ADD/ADHD.
Blind trust in centralized systems has an indoctrinated bias that some aren't able to overcome. Nothing is perfect, and some things are the worst possible solution of any solution.
The label in these cases was a classic authority based fallacy. The patients eventually did figure it taking their health into their own hands because the system had failed them, basically saying its all in their head. (Gaslighting).
It was a journey for many of them because they were repeatedly given false or misleading information from the vast majority of so-called experts. Desperation doesn't make things true.
Mind you not all experts are like this, there are some very decent and intelligent experts out there that know exactly what they should and act accordingly; but in the grand scheme they are almost impossible to find or differentiate.
What makes you blind is you assume the diagnostic label is automatically the disease, and that simply is not true in aggregate, or the correct way to approach these things.
You frame this in fallacy, false dichotomy circularly. For a refutation, is treating poisoning with something that masks the symptoms of poisoning without resolving the cause a good thing?
"Masks" is the problem here. If poisoning causes symptoms, like vomiting, you want to treat the symptom. Depends on various factors. Just like every woo purveyor you have a simple black/white mindset.
Ad Hominem, and lacking in facts.
You didnt make arguments, you just spouted a toxic opinion. You dont get shielded behind proper argumentation. The issue is you as a human are toxic. You specifically.
Ancedotal.
Not really, not for Adult sufferers. Its a very common story.
these people found that they actually had low-level poisoning
Lmao. "Low level Poisoning" you are cooked. Also right after complaining about anecdotal evidence. You literally stand for nothing.
Blind trust in centralized systems
No ones advocating for blind trust. Just informed trust. Instead of the blind trust in kooks you are peddling.
What makes you blind is you assume the diagnostic label is automatically the disease
What makes you blind is that you assume that anything anti authority is automatically true.
You didn't make arguments.
There was nothing to argue, your statement was unsupported, and the only thing you included was caustic criticism and broad over-generalization both fallacy implying what I was saying was shitty wellness cures and that has no basis and your post was designed to impose personal cost.
Why would I respond to that beyond my given response, when anything more is just giving psychopaths, narcissists, and other like-minded and rightfully ill people just what they seek?
I give very minimal effort to mindless bots; and that includes whether they are of the mechanical or base human variety level 0s incapable of introspection/objective reasoning, always trying to bring everyone else down to their crude and base level.
If you can't understand what you did and how it relates to fallacy, its not my job to educate you.
You clearly don't understand basic critical thinking skills, and are quite toxic for no good reason saying much more about yourself than anything you have to say about others. Arguably, no different than any other conditioned animal, and I don't take any pleasure in saying that.
You are mistaken, I'm not blind, I have a deeper understanding than you, quite apparently. I am also not easily manipulated and quite discerning.
I understand how things fail in detail, and I don't assume that contention you make about authority.
Those are your words, and false words at that.
Everyone has the potential to be better, few among the many actually choose to act on the potential and do so.
This is recognized earliest in Matthew 7:6, and in the behavior you exhibited. Compare and contrast.
As a thought experiment, insert "type 1 diabetes" in place of ADHD and apply your statement to it. You get "insulin does nothing long-term for diabetes, and in fact creates a dependency on drugs. The best thing for managing this is a disciplined lifestyle." See how ridiculous that sounds now?
As a thought experiment, insert "type 1 diabetes"
This is an apples to oranges fallacy flawed example, how about we do something that isn't apples to oranges, like heavy metal poisoning. How about we insert chronic low-level mercury poisoning in place of ADHD.
Here is a shocker, the symptoms are the same, and there are many other such environmental based issues that lead to these symptoms. The diagnosis is still ADHD/ADD which is made regularly because its a catchall, and so its the same label but its not the same thing.
So that ADHD diagnosis is ADHD, and its automatically neurological changes, or is it really Heavy Metal Poisoning, which then isn't being treated?
Are my sentiments causing real world harm to people when that diagnosis has been misdiagnosed? Really? This happens on the regular because of exposures that occur but aren't recognized or achieve testing thresholds.
The diagnostic label for spectrum disorders has been for decades incorrectly applied to people, in effect treating symptoms as a catchall.
How ridiculous do you sound in my particular example? Your causing harm to people because they thought they had ADHD because of the symptoms but actually were being poisoned because of a misdiagnosis that isn't questioned (which happens in centralized systems). Who is actually the one causing harm here. The one supporting that system and its consequences, or the one questioning the underlying truth of the matter (which has real anecdotal experiences backing this across a group of afflicted people).
Blood testing doesn't work well at detection of chronic low exposure without causing acute poisoning through a chelator, something that isn't done that regularly. Most doctors won't even order the test even after requests to do so.
Seriously, this kind of armchair theatrics and polemic is why the world is in such a horrible state today, but by all means continue shouting down people that actually know a thing about what they are talking about.
We're not going to bridge this disagreement over a HN comment thread. I would respectfully urge you not to spread that sort of misinformation online. Leave any advice regarding ADHD to be provided by qualified medical professionals, as your own advice could result in people not obtaining life-altering treatment due to FUD.
For there to be a disagreement in real terms there needs to first be a fair common definition of what is actually being disagreed upon, you haven't bothered participating enough to form that distinctly, so everything that follows isn't really a conversation; just ambiguous dissembling, imposition of cost, and manipulation of sentiment on your part to all other participants detriment. In other words, harmful noise that violates the social contracts.
There is a nuanced difference between advice in issues that occur in a medical setting, and medical advice. The former was asked and given in my responses and was the context we were talking about. The two are different contexts but sometimes similar in subject matter, and you suddenly switching to the medical context for the purpose of silencing what was said when we're talking about the former quite purposefully conflates the two to confuse readers in structured ways, which is quite reprehensible if done with malice as some of your actions and behavioral characteristics may suggest.
You claim that the information I provided, which included that of misdiagnosis, and the related facts (i.e. misdiagnosis exists, and the diagnostic challenges involved, with concrete references to heavy metal poisoning), is in fact misinformation; without any kind of support or reference despite there being easily found academic literature touching on this same subject (https://www.sciencedirect.com/science/article/pii/S0946672X1...).
Doctors get it wrong sometimes, and only the individual is left as their own advocate which is routinely not fully informed because of noise and channel capacity such as your activities here.
My own advice amounts to use your brain following rational scientific principles, with specific support, and that may result in people not obtaining "life-altering treatment".
The thing is that is a good thing for them to do when that "life-altering treatment", a contradictory ambiguous statement you used, directly resolves to a state where you as an individual are dead in the ground, or harmed as a result. Same exact statement, entirely different context and opposite contradictory and expected meaning. Such is the problem with doublespeak.
Ambiguities are indirect references, and one must always consider the intent of the person speaking and the direct resolution of such statements, and whether the person has shown they are earnest in their providing value with unconditional positive regard in a structured form that doesn't rely on credibility, or the alternative; malign influence which bases their activities in deception/coercion.
Rational practices don't rely upon the credibility of the person speaking. The reasoning is independently testable. You neglect much of this.
I would respectfully urge you stop your malign use of psychological priming, and other deceptive behaviors including the distorted reflected appraisal you've engineered into your responses.
If you were a rational person participating in earnest, you wouldn't be doing any of those things.
ADHD isn't something that people can just willpower their way out of.
I think conflating structured meditation practice with "just willpower your way out of it" is a pretty severe misconception of its own. That's not at all how it's supposed to work. (In fact, if you struggle with focusing your attention in a meditation setting, you're taught not to apply willpower at all; just "notice" that your thoughts have drifted away and comfortably bring them back without judgment. You wouldn't expect this to help, but apparently it does.)
The best thing for managing this is meditation, and a disciplined lifestyle regiment.
What would be your reaction to the numerous comments on this page where people are saying that they tried and failed to "discipline" themselves for years or decades, only to discover medication later and find that it instantly turned everything around for them?
Here's what discipline is and isn't.
Discipline is an extremely simple concept to develop but few actually know how to do it in any reasonable way because of so much misinformation out there, and malign influence seeking to take advantage and increase suggestability, and by extension addiction.
Discipline just like meditation is really a fundamentally simple practice.
Just like with meditation, where you don't use willpower, but instead simply focus your thoughts back towards a single point, and then relax that focus slowly, which stills your thoughts.
Discipline is simply the repeated practice of limiting when and where you choose to change your initial decision or choice, for all of the choices you make.
You take your time considering before making a choice, and once made you only change it when there is some new information that becomes available after the fact, whether that is a new consequence you didn't consider, or completely new information you received later.
Its a simple rule. You don't give yourself the choice except under those circumstances. When you are tempted, you remind yourself you don't have the choice. When you cave and fail, you don't beat yourself up because that destructively interferes with your psychology which only works towards outcomes framed in the positive. If you make a mistake you examine what led to it right away, and mitigate those circumstances moving forward. You imagine what you will do next time, with a successful outcome a few times that day.
With this repeated ritual comes an understand that willpower is always finite, and you pick and choose what you will spend that on each day. You recognize when its running low, and defer important decisions pigeonholing them for a later time. With repeated practice in everything this become a unconscious ritual with good outcomes.
You do what you say you will do, and you don't compromise yourself, and people recognize that level of discipline. It becomes easier with each successful choice, and its so damn simple.
These two things together make a world of difference in coping with everything. It places the locus of control for your life within your grasp.
only to discover medication later and find it instantly turned around everything.
First, medication in most cases in psychology doesn't instantly ever turn around everything. You still have the problems that led to your mental state, they are often subtle which have built up over time. You are just better able to cope with them where you weren't coping before, and following the initial euphoria of relief you still have those problems.
I know quite a number of people that have been diagnosed and use medication to cope with professional burnout. Eventually you pay the piper.
Sure you can take a drug, and maybe you feel better, but also maybe you feel like everything is 100x worse and to relieve the pain and suffering you end yourself; (a known sideeffect) or you have a chemical reaction that ends up in sudden death (a known sideeffect). Few actually consider this, minimizing it.
There is no panacea. Soma is just treating the symptoms. What you do, and things you choose to live by are far more important, especially in contrast to the fact that many medications make one more suggestible. For good or ill.
First line is a reasonable very rigid schedule where you sleep 8hs, exercise/walk in the morning, and contain your distractions to a specific time in the day. A strict healthy diet. Plan when to interact with people and when to go to nature. Do a lot of visualization of what you want the day to be like (be reasonable). Time-blocking is very good (see Cal Newport)
IMO, only when you mastered the basic of a routine like that you should try prescription drugs. And even when you do, figure out how to need the least possible dosage. For example, eating a high-protein breakfast 1 hour before taking the medication and zero/low carb until evening. Then taking vitamin C foods with dinner to clear it out and prevent crashing or insomnia. Try well-timed over-the-counter supplements to improve how the medication works (magnesium, tyrosine, etc). IF YOU DON'T DO IT THIS WAY YOU WILL GET LESS DESIRABLE EFFECTS AND MORE SIDE EFFECTS. And you will risk spiraling into more and more mg and addiction. Remember: if you have ADHD you are very, very prone to addiction!
Ask your psychiatrist for a slow-release medication (Lisdexamfetamine or XR). And time how you react to it so it matches your ideal schedule. Have detox and reset days where you don't take the medication and don't study/work. (e.g. weekends or at least Sunday)
If only there was something, like, some kind of pill that could help with it...
You have to train your brain. If you always walk with a crutch you will never walk properly. IMO, you should only try drugs once you can sort of stick to the schedule and you are still not reasonably productive.
If you start with drugs you'll become dependent and will need more and more. There is no magic pill.
It's not always possible for someone to just tell themselves to start obsessing over a perfect schedule and just do things perfectly
the whole problem is the inability to do those things.
Yes, you can do it to a degree, but a kind of "follow the instructions" rarely works for me in any way.
You saying you should only "try drugs" if this schedule doesn't work just makes no sense to me.
You can't treat ADHD with just a schedule
But one thing I do think is that too many people expect the drugs to be a magic bullet that removes ADHD
from my own experience and from what I've heard, that is absolutely not the case.
It's a tool, and it helps somewhat but it depends on a lot of variables and sometimes it barely helps at all.
It's not a choice.
Medication is not a silver bullet, but it allows, as explained in the parent article to do those things.
Your comment show a lack of understanding of the condition.
Perhaps, since I'm not a specialist. I did use to think like you but I changed my mind through personal experience and helping relatives and friends with the same condition.
I wish you well.
I have obsession: I can't decide on what.
This is something that some good old-fashioned introspection (and meditation definitely involves introspection) might be able to fix for you. Learning to harness and redirect the inner energy of your "bad" tendencies is a well-established aspect of many kinds of therapy.
But if you do end up taking stimulant medication for ADHD, that's not allowed. So unfortunately sometimes (rather often with the FAA) it's better not to ask questions you don't want the answer to.
The fact that somebody can be completely undiagnosed, untreated, and potentially self-medicated, will get their medical certificate issued while those seeking treatment and function at the same level as their peers get deferred is madness. I completely understand concern being warranted, given a majority of airline accidents can, unfortunately, be attributed to pilot error, but it shows a maddening lack of understanding of the condition by the agency. Especially when their justification for telling AME's to defer individuals actively taking ADHD medication has nothing to do with the condition itself, but some bullshit that it actively increases cognitive deficits? Give me a break, I'd rather they just be honest, "we don't trust people who need stimulants to properly follow routine checklist procedures that are the bread and butter of a commercial pilot's job."
but some bullshit that it actively increases cognitive deficits?
It doesn't look like obvious "bullshit". A number of ADHD medications are well-known intoxicating substances; it's not unfathomable that they might induce some kind of cognitive or behavioral impairment (not necessarily the same kind one might get diagnosed for, either).
And it's not like flying airline routes is a job that would even appeal to the typical ADHD-diagnosed person - like you said, its "bread and butter" is sticking to boring checklists.
My ADHD diagnosis is not a reflection of my personality, it's a chemical imbalance of my brain that prevents things non-ADHD individuals would consider rewarding from feeling that way to me. I fucking love spending hours flying an A320 around in Flight Simulator, and I literally go through most of the same checklist items that commercial pilots do in a game, just to fly some virtual cargo around in return for imaginary internet money on FSAirlines.
Do I want to be a commercial pilot? No, I've got a pretty good job as a SWE/SRE that requires substantially less bullshit, and the vision in my left eye can't be corrected enough to pass a FAA ME for a commercial pilots license anyway. But I will be absolutely damned if I let somebody say it wouldn't appeal to me anyway just because I have ADHD - like I don't have enough bullshit checklist work to go through in any other job.
If this were really about safety, there is so much other actionable low hanging fruit to make things safer. Looking at the TSA and ask the security theater there. It's not surprising.
So then the question is, if in a professional pilot and I think I might have ADHD, do I follow up on that hunch? Of course not, because a diagnosis would cost me my career.
There’s good research to show that stimulants reduce the rate of car crashes in people with ADHD. I have no doubt that if we encouraged pilots to seek ADHD treatment, it would improve safety.
IMO the diagnoses that should exclude someone from flying are those that could cause them to become suddenly incapacitated. For everything else, we can just test whether someone can safely fly an airplane, which we already regularly do for pilots.
What is the difference between someone with ADHD who passed their pilot lessons but doesn't have a diagnosis and is not taking medication vs someone with ADHD who is getting help?
Why is this an aeromedical issue and not a certification issue? What is the training and testing for if not to confirm that someone has the capability to successfully fly a plane?
I tried the major ones (Adderall, Ritalin, Vyvanse, Concerta, etc.). They all made dealing with ADHD significantly easier, but even at the lowest doses they turned me into an extremely anxious and irritable person. I had never experienced anything close to a panic attack or nervous breakdown in my 30+ years of being alive until I started taking stimulant medication.
I decided that living with untreated ADHD was the better alternative, so now I'm back to copious amounts of coffee to deal.
Again, chances are it will work for you without side effects so work with your doctor. Just be well informed.
After that it normalized.
I started taking it 1h before I get out of bed every morning, so I could sleep well at night.
My wife gets good results with atomoxetine, which isn’t a stimulant.
Try a much, much lower dosage (e.g. 7mg/day instead of 30mg) and spread it out over hours (even if it's already a slow release medication!). Do exhausting exercise in the morning. Eat very small amounts of slow releasing carbs over the day to keep your glucose levels right as these medications lower blood glucose and that gets you grumpy, and also they reduce appetite. If you absolutely need caffeine, drink green tea with 3x water, and take L-Theanine to curb the anxiety.
Zero alcohol, cannabis, and nicotine because they will mess up your dopamine system.
And find a better doctor.
(And read this other comment on schedule https://news.ycombinator.com/item?id=45091187)
How do you take 5-10ug? Dissolve 10mg in a litre of something. Get a 1ml dosing syringe. It has 0.1ml markings.
You could start there and increase it until you find what works. Also, if you take very little you can have a break on weekends and not suffer too much while remaining sensitive to lower dosages.
It's definitely a stimulant and can give you the kinds of side effects you might expect from any stimulant, including a raised BP and heart rate.
Sure, but people wouldn't downvote a comment suggesting having couple of cups of coffee per day to improve ADHD symptoms as hard, for example. And for me caffeine withdrawals symptoms have always been more difficult to overcome compared to nicotine.
For average tech worker HN user living a sedentary life-style, having stressful job in polluted city periodic usage of nicotine patches won't make it to their top list of health concerns IMO.
We can have two companies release the same code, but the ui/UX of the users interaction with it can make all the difference.
Plus pretty bad for your health and crazy addictive. Absolutely not a good recommendation.
Tolerance builds up crazy fast and doesn't meaningfully lower even when you cease smoking for years.
I specified not smoking it though?
Plus pretty bad for your health and crazy addictive. Absolutely not a good recommendation
You’re saying that it’s “bad for health” as something separate from its addiction potential?
How is it bad for your health exactly?
Also, ‘Crazy addictive’ is related to delivery method.
Also, there may be critical differences to people who have never smoked before.
https://www.pbs.org/newshour/amp/science/column-recent-resea...
As a note, bupropion did make me feel a little funny. It wasn't bad, weird, or intolerable, but yes I did have a faint perceptual awareness that I was in a medicated state.
- made me feel pretty energetic. Not buzzed, but maybe counteracted low-grade depression. I was on it because I wanted to quit smoking, because I was hoping quitting smoking would make me feel better/happier
- slightly affected my vision/perception. Colours seemed more vibrant. Everything just felt perceptually… brighter.
- made me really horny, but not in a compulsive way. It wasn’t distracting and didn’t cause any problems, but I definitely had more drive. When it was go time, it was Go Time :)
:D
every thought comes with a couple of extra thoughts, for free!
Bonus points if you branch deep enough to lose the original thought.
b) plan a trip to the Turkey, find a specialist there, get the prescription, do all the paperwork/preparations before going back
c) fill all the papers and get the approval at customs even if they didn't know about that before - prepare all the necessary links to official documents, as maybe you would have to explain them how to do their job
p.s. I know that feeling. Atomoxetine is full of side effects without direct effects.
I had various neurological issues for the past 10 years, some of them common like visual migraine auras, GAD, panic attacks, and some of the less known and frankly hard to describe - visual snow, poor night vision, problems with adapting to light/dark places, constant fatigue, over stimulation (pins and needles over the whole body when overheating, as an example). On top of that, ADHD and I was really afraid of any and all kinds of medication, especially mind altering ones.
At one moment, I was in a really bad shape and place mentally and I decided to get professional help and start medicating, as I felt nothing else can help me anymore. And believe me, I did try all kinds of therapies, exercising (how do you do it with constant fatigue?), mindfulness and meditation (closing eyes when stressed was horrible experience for me!), nothing helped.
Look, you can tell me it's placebo or whatever, but I started on SNRIs and later on stimulants for ADHD. It took me _2 weeks_, to cure 80% of my neurological issues. It was almost like someone flipped a light switch in my nervous system. I still can't fully believe it or even try to understand, but my theory is that I've been genetically destined to have these problems, and "just trying hard enough" was not enough and would've never been enough.
SNRIs cured my neurological issues, and stimulants like Ritalin gave me willpower to start making positive changes and for the first time - start making habits. I believe, at least in my case, it would've been impossible without medication, or it would take me half my life to get to a place where I would've felt comfortable with myself and my problems. I believe my life is too short to fight with all of these issues alone, and I'm really glad I did start that.
tl;dr: medication gave me my life back, not just from ADHD but from variety of other issues, that ADHD just exacerbated. Please do try medication, it's not a one way door and we humans don't have infinite willpower to deal with all the issues on their own.
I seem to be in opposite camp where SNRI actually lift like majority of visual snow syndrome, but that was not the only syndrome I had. I believe I had something more like HPPD.
Believe me, I was scared as hell as I thought these meds will make it worse, and I am really glad now that I did try them and they did work for me. I still have a really small amount of snowing, but I can ignore it entirely and carry on with my life.
A big realization I had was that doctors don't necessarily start by prescribing the medication that's most likely to help, they prescribe the one that's got the highest expected benefit to negative side effect ratio.
If you had diabetes, you wouldn't feel hesitant to take insulin. It's not a moral failure. It doesn't mean you're weak or bad or a disappointment. It just means you have a medical issue that can be treated. Well, same here.
When I was in the hospital and couldn’t get out of bed, the nurses provided me with some. They seemed to be partially working, but I was still having pretty intense cravings all the time. After doing a bit of napkin math I realized that the patches were only providing about 1/3 of the daily nicotine I’d been consuming before my appendectomy.
When I tried to quit on my own, I started out with the recommended dosage from the package and had the same experience. They modulated the cravings a bit but were nowhere near effective enough to actually allow me to go through the day without chronic acute cravings. I bumped up my daily dose from the patches and did successfully stop smoking, but trying to reduce the dose too much led to the same brutal cravings. I ended up abandoning patches as a way to quit because of the daily hassle of trying to slowly wean myself off of the patches; a full patch decrement was too much at once, so I was cutting them into halves and quarters to try to make progress without ruining my concentration and focus.
...without ruining my concentration and focus.
I suspect that this just isn't in the cards given that kind of situation. You're ultimately just better off suffering through that withdrawal (especially since you've said you were in a frickin' hospital to begin with. It's not like you're losing that much effectiveness and productivity) and trying to find a new normal after the worst symptoms are over. It might take some time but our best guess is that kind of habituation is not permanent, so you should see quite a bit of improvement over time if you just stick to it.
I used the patch to quit, and I used to enjoy slapping those patches on in the morning almost as much as I enjoyed a morning cigarette.
It might be possible to manage the addiction and maybe keep it from escalating with discipline, but the addiction will always be there.
Humans are excellent at denying addiction and rationalizing addictive behavior. And you don't even realize you are doing it - I've seen it in myself with cigarettes, which I fortunately quit years ago.
This led to what was probably the worst headache of my life. I don’t know enough pharmacology to understand how exactly that worked, but it was terrible. Having a cup of coffee reversed the effect pretty quickly, luckily.
Outside of medication there's therapy, cognitive training, coaching, etc.
And yet here I am, commenting on HN...
Since Concerta is extended-release, this usually means that I have to start work early most days. If I take the medication too late in the day it’ll disturb my ability to get to sleep, and since the medication has mostly worn off by that time it’ll generally mean… browsing Reddit in bed until way later than I should be up.
(I should add that IME "body doubling"/"task shadowing" is somewhat effective, though not very consistently. It's also probably the hardest intervention to get, though maybe things like Focusmate https://www.focusmate.com/ might help with that nowadays.)
Additionally, the boost in dopamines rewards anything you happen to be doing, so it can lock you into your avoidant behavior that day once you start doing it.
I go unmedicated now because it's a pain in the ass to get the prescription refilled (not the best, but whatever). But my experience was that the anxious procrastination mostly still happened when on the crank (I was a lot less absent-minded though which was something).
As a direct outcome it means I don't have bad thoughts and feelings sitting in the back of my mind when trying to do something else 24/7 so I'm generally more balanced. Indirectly, it was helped by actually getting stuff done and feeling less shit in general and not putting myself down as much for failing.
Some of us have to deal with the decision of a loved one taking meds and increasing their probability of a sudden cardiac death ( by qt Interval prolongation ) or staying unmediated.
Strategies to deal with ADS without meds are valuable I situations like this.
Some of us have to deal with the decision of a loved one taking meds and increasing their probability of a sudden cardiac death...
Why is this such a concern to you? At some point, everything has _some_ risk, and this feels like you're putting a lot of guilt on someone else for making a medical decision they deserve to make on their own.
Pharmacology is not my main area of expertise but I used to do a lot of work in cardiology, and anything that increases the QT interval in the ecg increases the risk of Torsades de Pointes.
Rule of thumb is 5–7% more TdP risk per 10 ms QTc.
Quite a few adhs meds do this moderately, not enough to make an ecg mandratory.
I still believe that making medications the default for adhs is not warranted given the side effects, especially since in many cases it’s not clear if it treats the condition or just makes the lives of education professionals easier.
I, and millions other people, could tell you that it does immensely benefit with issues like executive dysfunction. Medication quite literally made the problem I had been battling for decades disappear instantly.
Associating adhd just with childhood is in itself an obsolete view that causes issues for people.
Lack of trust in delivery speed at work, friendships damaged by unintended slights and so on.
Even building habits that I could never have kept before is a grind. The fact that I now can build habits only places me at a neurotypical starting line, now habits still need to be built.
The good news is that after you’ve been diagnosed, getting near the bottom of the bottle of pills is a great reminder to call the pharmacy for a refill. Plus… shortly after noticing that you’re almost out happens to coincide with the medication taking effect, so you’ll be in the perfect place to make that call!
Running out? Your physician needs to write a new prescription, since they can't write one with multiple refills. Maybe your physician will write multiple with "don't fill before" dates on them, but overzealous regulators make many uncomfortable writing more than your next 28-30 days of medication.
Called your physician and got them to send your new script in? Hope your pharmacist isn't an ass, because some will straight up refuse to fill until the exact day you run out. Oh, and hope they have it in stock - because limits regulators and/or distributors put on ordering make the lives of retail pharmacies just buying these medications a special kind of hell.
I've been extremely lucky, my physician wisely writes me 28 day scripts so I can consistently time my requests for a new prescription be written, so every fourth Monday I send him a message and no later than Wednesday I get a text saying it's been sent to my pharmacy. The pharmacy I get my medication filled at doesn't treat me like I'm scum that's going to be selling my medication, so I can easily pick up my next 28-day supply a few days before I would run out if it works better for my schedule. But more than once I've had to play the game of figuring out which store actually has my medication in stock, and have the script pulled and resent to a different location....
And then I did a psychoeducational assessment and found out I have ADHD - and not just a little hint of ADHD, but really quite profoundly terrible ADHD. I learned about how much my brain had short changed me in my personal life too; because real ADHD affects you in many areas of life. It’s not just about “getting things done.”
Medication is a must have to make any progress. If you’re like me, you already tried everything else. Maybe you’re also really intelligent and even managed to get a great job and somehow maintain it. But you can’t ever follow a plan for long and never go to bed on time and always seem to be burning the candle at both ends?
Yeah, this is where you need some help from meds. And good god do they help. That being said, your brain is a responsive self-correcting system. So my advice to anyone taking this journey post-diagnosis is to not give up if things stop working. You may need to pivot, change dose, switch to something else, or add a non-stimulant option.
But, don’t ignore meds. ADHD is neurochemical in nature and it’s a joke to expect anyone will manage it without drugs.
The first way to tackle ADHD is to manage your behaviour and manage the way you deal with ADHD. If you can't handle the pattern of behaviour, then stimulants don't make you magically able to concentrate. If you're in a pattern of seeking out distractions, then stimulants can potentially can increase that behaviour
What stimulants do help is for you to be able to get over the hump of wanting to get back to what you should be doing. It reduces the difference between boring task and other tasks and you need to be able to address your behaviour so that you can take advantage of the boost that meds give you
Unfortunately I've seen way too many people intentionally mess up their titration so that they're overdosed, bouncing off the walls and claiming that they're cured because they can clean the house for 10 hours straight. That's totally missing the points
This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.
The cruel paradox of ADHD treatment. I only got meds in the first place because my husband was able to follow through with getting me the appointments. It's been life changing. I needed a ton of support before and now we've reached parity with chores and finances. I never could have gotten that first step without someone helping me though.
You do have to see a physician and psychologist to get diagnosed and to get a therapy plan.
Although be aware that this might be a career limiting (or career ending) move. From the FAA, "Taking ADHD medication or symptoms of ADHD are incompatible with aviation safety." This is one of many areas where the upside of diagnosis and treatment needs to be balanced against being locked out of various careers and hobbies.
In recent years, I've become increasingly convinced that I've got ADHD. Before, I used to think I've got Asperger's or something. Before that, motivational problems (that was an actual diagnosis when I was a teen). By now, I'm ready to give chemicals a try, but I can't get them without the diagnosis. (Well, except caffeine, but I'm actually trying to reduce that.)
Also, I'm trying to channel that hyperfocus. It rarely works, but sometimes it does.
The only times I've felt my brain was executing how I should was while doing coke. the only times my anxiety is at rest is when smoking high CBD weed.
I'll go to the doctor, see if I can get the right pills.
Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.
How exactly is this supposed to work?
(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)
You did okay at school? Clearly it's not ADHD. And so on. Heard similar stories from my friends and colleagues.
Americans have that one easier, ngl.
Speaking as a fellow European that until recently had the same views as you.
But even on that, it's unlikely that someone will concur it might be that. General vibe I got was that, as I said - it's something you grow out.
And sometimes I find myself doubting, maybe they're right and it's something wrong with us? Many times I have wondered if it is just my subconscious way of trying to avoid responsibility for myself.
And sometimes I find myself doubting, maybe they're right and it's something wrong with us?
Yes. The thing wrong with us is that our life style is not a good fit but we persist to it despite knowing that. But why? Well we are more or less forced into it because society currently values dicking around with the JS library of the day much higher than herding a flock of sheep.
Source: diagnosed in Poland, see my other comment. Feel free to contact if need help.
And yeah, I've read it. I'm happy it got better for you. (not saying that sarcastically, I just have trouble with tone over text) How hard was the process for you to get it diagnosed?
And other comments - you NEED to look for people who specialize in ADHD specifically, both on psychologist and psychiatrist side. I got SNRI only because the doc said "it's used as last resort for ADHD, perhaps it will help you" - no, it does shit nothing for ADHD in my case. But it did help with many other things so I'm still grateful for that.
Also, keep in mind that non-stimulants also do work, but they don't work _immediately_ and that requires actual regime to make know whether they work on you.
How exactly is this supposed to work?
It's not exactly "executive function in a pill", but in people with ADHD, stimulants help with task initiation and sustained attention. That's often enough to help people create a structure for creating and maintaining habits that work for them.
Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you [get diagnosed and then] get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.
I was fortunate to find a physician that specializes in ADHD. Most of his patients are children/teens but they also see adults like myself. You can also go the route of seeing a psychologist that specializes in ADHD.
If you really want ADHD medication, you can get it today. The doctor will probably still start with atomoxetine (it's not a stimulant) at first, but then they'll transition you to stimulants after a couple of months if you ask for it.
Edit:
How exactly is this supposed to work?
People with ADHD often have an irrational aversion to doing some tasks (e.g. paperwork or laundry) and have to actively trick themselves into doing them. TODO lists, automated voice reminders, and daily routines are some ways to do it.
Once a task is started, it's easier to keep rolling. Stimulants help to reduce this initial barrier, and they help with staying focused. They do NOT make you high in therapeutic doses.
ADHD diagnosis is extremely easy to get.
I am in Canada. My family doctor apparently cannot do this, and has advised that a private specialist would be quite expensive (not that I'd know where to start looking anyway). I can't fathom that an online questionnaire would lead to legal access here to stimulant medications, considering that even things like SudaFed are controlled. And anyway if I am going to feel safe with a medication I don't want it prescribed on the basis of self-reporting on "extremely leading questions".
will probably still start with atomoxetine (it's not a stimulant)
First I've heard of this one.
How exactly is this supposed to work?
By "this" I indeed meant dealing with the "not diagnosed" hurdle.
And once you get the initial prescription from a provider, it's much easier to keep renewing it going forward.
I can't fathom that an online questionnaire would lead to legal access here to stimulant medications, considering that even things like SudaFed are controlled.
Nobody ever accused the US drug enforcement policy of being consistent and sane.
And we are talking about an active process here of actively calling therapists, adding yourself to their wait lists and so on. There is no central system. If you have the money to pay privately you can get it done in months but it is a lot more involved than a simple questionnaire either way.
And even if you have an official diagnosis this does NOT get you medication. You got to find a psychiatrist first. So back to square one. Call ten, twenty, thirty, forty people, maybe get an appointment in a few months.
The US is pretty progressive when it comes to mental health all things considered. Most people in this world are not so lucky.
There are tests they can run on you but no one has ever required me to do them, and I’ve been rediagnosed 4x when switching psychiatrists due to moving/switching insurance.
Note: last time I did this was 2020 or so, so maybe outdated. First time was 2014ish.
Public healthcare queues for ADHD diagnosis range from 1 to 2 years. At the end of the process, many end up with a "You clearly have ADHD, but there are others that have way more issues than you, so therefore we can not provide you with a diagnosis nor medication". They prioritize diagnosing people who struggle enough with their economy or have children that they are unable to take care of.
I went the the private route, paying out of pocket to hopefully sidetrack the long queues. Sweden is very strict on diagnosis criteria and subscribes to the WHO standard. My result is "You very clearly have symptoms of ADHD, but you fail on the 'must have been present before 12 years of age' criteria". This is a ridiculous criteria when diagnosing ADHD in adults, with either parents who have passed on, or are in a mindset of "No, you were just lazy".
My only option is "beat it through willpower alone", which is hilarious when you have a massive dopamine deficiency with an executive function disorder.
Either that, or get medication off the black market, which is likely just sourced from some poor student who has to sell theirs off to make ends meet, due to Sweden's insane stance on drugs.
ADHD may present with many brain-network anomalies, but I believe the classic case is one where there is more default-mode activity, less executive control activity, and ineffective switching occurring from the salience network. Mindfulness meditation is honed at training the salience and attention networks towards playing closer attention, which offsets the deficits observed in ADHD.
That's my lay interpretation; but actually, I believe that people who suffer from ADHD probably have even more to gain, relatively, than those who don't from taking up the habit of mindfulness meditation. It's not an easy fix--I've read that it takes about twice as long for those with ADHD to benefit from the practice. But it seems like it's worth it; after all, your mind is really the only tool that you have.
Those interested in this topic should read about ADHD and it's relation to the salience and executive networks; and how mindfulness sharpens the function in these areas.
For some people with ADHD, this will work very well, others will not. Some with ADHD are already naturals at mindfulness because they have really bad time blindness. They are always, a bit too in the moment and low anxiety.
...naturals at mindfulness because they have really bad time blindness...
FWIW, this is not what "mindfulness" means. Mindfulness is a combination of concentration (i.e. intentionally focused attention) and insight (i.e. a deep intuitive knowledge and familiarity with the three characteristics, viz. anicca, dukkha, anatta). People who have reached the deepest stage of enlightenment (known as arahants) are believed to be able to switch their default mode network on or off pretty much arbitrarily (there is interest in verifying this claim experimentally, and it doesn't seem to have been outright refuted so far); they seem to have reached a deeply ingrained understanding of what it does and doesn't do for them, and the control ultimately flows from that.
It doesn't matter how you get there—mechanisms that can improve executive control and control over the mind's salience network will greatly end up benefiting those who suffer with ADHD. Those who practice mindfulness meditation—ADHD sufferers or not—show strengthened neural circuitry in both executive control and salience networks. Head trauma, environmental factors, genetics or what have you; working to strengthen these networks is a good thing.
I have ADHD and meditation, for me, is very difficult. Painful even.
“Have you tried” comments from people without firsthand experience is basically asking others to be your guinea pig. I didn’t say “hard” I said “pain” as in a physical reaction. If you don’t have the same pathology I don’t think you can truly empathize or understand what you’re asking me to do (even if you think you do).
I’m glad you found meditation and that it’s helpful for you. I’m asking that you modify your evangelism in the future to give people maximum context on where your suggestions are coming from (and associated limitations).
Mindfulness is not the same thing, but I’m not sure it’s a solution for us either.
I have a trick for you but quieting your mind won’t necessarily make your life better. I would instead encourage you to look at “walking meditation”. Forest bathing, cycling, walking. Tai chi is remarkably good. A lot of people with emotional issues are detached from their bodies, and part of healing is accepting that “you” is both your mind and your body.
Alright, caveat served: count your breaths. Count to ten, then start over. This gives your brain something to do, connecting the math and verbal centers but without triggering deeper thoughts. You will catch your mind has wandered when you realize you just counted 13. Just stop and start over, don’t get into judging yourself. It happens to everyone. Just go back to 1. You can analyze the sitting afterward, not in the middle.
But seriously, tai chi is fucking amazing.
Breathe in: ONE. Breathe out: TWO. Next: THREE... reset at 10.
If you find yourself breathing in on an even number, or out on an odd number, you've gotten lost. No problem, just reset to 1. Got to ten? You win! Also, reset to 1.
Very useful and simple technique for calm and focus.
If being organized makes you feel goodIf you are very OCD
Please educate yourself, OCD is serious shit: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_d...
Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").
Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.
I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.
Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)
I wish people would stop attributing a quirky/controlling personalityfor me this casts serious shade on the whole article
I think that's healthy wariness. The article seems overall well thought out, but OCD is an extremely common blindspot today, so I don't think it spoils the rest of the advice (which is largely good and spot-on).
Even my primary care doctor, when I told him I'd been diagnosed with OCD causing many disparate kinds of anxiety and depression, said something about "well you want your accountant to have a little OCD for example." I was a little stunned!
See, "the good advice" is knowledge I can recognize as such, therefore information I already have. You need a basis of trust accepting any new information. A flat-earther may get Newtonian physics right, but I won't go there to learn about it.
I don't think the OCD section adds much anyway, so I think the article would be greatly improved by removing it.
I'm sorry to tell you, but both ADHD and OCD exist on a spectrum. Furthermore, ADHD like symptoms can be caused through other illness than actual dopamine deficiency.
"Some people", "commonly" already implies a variety in symptoms and manifestations. But by definition, they all cause clinically significant impairment, or distress.
Here is the version I was referring to: https://web.archive.org/web/20250828075812/https://borretti....
As mentioned in a comment elsewhere, the article has changed since I wrote the call out. It doesn't contain the ignorant OCD remark anymore. I didn't bring up OCD out of nowhere.
A good deal of ADHD masking/coping mechanisms show up as trying to control certain parts of the environment. We need to do this thing that way and keep this thing at that location and never ever do X but instead Y.
It can look like someone who needs those things for other reasons, like mild OCD or even autism. But it’s really about preventing everything from going to shit in the worst ways that we cannot deal well with.
So while your room may look like a bomb went off and your fridge is half empty, there are certain things you are super precious about. Because a little work now saves a lot of grief later, and for those little islands of sanity you find the motivation to perform them.
For me this is mostly at work. And the things I need to be a certain way help everyone during an emergency. High cortisol levels make every brain more like an ADHD brain.
However. The article encourages a diagnostic approach—it asks the reader to introspect and identify the root cause of their inaction. But by omitting both PDA and RSD from its list of potential causes, it creates a "diagnostic trap" that can lead to misdiagnosis and self-blame. The omission is particularly damaging because PDA and RSD are two of the most powerful (and often invisible) drivers of severe, persistent avoidance.
But I agree it's good to spread awareness of these kinds of things.
In my own case, I was diagnosed with ADHD. Autism didn’t enter the discussion even a little bit. I’m medicated with stimulants and it works well for me for executive dysfunction part of my overall symptoms. It’s only very recently, while helping someone close to me go through a combo diagnosis, that I’m realizing that there are probably some other traits I have that would be better addressed with Autism counselling.
https://gekk.info/articles/adhd.html
https://miniver.blogspot.com/2021/08/the-subjective-experien...
HOWEVER, there are also birth defects such as the MTHFR gene mutation which reduce Vitamin B12 utilization of your cells by as much as 70%. It has far-reaching consequences for every single cell in your body. Modern medicine is mainly symptom-based and things like chronic Vitamin B12 deficiency are hard to diagnose (unlike famous low Vitamin D levels). In many countries you can't even sequence DNA of your own child, and for a hereditary gene defect in a core chemical reaction of the human metabolism this is just staggering.
For example as someone who has the MTHFR gene defect, my organism needs the "bio-available", methylated version of Vitamin B12, because it can only use 30% of the Vitamin B12 in my bloodstream.
The effects of Vitamin B12 (methylcobalamine) supplementation after many decades of Vitamin B12 deficiency is staggering. Within 30 minutes it felt like someone lifted a very heavy baseball cap off my skull. If someone would've told me methylcobalamin is a potent anti-depressant or some illegal drug I would've believed them based on the effects.
If you scout google scholar or NCBI for recent studies on Vitamin B12 you will find recent case studies that use Vitamin B12 supplementation to treat infertility, long covid symtpoms, and autism in children. And if nature gifts you with the MTHFR gene defect(s), Vitamin B12 can be really rare in your cells.
Yet here we are, even in one of the wealthiest countries in the world you need to do gene sequencing on your own if you want to learn about basic genetic defects, because doctors won't touch anything involving "genes" if the disease is not named after yourself. According to Wikipedia roughly 20-30% of all people have this exact MTHFR defect.
Here is some more info: https://www.snpedia.com/index.php/gs192
PS: ADHD is often linked to depression, and I've been discussing with a good friend what comes first. If you have chronic disease, there is first the disease, then comes the depression. But then doctors or others see you and only focus on the depression which - funnily - increases the depression / anxiety even more.
I wish I knew at a younger age that methylated Vitamin B12 / folate supplementation is needed due to a genetic defect.
I tried too high a dose once and it worked imo too well. I couldn’t procrastinate if I wanted to, and I found the lack of choice disturbing. I wonder though sometimes if I should be on that dose. But the side effects (muscle spasm) created more intense feelings of loss of body autonomy.
Has anyone talked to you about guanfacine? It reduces RSD, which makes it easier to start things.
If you finish a task that wasn't on your TODO list, don't fret. Just add it but don't check it off. Then when you come back to the list later, you check it off. This reminds you that you did it and gives you the gratification of completing it. Otherwise, the finished task will slide into oblivion and poke at your self-worth along the way.
Edit: Oh also want to mention that I generally prefer privacy oriented apps - so if there is something, even paid, that will keep my notes on device without sharing them with a server I'd love to hear about it.
I'm on an iPhone and I use Streaks https://apps.apple.com/us/app/streaks/id963034692 . I really dig it. It's easy to set up, easy to add or pause tasks, and easy to correct past mistakes (I often forget to record I took my meds even though I can see I remembered by looking at my pill organizer, fixing this takes a couple taps).
You can configure it to remind you to do a task N days a week. I use this feature to track checking the mail. You can also make a daily task and configure it with a "2 day rule" that gives you a little wiggle room. I want to read a book and practice chess every day but sometimes I miss a day -- this rule lets me miss one day but not two days in a row.
It's well designed with lots of color choices and icons for each task, plus it has Apple watch support. I'm pretty sure it's all entirely offline other than backups to iCloud, which can be disabled.
Finally, it's a one time purchase. If it wasn't I wouldn't have given it a try.
And for someone who likes to "work on their productivity", it's a never ending swamp of plugins and optimising data views and reports.
I just switched to Things3 and couldn't be happier. It has very little customisation and options. It just lets me write down my TODO-lists.
The symptoms of ADHD and thyroid disorder are similar.
Ask your doctor to check that first before ADHD.
anyone from India willing to share some pointers on how to get an evaluation
signed - someone who has been procrastinating on it for a few years now
It helped. I do. That was it!
I've tried several to-do apps, but centralized systems didn't work for me. I now use multiple to-do lists across different media: some on paper, some on my phone, others in markdown files within project folders... sending email to myself. It may seem messy, but it works for me. One system doesn't fit everyone. And any customization and tweaks are encouraged.
Books that helped me:
Atomic Habits by James Clear emphasizes small, consistent changes. Over time, they build into significant improvement. It’s better to improve your system gradually than attempt a major overhaul.
The Now Habit by Neil Fiore offers tools to overcome procrastination and start tasks. It helped me understand my resistance and find ways to move forward.
Getting Things Done by David Allen focuses on reviews and planning. I struggle to make time for them regularly, but even occasional reviews help.
Marcus Aurelius' Meditations, especially annotated versions, provide a Stoic perspective. His reflections on virtue and responsibility inspire me. He seemed to dislike being emperor, preferring philosophy, but accepted his role out of duty. That example helps me do necessary tasks, even when I don't feel like it.
An example: you have to fill out some government form. You’re averse to it because you worry about making a mistake. And just the thought of opening the form fills you with dread. So, take the boxes in the form, and make a spreadsheet for them. If fonts/colours/emojis/etc. if that makes it feel more personal, or like something you designed and created. Then fill out the form in the spreadsheet. And then copy the values to the form and submit.
Oh wow this spoke to me - do it a lot …
Some primary care doctors will refer you to get proper testing, but many will either ask you a subset of the questions you took on the questionnaire and say “yeah you have it,” or ask you nothing further and say “no you don’t have it,” depending entirely on their personal feelings on the matter. Testing isn’t cheap if your insurance doesn’t cover it but if you work in a knowledge field, being informed is an investment.
Medication, if it makes sense for treatment goes beyond controlling attention to tasks at a higher level — like not getting squirrel brain distracted trying to code. It also has much lower-level cognitive effects that I can’t directly perceive, but are completely obvious looking at my raw capability. A modest dosage of methylphenidate makes complex math problems that previously made me drop classes after putting in 20 hours per week of hyper-focused study time effortless. I don’t ‘feel’ smarter on it, or dumber off it— I can’t even perceive the specific threads of thought getting derailed in my normal state that make some cognitive tasks so difficult. The proof is entirely in my ability to do things that were incredibly difficult before.
Barring any of this, regular physical activity and good sleep have huge benefits. For some, it increases the dopamine enough to make medication totally unnecessary. I see dramatically worse results if I get super busy and drop sleep and gym visits staying up late working.
But seriously, getting medicated absolutely changed my life.
My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.
Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.
One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.
Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.
The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.
I was diagnosed with ADHD as a child and spent several years in special classes as well as receiving a lot of private therapy/tutoring. I'm not a self-diagnosed adult (as is common). I've managed my situation in various way for a long time (50 years) and refused medication the entire time. Phone alarms really helped me when I started using them.
There may be good reasons for drugs but there are also bad reasons - especially, they're a quick "fix" allowing a care provider to do this and wash their hands of the situation.
Further, of course ADHD has a biological cause - human beings are biological beings so every human behavior has a biological cause when you come down to it. But the implication that proscriptions drugs designed based on a deep and verified understanding of the mechanisms of ADHD is completely false - ADHD drug prescription, like all behavior-altering drug prescription, is based on just "bucket chemistry", maybe-educated guess work. Which isn't implying drugs don't work for some people. But I think it's important to be clear the various drugs aren't ADHD cures in the way that antibiotics are cures for infection. But again, I support the right of people want ADHD drugs to have them. But I think drug use shouldn't be automatic.
1. My brain drifts away very easily. Even in an important work conversation, my brain just starts thinking about a completely different project or upcoming meeting. 2. I have a hard time remembering things/events that my spouse and others can easily recall (ie: which restaurants we have been to) 3. I can't seem to form an opinion on very basic things like do you like restaurant A or restaurant B better? do you like option A or option B? I can't decide or come up with any heuristics.
At first I chalk it up to I am being too critical about myself and others are having the same issue. But that doesn't seem to be the case. Can these all be rolled up in the same conversation with my doctor?
I often fail to finish projects simply because I forget about them. I start reading a book, but I don’t write it down anywhere (say, in Goodreads) that “I’m reading this book” is something I have committed to.
I don’t have a history of ADHD symptoms. But I’ve been happier and arguably more productive since I abandoned the idea that I must complete projects just because I committed to them at the start. Sometimes you learn, halfway through a book, that it doesn’t contain the info you thought it would; then it’s best abandoned. The same applies to many commitments, I think. We learn more about them as we undertake them. Something might stop being engaging because deep down we’ve realized that it won’t serve us as we expected.
But maybe I’m able to discern productive vs nonproductive commitments because I don’t have ADHD? I just hate to see people beating themselves up about not following through with ideas which really don’t deserve follow-through.
I can notice if something has not been worked on for a while, and act on it. Otherwise: out of sight, out of mind.
A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".
Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.
I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.
I use Todoist and have a script to manage the parentheses. https://github.com/leroux/todoscript
Credit to intend.do. I shamelessly stole the concept from NotDone Propagator. https://intend.do/features#notdones
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
They didn't even suggest that I could/should speak to my GP first. And I can't actually get an appointment with my GP other than the way I specifically tried to. At least not my local GP.
If you're able to, I'd go for the private option. Really, the medication helps tremendously and having access to it makes every other step easier to take - I really wouldn't have thought that's how it would make me feel.
Good luck going forward!
I need the higher doses, so I'm practically screwed. Makes me so damn frustrated, cause I'm 4-5 months down without meds and I'm REALLY STRUGGLING. Depression, zero motivation, practically no executive function. Really needs to be accountability on these companies to ensure they can supply.
I eventually found a dental/nasal engineer guy and his testing was more thorough than the sleep studies I undertook. I paid for his device (300 bucks or so) but in the process he gave me a lot of techniques and understanding. He diagnosed me as borderline, despite 2 sleep studies telling me it was severe and chronic. Largely through blood oxygen levels and mouth position.
"Decision Paralysis Procrastination". I've been going round in circles for 3 days trying to decide where to go travelling. I can go pretty much anywhere I want to and there are lot of places I want to go. I've even found some /really/ good deals but couldn't pull the trigger.
One thing to consider is that thinking in your head is inherently circular, because you have a limited working memory, and you will inevitably start going in circles
That REALLY resonates. It's crazy how much I will put off writing things down. Like my mind keeps telling itself "that's too simple to actually help"
Some decisions you want to sit with so they need to be made early, and then god help you if they change last minute. Doom for ASD, lots of emotional energy spent twice or three times for the rest.
Others you’re more afraid of deciding wrong than not having prep time. Things like writing papers in an adrenaline fueled marathon versus just writing a fucking outline on day 3.