This is one of the best linked articles about ADHD i've seen on HN.
Especially because it gets quickly to the most important point which often times is still neglected:
> 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.
I wish I could go back in time and drill this into my own head. I evolved a large set of coping mechanisms that let me get by alright without medicines. I was putting food on the table and a roof over our heads. Still, it took a phenomenal amount of mental effort just to get started with critical things. I'd have all my tax receipts scanned in and organize and just needed to make an appointment to send it all to my accountant, but I'd sit on that until the last minute. I knew it needed to be done. There was no reason not to do it. I wanted to do it. I was ready to do it. And yet, I couldn't freaking do it.
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?
Late diagnosis here (38 when diagnosed, now 42)… I agree with everything you said. I had an amazing set of systems and coping mechanisms in place to get through life without realizing I was playing the game on hard mode. In retrospect, the signs were all there my whole life but I just hadn’t had the realization.
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.
> 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.
I can’t agree more. I spent a lifetime trying to master every productivity hack, reading books, doing hundreds of hours of therapy (this is not a joke - hundreds of hours), and organizing my desk and using tools and … everything.
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.
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.
Just a heads up, Ive taken stimulants on and off as a treatment for ADHD for many years but my body/emotional health always felt compromised as a result. I've recently started on a non-stimulant ADHD medication called Atomoxetine and so far it has not had the emotional blunting, irritable effect of stimulants at all, and I haven't noticed any negative effects so far. It seems to help me get over the hump of being able to start things and stay with them which has always been my biggest downfall. We will see if I stick with it, but just wanted to mention that there are alternatives. There is also another medication called Guanfacine that I may try if this current medication does not work out - I don't think I can go back to stimulants.
Things that work for people with too many side effects:
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.
Same here, the lowest dose concerta keeps me wide awake for 24 hours. The non stimulants give me side effects not touching those with a 10 foot pole. Did you try 2.5mg ritalin? i think thats the lowest dose.
You might be how surprised how low a dose you need for an effect. 5-10ug of Ritalin noticeably reduces the "noise floor" for me.
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.
> 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.
Here's a fun fact. In the US, if you would like to fly a plane, and you have undiagnosed and thus untreated ADHD, no problemo.
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 amount of undiagnosed ADHD (and secretly treated anxiety and depression, for that matter) in the aviation industry is off the charts. I have a lot of respect for most of the FAA, which is professional, reasonable, and evidence-based. But the FAA aeromedical division is a joke. They're bullies with a stone-age mentality about treatments and medications that have been accepted for decades.
Hell, taking medication or not, if you have had a diagnosis in the past (and didn't lie on your medical history), merely having current symptoms is grounds for your FAA medical certificate being deferred.
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."
Getting a real diagnosis is a big obstacle. Waiting lists are ridiculous, and the medical landscape is confusing.
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.
I take guanfacine. It’s an older blood pressure medication that happens to treat adhd. I also have high blood pressure so I get an added bonus. Stimulants are great for laser focus. Guanfacine helps with focus but its biggest help, for me, is executive function and curbs some of my emotional effects of adhd. I notice I’m not as sensitive to feedback or criticism.
Coffee and chocolate (plus potentially tobacco) are technically stimulants, 100% legal, and people seem to handle them just fine. Just take them strategically as opposed to recreationally (i.e. only as support for building up healthy habits; go cold-turkey otherwise!) and you should do just fine. The effect is way stronger than most people might think, provided that habituation hasn't built up and the existing tolerance has been dissipated.
Take less. I don't mean to be snarky, but if it makes you anxious, it's too much. If 5 mg of Adderall feels like too much, I think the issue is just that you feel different. Give it a few weeks. Psychotropic medication isn't an instant fix without side effects. You'll get used to it.
There are non-stimulant medications for ADHD but I think their effectiveness is more variable, they work well for some people and not at all for others. Strattera, guanfacine, and wellbutrin come to mind.
Outside of medication there's therapy, cognitive training, coaching, etc.
That's me. I had to stop because of the anxiety. I just have to get back to life as I always used to and measure the distractions via behavioural changes
Fringe product, not geared for ADHD specifically. But look at Gorilla Mind Rush/Smooth depending on your stimulant tolerance. In your position you don't have many efficacious options, but this works for me as diagnosed ADHD probably 60% as good as the low dose stimulant medication I take.
a) try to find a way to fill declaration of prescribed medications for customs and for police. (let the google/llm and local adhd communities help you) Find verified cases of how that have worked for others in your particular country.
Sometimes workarounds exists, but it would take some paperwork
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.
Nicotine. But not the smokeable kind. And low dosage. But not if you’re likely to get addicted.
The absurdity is that your country definitely makes it legal for historical reasons rather than useful less addicting stimulants.
Getting diagnosed and medicated should absolutely be the first port of call and one should do it without delay. However I should add that they never made much concrete difference to my "clinical outcomes". Now I'm sure I was holding them wrong (or holding the wrong model of iPhone), and I should get around to getting prescribed again, but if your main problem is anxious procrastination I honestly think you should temper your expectations about what drugs (or certainly methylphenidate or amphetamine) will do for you.
> 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.
Yes, though it might take more than one to find someone who's actually qualified and up to date on evidence-based treatment of ADHD. There are some really ignorant physicians out there who are still peddling misinformation that's been debunked for over 20 years.
As someone who is struggling with ADHD and tried Ritalin at one point. The Ritalin did not really change anything for me, I was calmer, but it didn't help me get a better grip on my life so to say. Do you think there is a chance this would be different for other stimulants? Just looking for some experiences people had I guess.
A study I glanced over a while ago said something like 40% of people respond to dex or ritalin, around 80% to either (I'm in this group but dex had more annoying side effects), and the last 20% to neither (but there is other stuff out there). So it's definitely worth trying both branches of the common meds first. You should also talk about dosages because there is titration period where they need to monitor and adjust to see how your specific body responds.
The first line of therapy is not stimulants though, this is a massive falsehood that gets spread by those seeking ADHD treatment.
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
True to a point:
Noting that has an effect has no side effect.
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.
I have to add my 5 cents to that because I've experienced something I've not seen anyone else experience and I think it might be worth to share it with others that might struggle with the same.
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.
In a similar vein to "try medication", I'd like to add "don't write all medication off after one doesn't work". The first seven medications I tried had basically negligible effects, and then the eighth one I tried (also an SNRI) had absolutely life changing effects within hours. I had the same moment where it seemed like a switch flipped and I couldn't believe the difference one medication could make.
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.
Absolutely. If you're having problems, please consult a doctor! Medicine can't fix everything, but there's a whole lot that a good doctor can help with.
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.
Thank you - I've been putting off getting an assessment and seeking medication for a while, and I've just booked an appointment with a psychiatrist after reading your comment.
I disagree with this article on fairly foundational grounds.
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.
This is a profoundly ignorant take on the subject matter. Notwithstanding neurological changes that happen to everyone over the time span of decades, ADHD isn't something that people can just willpower their way out of. It's a spectrum of disorders with a strong genetic component. None of what you wrote above bears any resemblance to fact, and these sentiments can cause actual real-world harm to people.
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?
> 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?
>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.
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 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.
The article mentions sleep, which is very important to us all. But something not mentioned is that the symptoms of Sleep Apnea can look a lot like ADHD, and if you have sleep apnea and ADHD then you get a double whammy. Sleep apnea can start at any age, which could be one reason why your attention suddenly got worse. If you're waking up unrested, or have any of the other signs of sleep apnea, get it checked out. In my case my doctor resisted testing "because I wasn't obese," (more or less, perhaps I'm being unkind), so you may have to work at it. But an in-lab sleep study will give you a clear diagnosis. I have seen reports of people who were able to stop ADHD medication once their apnea was treated.
I was treated for sleep apnea 3 times trying to get ADHD treatment.
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.
as someone who has been down this road, this doesn't sound scientific... but I'd love to be proved wrong. sleep studies (PSGs) are rather detailed, and that price doesn't align with medical-grade oral appliances
>>> 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.
This maps pretty closely to the theories of Dr. Russell Barkley!
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.
I am obviously not a psychologist, I got kind of worried reading this that maybe I had misdiagnosed myself and that going the route of official diagnosis would lead to a lot of wasted effort. But reading into these two things you describe (Pathological Demand Avoidance (PDA) and Rejection Sensitive Dysphoria (RSD)), I am glad to note that I don't think I've ever had anything of the sort.
But I agree it's good to spread awareness of these kinds of things.
It's heartening to read the comments in these threads and see that this might actually be the problem I have dealt with for 29 years and that there might be a solution for it.
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
My GP applied on my behalf. The queue in my area is more like 8 months though. You have to fill out a bunch of forms but importantly that's after you are in the waiting list.
You might want to just have a chat with your dr, as you'll likely try something like concerta if you are diagnosed - but you can skip the long process of diagnostic and just try the medication if you fill out a few questionnaires. At that point it's pretty self evident if the medication helps the issue or not and bam, you might have solved your problem without going through the hurdles.
Tried to speak to my GP and my local surgery told me to either register for the NHS waiting list (probably 100 years long at this point) or use the right to choose process to get the NHS to pay for me to see a private clinic (takes 2-8 weeks to see someone instead of years).
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.
Doesn't apply to UK. In the UK the NHS will pay for a private company so there is no reason to go private yourself. But they absolutely won't dispense medication without a diagnosis. And the waiting list is at least a few months, closer to a year in my area.
I appreciate the author's notes on managing ADHD. I was glad to find I didn't learn much new, because I'm already applying many of these practices.
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.
ADHD has a biological cause and drugs are the first-line treatment for good reasons.
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.
Stimulants are still first line therapy for treating ADHD but I think mindfulness meditation is wholly underrated. People with ADHD have too much activity and overly-robust neural nets in the default-mode network in comparison to healthy controls. There is a network above this network, the salience network [0] that is responsible for the switching between the default-mode and executive control networks.
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.
Meditation practitioners have been writing for thousands of years about the problem of "quieting the monkey mind" which reads just like your typical description of ADHD, only in the specific setting of a meditation retreat (which is typically an intentionally challenging, spartan, uncomfortable environment - hence one where pretty much everyone is enticed to get fidgety and hyper). It's difficult for everyone at first!
I have unmedicated ADHD (Psychiatrist diagnosed) and I really struggled with mindfulness meditation (Even tried a Vipassana retreat). However Transcendental Meditation (TM) worked really well. I find my mind is more organized after a year of practising.
I had a bad back before trying meditation so it was doubly bad.
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.
I also think ADHD is a combo of many different, more specific problems that we blob into ADHD since we are not precise enough to diagnose it beyond the 3 types we have now, and these sets of problems are responsive to stimulants.
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.
I'm sort of inclined to agree with your premise that ADHD may describe how a patient presents without describing the underlying faulty physiology; but, at the same time—it's all about attention.
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.
"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"
On deciding I think you’ll find that most of use are sort of bipolar in this regard. But moreso introverts, particularly ASD and HSP ones.
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.
> 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 have set up my projects in a way that whenever I work ok it, all the context I need is available from one single starting point. My goal is that zero friction is needed for to resume work on any project, no matter how long it was paused.
My habit to keep the context for each project fresh is a at-least weekly, timestamped, append-only Captain‘s Log, which - just as its namesake - is a very brief 1-2 sentence summary of what’s going on for everyone to get back into the story after the commercial break. „No updates“ is a valid update. Since its append-only, retrieving more context is just a matter of keeping on reading after having read the latest update.
adult diag ADD (prob some ASD also). Kids were diagnosed, had one of those ahah moments. At least in my generation, the quite, bored as hell kid in the back of the room. Thankfully, I think the ASD made me determined, hardheaded, and perceptive, and my parents encouraged and supported me to set good goals. That served me well, but I look back and wonder what could have been if I could have stayed awake in high school classes.
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.
IDK if I have ADHD but I started taking Bupropion to help me quit smoking and stayed on it because I feel better on it, and naturally have picked up a lot of this organizational stuff over the past few years like lots of reminders, notes, managing inboxes, calendars, pomodoro. I don't think I've had or have any of the main symptoms of ADHD but sometimes I see a post like this and think maybe? It's also hard because the list of symptoms of ADHD in pop culture seems to be growing out into infinity and it's difficult to separate what's actually ADHD and what's not.
Also there many are other potential factors such as desk-job, sports, sun exposure, and nutrition.
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.
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.
Bupropion is an interesting one because pretty much everyone with ADHD is dogged by situational depression. So it helps a bit with that as well as executive dysfunction.
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.
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 personality
> for 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!
I agree, there is some good advice in there. However, this makes the OCD remark stand out even more for me. Bit like a doctor recommending homeopathy or starts talking about flat earth stuff. Getting such a basic thing so wrong, taints everything else.
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 would say that control issues are the seed of OCD. Nobody wants OCD, but Illusion of Control is no cakewalk either. Generally that will also go along with an anxious or avoidant attachment style, which is even less fun.
I don't get your point, sorry. Not sure you got mine, either.
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.
Do you really believe there is only one kind of OCD, specifically one you described?
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.
There are many kinds of OCD! There are zero kinds of OCD that aren't a disorder. A helpful mnemonic is: you could imagine OCD stands for "obsessive compulsive disorder".
"Some people", "commonly" already implies a variety in symptoms and manifestations. But by definition, they all cause clinically significant impairment, or distress.
Came all the way down to see if someone has a comment like this. I have tried all possible frameworks but finding the energy to execute them is the hardest part. Has gotten slightly better after I started meds but a lot depends on how my energy and emotions are at that moment
For me, first came the stimulant meds, then slowly and over time the energy, as I started being more organized and putting my day into a routine. Try Bullet Journalling, it was created (discovered?) by a guy with ADHD.
Thank you for this article. I have yet to discuss with my doctor about this. But I have noticed several issues that are severely lacking for me compared to my peers:
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?
Probably all part of possible ADHD, except point 2, which might be a sign of SDAM (Severely Deficient Autobiographical Memory). It’s recent and not well known.
> 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".)
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.
That's unfortunate. It's not exactly easy in the US, either. When I wanted to get treatment, I asked my family doc, who referred me to a psychiatrist. The psych diagnosed me with anxiety and depression. We tried treating that; it failed. Turns out ADHD causes a lot of anxiety. The anxiety was a symptom, not the cause. I found another doc who specializes in ADHD who finally started treating it, and the change was immediate.
You need to look for a psychiatrist that specialises in attention disorders. You also need to work with them on a therapy -- you don't go to them and ask them to give you amphetamines, but instead go talk to them about the issues you have in your day to day life.
Speaking as a fellow European that until recently had the same views as you.
I literally went through the process in Poland with success. It was back in 2021 though but I don't think much has changed since then.
A bigger probablem at that time was just finding pharmacies that stocked the medicine.
It was much easier for me to get a diagnosis than to make my bed every day. I talked to my PCP, she recommended I talk to a therapist that was qualified to diagnose ADHD (among other things). Went there a couple times and took some tests and got a diagnosis. It took only a handful of appointments. Making your bed every day goes on forever.
ADHD diagnosis is extremely easy to get. There are websites that will link you with a doctor that will "diagnose" you remotely by giving you a questionnaire with extremely leading questions. Even with more reputable doctors it's easy: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
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.
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.
Here in Germany people can wait years to get an diagnosis. And I mean literal years.
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.
In the States, frankly, if you are a clearly responsible adult, it is incredibly easy to get diagnosed: just describe your symptoms like missing deadlines etc. The psychiatrist said “yeah, sounds like adult ADHD. If the medication works, clearly you have it”.
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.
> 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.
Definitely make sure to check since it's easy to test and easy to treat, but remember that it could be both. What blows is that some doctors can become really dismissive of the idea that you might have something like ADHD if your chart already carries a different label (thyroid, personality disorders, depression, etc.) so watch out for that, it can be a challenge to get them to take it seriously.
Generally you’ll have both a blood test for thyroid dysfunction and possibly a sleep study because chronic sleep deprivation also presents with adhd like lack of focus.
For those who cannot be prescribed amphetamines, I recommend seeking out Modafinil. It works really well and a regular psychiatrist should be able to prescribe it.
Preach, this is a great post. The author has approximated the same system I (and many others) independently found to be working well for themselves. The bad news is that it’s very hard, if not impossible, to teach masses with ADHD all these elaborate, often very personal systems. The good news is you can make an app which will automatically make it work for individual people. Which is what I’m working on right now (not out yet).
I'd be taking my meds if the pharmaceuticals didn't keep having many-month long shortages of the ones I'm taking...
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.
Has anyone used the Todoist app? What are the apps that you find the most helpful in supporting ADHD - I am thinking to get this app, but also have never used Obsidian before, would love to hear what others are using.
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.
(Edited to add: this is an app I use to help with my likely-ADHD, however it is not a note/taking app)
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.
Have possibly tried every single app out there. iPhone reminders for basic personal stuff. Doesn’t scale for work related stuff. At work I operate better when there is a free flowing hierarchical view on my laptop - Workflowy is what I keep coming back to
My doctor in the states was willing to do what she called a "clinical diagnosis". After filling out a short questionnaire, my score indicated I may have ADHD. She prescribed a medication for me to try. The idea was if the medication helps, and doesn't make me feel bad, then it would indicate I have ADHD.
Unfortunately in India it’s nearly impossible to get a prescription for stimulant medication because of “abuse potential” even if the psychiatrist acknowledges you exhibit ADHD traits.
I am from India and got diagnosed in my mid 30s. If you live in a tier-1 city it’s not that hard to get diagnosed. Go to a psychiatrist. Reddit has a lot of good recommendations based on your city
On the chemical note, I found glycine supplementation to be actually helpful in avoiding hyperfixation (not being able to stop on a task). In contrast, stimulant meds solve the issue of not being able to start on a task (not enough motivation/dopamine). Make your own N=1 experiments though.
Glycine makes me feel depressive/anxious if I take more than 1-2g per day, for more than a few days. Very calming otherwise. Common effect for many people.
Take one of the more reputable questionnaires... they never require a login or anything. If you score high enough, see if you can get proper neuropsychiatric testing done. Really think about the questions and be honest with yourself… is easy to gloss over problems we have that we learned to compensate for, or be too eager to answer yes to everything if we’re just looking for an explanation for having a hard time at work, for example.
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.
I read at one place regarding an ADHD drug that is non-stimulant and makes people a little drowsy, which is why it is good to take before going to bed. I don't remember what the drug is called. Does someone know?
As a life long member of the decision paralysis club, this was incredibly refreshing to read. Have been getting better, but reading this has brought it back to the forefront of good habits.
I guess I have some reading to do tomorrow! Which is also a great reminder that I should update my own posts with all my current techniques of managing with ADHD.
For reasons of personal history, stimulant medications like Adderall are a hard no for me. I am curious, though, about non-stimulant options like atomoxetine, if anyone has views.
Stimulants are a front line defense because they pretty reliably treat the symptoms in just about everyone. There are many other medications that _can_ help with symptoms, but their effectiveness is largely dependent on your body chemistry. It can take trialing several drugs to find one that works best with you.
Methylphenidate was a no-go for me too, was emotionally unstable and burnt out at the end of the day.
However, this is my second month on atomoxetine and so far, I have only words of praise. There are one or two months to go for full effectiveness but I am satisfied so far. Focus is better, my mind is much more quieter, I've been able to kick some dopamine seeking behaviors and am working on new habits. I really feel positive and ready for change in life -- speaking this as an anxiety ridden person for more than ten years.
The only negative is that it slightly increases heart rate, but I think this is supposed to go away too.
I'd note that I am on some supplements as well and beforehand I did a simplistic dna check to see my methylation/detox profile (wanted to see why methylphenidate was a no-go).
I searched the article for "meat" and "carnivore". Zero mentions. First paragraph admits that this is a biochemistry issue and then immediately jumps to the conclusion that MEDICATION is needed.
Insane.
Eat a proper human diet, and your ADHD symptoms will mostly go away.
This is one of the best linked articles about ADHD i've seen on HN. Especially because it gets quickly to the most important point which often times is still neglected:
> 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.
I wish I could go back in time and drill this into my own head. I evolved a large set of coping mechanisms that let me get by alright without medicines. I was putting food on the table and a roof over our heads. Still, it took a phenomenal amount of mental effort just to get started with critical things. I'd have all my tax receipts scanned in and organize and just needed to make an appointment to send it all to my accountant, but I'd sit on that until the last minute. I knew it needed to be done. There was no reason not to do it. I wanted to do it. I was ready to do it. And yet, I couldn't freaking do it.
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?
Late diagnosis here (38 when diagnosed, now 42)… I agree with everything you said. I had an amazing set of systems and coping mechanisms in place to get through life without realizing I was playing the game on hard mode. In retrospect, the signs were all there my whole life but I just hadn’t had the realization.
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.
11 replies →
> 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.
3 replies →
Does it mean you DON'T have ADHD if you get a stimulant affect from Adderall?
2 replies →
Similar experience here. I usually take the weekend off from the medication. Sometimes it serves as a reminder of what it was like before.
I can’t agree more. I spent a lifetime trying to master every productivity hack, reading books, doing hundreds of hours of therapy (this is not a joke - hundreds of hours), and organizing my desk and using tools and … everything.
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.
I really wish my body could tolerate stimulants.
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.
Just a heads up, Ive taken stimulants on and off as a treatment for ADHD for many years but my body/emotional health always felt compromised as a result. I've recently started on a non-stimulant ADHD medication called Atomoxetine and so far it has not had the emotional blunting, irritable effect of stimulants at all, and I haven't noticed any negative effects so far. It seems to help me get over the hump of being able to start things and stay with them which has always been my biggest downfall. We will see if I stick with it, but just wanted to mention that there are alternatives. There is also another medication called Guanfacine that I may try if this current medication does not work out - I don't think I can go back to stimulants.
3 replies →
Hey, just popping in as a psychiatrist:
Speak to your psychiatrist about atomoxetine, viloxazine, guanfacine, clonidine, bupropion, desipramine, or protriptyline. Probably in that order.
1 reply →
Things that work for people with too many side effects:
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)
Same here, the lowest dose concerta keeps me wide awake for 24 hours. The non stimulants give me side effects not touching those with a 10 foot pole. Did you try 2.5mg ritalin? i think thats the lowest dose.
2 replies →
You might be how surprised how low a dose you need for an effect. 5-10ug of Ritalin noticeably reduces the "noise floor" for me.
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.
On Vyvanse, I felt like a machine for like two weeks. Couldn't sleep and had to be productive.
After that it normalized.
I started taking it 1h before I get out of bed every morning, so I could sleep well at night.
2 replies →
[dead]
> 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.
Here's a fun fact. In the US, if you would like to fly a plane, and you have undiagnosed and thus untreated ADHD, no problemo.
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 amount of undiagnosed ADHD (and secretly treated anxiety and depression, for that matter) in the aviation industry is off the charts. I have a lot of respect for most of the FAA, which is professional, reasonable, and evidence-based. But the FAA aeromedical division is a joke. They're bullies with a stone-age mentality about treatments and medications that have been accepted for decades.
4 replies →
This was a big theme / topic on the latest season of Nathan Fielder’s “The Rehearsal” this year: https://ew.com/nathan-fielder-flies-full-boeing-737-plane-do...
Hell, taking medication or not, if you have had a diagnosis in the past (and didn't lie on your medical history), merely having current symptoms is grounds for your FAA medical certificate being deferred.
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."
5 replies →
Not doubting the truth of your claim, just trying to understand you mean... How would the FAA know a pilot has ADHD if the condition is undiagnosed?
2 replies →
Getting a real diagnosis is a big obstacle. Waiting lists are ridiculous, and the medical landscape is confusing.
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.
One thing I haven’t ever seen mentioned in these threads is how do people who can’t handle stimulants get by?
I take guanfacine. It’s an older blood pressure medication that happens to treat adhd. I also have high blood pressure so I get an added bonus. Stimulants are great for laser focus. Guanfacine helps with focus but its biggest help, for me, is executive function and curbs some of my emotional effects of adhd. I notice I’m not as sensitive to feedback or criticism.
Coffee and chocolate (plus potentially tobacco) are technically stimulants, 100% legal, and people seem to handle them just fine. Just take them strategically as opposed to recreationally (i.e. only as support for building up healthy habits; go cold-turkey otherwise!) and you should do just fine. The effect is way stronger than most people might think, provided that habituation hasn't built up and the existing tolerance has been dissipated.
15 replies →
Take less. I don't mean to be snarky, but if it makes you anxious, it's too much. If 5 mg of Adderall feels like too much, I think the issue is just that you feel different. Give it a few weeks. Psychotropic medication isn't an instant fix without side effects. You'll get used to it.
There are non-stimulant medications for ADHD but I think their effectiveness is more variable, they work well for some people and not at all for others. Strattera, guanfacine, and wellbutrin come to mind.
Outside of medication there's therapy, cognitive training, coaching, etc.
There is at least one non-stimulant ADHD medication which may help them: https://en.wikipedia.org/wiki/Atomoxetine
That's me. I had to stop because of the anxiety. I just have to get back to life as I always used to and measure the distractions via behavioural changes
And yet here I am, commenting on HN...
The country I live in prohibits stimulants and moving is not an option for the time being. What are my options besides atomoxetine?
Fringe product, not geared for ADHD specifically. But look at Gorilla Mind Rush/Smooth depending on your stimulant tolerance. In your position you don't have many efficacious options, but this works for me as diagnosed ADHD probably 60% as good as the low dose stimulant medication I take.
Bupropion would be one. Helps with quitting smoking, which around 50% of ADDers do, too.
10 replies →
a) try to find a way to fill declaration of prescribed medications for customs and for police. (let the google/llm and local adhd communities help you) Find verified cases of how that have worked for others in your particular country. Sometimes workarounds exists, but it would take some paperwork
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.
Bupropion, Guanfacine, Clonidine, Modafinil. Check out John Kruse on YouTube for explanation of these and others.
1 reply →
Caffeine perhaps? Yerba mate? Also CBT therapy on its own is pretty good.
1 reply →
Guanfacine is underrated.
Nicotine. But not the smokeable kind. And low dosage. But not if you’re likely to get addicted. The absurdity is that your country definitely makes it legal for historical reasons rather than useful less addicting stimulants.
11 replies →
Khat?
1 reply →
Getting diagnosed and medicated should absolutely be the first port of call and one should do it without delay. However I should add that they never made much concrete difference to my "clinical outcomes". Now I'm sure I was holding them wrong (or holding the wrong model of iPhone), and I should get around to getting prescribed again, but if your main problem is anxious procrastination I honestly think you should temper your expectations about what drugs (or certainly methylphenidate or amphetamine) will do for you.
Do you mean this because the stimulants can also cause anxiety?
10 replies →
> 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.
Just chiming in to mark the importance of the seeing an actual physician part. To get diagnosed, prescribed medicine and have treatment follow-ups.
Problem is I'll keep putting that appointment off...
3 replies →
Yes, though it might take more than one to find someone who's actually qualified and up to date on evidence-based treatment of ADHD. There are some really ignorant physicians out there who are still peddling misinformation that's been debunked for over 20 years.
As someone who is struggling with ADHD and tried Ritalin at one point. The Ritalin did not really change anything for me, I was calmer, but it didn't help me get a better grip on my life so to say. Do you think there is a chance this would be different for other stimulants? Just looking for some experiences people had I guess.
A study I glanced over a while ago said something like 40% of people respond to dex or ritalin, around 80% to either (I'm in this group but dex had more annoying side effects), and the last 20% to neither (but there is other stuff out there). So it's definitely worth trying both branches of the common meds first. You should also talk about dosages because there is titration period where they need to monitor and adjust to see how your specific body responds.
I think it's worth trying. I started with Focalin but found Adderall works better for me. It's a little different for everyone.
The first line of therapy is not stimulants though, this is a massive falsehood that gets spread by those seeking ADHD treatment.
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
True to a point: Noting that has an effect has no side effect.
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.
5 replies →
I have to add my 5 cents to that because I've experienced something I've not seen anyone else experience and I think it might be worth to share it with others that might struggle with the same.
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.
In a similar vein to "try medication", I'd like to add "don't write all medication off after one doesn't work". The first seven medications I tried had basically negligible effects, and then the eighth one I tried (also an SNRI) had absolutely life changing effects within hours. I had the same moment where it seemed like a switch flipped and I couldn't believe the difference one medication could make.
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.
Absolutely. If you're having problems, please consult a doctor! Medicine can't fix everything, but there's a whole lot that a good doctor can help with.
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.
Thank you for sharing your experiences - can I ask specifically about your visual snow syndrome? Is it improved now? Totally cured?
2 replies →
Thanks for this.
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.
Thank you - I've been putting off getting an assessment and seeking medication for a while, and I've just booked an appointment with a psychiatrist after reading your comment.
I just wish my stimulants didn't make me such a shut in.
I disagree with this article on fairly foundational grounds.
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.
This is a profoundly ignorant take on the subject matter. Notwithstanding neurological changes that happen to everyone over the time span of decades, ADHD isn't something that people can just willpower their way out of. It's a spectrum of disorders with a strong genetic component. None of what you wrote above bears any resemblance to fact, and these sentiments can cause actual real-world harm to people.
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?
4 replies →
> 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?
1 reply →
>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.
3 replies →
> The best thing for managing this is meditation
The research support for this claim doesn't seem to be very strong.
1 reply →
go kick rocks
Bullshit. It’s just easier. I’m doing fine without any medication tyvm, no need for speed in my ADHD brain.
I'm happy it works for you. For many others unmedicated life doesn't work, especially if we need to work to live.
I'd be off my meds too if I was independently wealthy and didn't need to hold a stable job. I could start SO MANY projects and never finish them :D
1 reply →
I strongly disagree.
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)
Cool, how do you propose people who _notoriously_ have trouble adhering to schedules, start and _stick to_ a "very rigid schedule"?
If only there was something, like, some kind of pill that could help with it...
7 replies →
Here's a TODO hack that really helps me:
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.
I will forget to check it off...
I will forget to add it.
4 replies →
The article mentions sleep, which is very important to us all. But something not mentioned is that the symptoms of Sleep Apnea can look a lot like ADHD, and if you have sleep apnea and ADHD then you get a double whammy. Sleep apnea can start at any age, which could be one reason why your attention suddenly got worse. If you're waking up unrested, or have any of the other signs of sleep apnea, get it checked out. In my case my doctor resisted testing "because I wasn't obese," (more or less, perhaps I'm being unkind), so you may have to work at it. But an in-lab sleep study will give you a clear diagnosis. I have seen reports of people who were able to stop ADHD medication once their apnea was treated.
I was treated for sleep apnea 3 times trying to get ADHD treatment.
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.
as someone who has been down this road, this doesn't sound scientific... but I'd love to be proved wrong. sleep studies (PSGs) are rather detailed, and that price doesn't align with medical-grade oral appliances
3 replies →
Tell us more, where can I find this person?
My ADHD meds (mostly) cured my sleep apnea. The remainder has to do with allergies.
Most diagnoses of ADHD start with a sleep study.
Of course a sleep study for a child in a loud hospital will probably fail due to the constant PA messages.
>>> 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 …
This maps pretty closely to the theories of Dr. Russell Barkley!
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.
I am obviously not a psychologist, I got kind of worried reading this that maybe I had misdiagnosed myself and that going the route of official diagnosis would lead to a lot of wasted effort. But reading into these two things you describe (Pathological Demand Avoidance (PDA) and Rejection Sensitive Dysphoria (RSD)), I am glad to note that I don't think I've ever had anything of the sort.
But I agree it's good to spread awareness of these kinds of things.
These are the two articles that got me to get diagnosed:
https://gekk.info/articles/adhd.html
https://miniver.blogspot.com/2021/08/the-subjective-experien...
I have the sinking feeling of having both, they both explain me very well.
5 replies →
PDA is more associated with autism isn’t it? Though some people have both.
It's heartening to read the comments in these threads and see that this might actually be the problem I have dealt with for 29 years and that there might be a solution for it.
Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.
My GP applied on my behalf. The queue in my area is more like 8 months though. You have to fill out a bunch of forms but importantly that's after you are in the waiting list.
You might want to just have a chat with your dr, as you'll likely try something like concerta if you are diagnosed - but you can skip the long process of diagnostic and just try the medication if you fill out a few questionnaires. At that point it's pretty self evident if the medication helps the issue or not and bam, you might have solved your problem without going through the hurdles.
Tried to speak to my GP and my local surgery told me to either register for the NHS waiting list (probably 100 years long at this point) or use the right to choose process to get the NHS to pay for me to see a private clinic (takes 2-8 weeks to see someone instead of years).
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.
2 replies →
Doesn't apply to UK. In the UK the NHS will pay for a private company so there is no reason to go private yourself. But they absolutely won't dispense medication without a diagnosis. And the waiting list is at least a few months, closer to a year in my area.
I appreciate the author's notes on managing ADHD. I was glad to find I didn't learn much new, because I'm already applying many of these practices.
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.
ADHD has a biological cause and drugs are the first-line treatment for good reasons.
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.
Stimulants are still first line therapy for treating ADHD but I think mindfulness meditation is wholly underrated. People with ADHD have too much activity and overly-robust neural nets in the default-mode network in comparison to healthy controls. There is a network above this network, the salience network [0] that is responsible for the switching between the default-mode and executive control networks.
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.
[0]: https://en.wikipedia.org/wiki/Salience_network
I’m not clear. Are you someone who has ADHD or is this recommendation based on experiences with someone with ADHD?
I have ADHD and meditation, for me, is very difficult. Painful even.
Meditation practitioners have been writing for thousands of years about the problem of "quieting the monkey mind" which reads just like your typical description of ADHD, only in the specific setting of a meditation retreat (which is typically an intentionally challenging, spartan, uncomfortable environment - hence one where pretty much everyone is enticed to get fidgety and hyper). It's difficult for everyone at first!
5 replies →
I have unmedicated ADHD (Psychiatrist diagnosed) and I really struggled with mindfulness meditation (Even tried a Vipassana retreat). However Transcendental Meditation (TM) worked really well. I find my mind is more organized after a year of practising.
I had a bad back before trying meditation so it was doubly bad.
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.
1 reply →
I also think ADHD is a combo of many different, more specific problems that we blob into ADHD since we are not precise enough to diagnose it beyond the 3 types we have now, and these sets of problems are responsive to stimulants.
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.
2 replies →
I'm sort of inclined to agree with your premise that ADHD may describe how a patient presents without describing the underlying faulty physiology; but, at the same time—it's all about attention.
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.
Oh man, this article is timely!
"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"
On deciding I think you’ll find that most of use are sort of bipolar in this regard. But moreso introverts, particularly ASD and HSP ones.
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.
> 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
Interesting - how is this used? Run every day or its a long-lived server?
I have set up my projects in a way that whenever I work ok it, all the context I need is available from one single starting point. My goal is that zero friction is needed for to resume work on any project, no matter how long it was paused. My habit to keep the context for each project fresh is a at-least weekly, timestamped, append-only Captain‘s Log, which - just as its namesake - is a very brief 1-2 sentence summary of what’s going on for everyone to get back into the story after the commercial break. „No updates“ is a valid update. Since its append-only, retrieving more context is just a matter of keeping on reading after having read the latest update.
How do you remember to update it?
Recurring todo list entry.
adult diag ADD (prob some ASD also). Kids were diagnosed, had one of those ahah moments. At least in my generation, the quite, bored as hell kid in the back of the room. Thankfully, I think the ASD made me determined, hardheaded, and perceptive, and my parents encouraged and supported me to set good goals. That served me well, but I look back and wonder what could have been if I could have stayed awake in high school classes.
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.
IDK if I have ADHD but I started taking Bupropion to help me quit smoking and stayed on it because I feel better on it, and naturally have picked up a lot of this organizational stuff over the past few years like lots of reminders, notes, managing inboxes, calendars, pomodoro. I don't think I've had or have any of the main symptoms of ADHD but sometimes I see a post like this and think maybe? It's also hard because the list of symptoms of ADHD in pop culture seems to be growing out into infinity and it's difficult to separate what's actually ADHD and what's not.
Also there many are other potential factors such as desk-job, sports, sun exposure, and nutrition.
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.
They even ban things like ancestry DNA tests??
1 reply →
Bupropion is an interesting one because pretty much everyone with ADHD is dogged by situational depression. So it helps a bit with that as well as executive dysfunction.
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.
Interesting, i might try to talk to a psychiatrist about it sometime.
> If being organized makes you feel good
> If 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 personality
> for 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!
I agree, there is some good advice in there. However, this makes the OCD remark stand out even more for me. Bit like a doctor recommending homeopathy or starts talking about flat earth stuff. Getting such a basic thing so wrong, taints everything else.
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.
Apparently, the article has changed and now doesn't contain the OCD reference anymore. Cool!
Here is the version I was referring to: https://web.archive.org/web/20250828075812/https://borretti....
I would say that control issues are the seed of OCD. Nobody wants OCD, but Illusion of Control is no cakewalk either. Generally that will also go along with an anxious or avoidant attachment style, which is even less fun.
I don't get your point, sorry. Not sure you got mine, either.
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.
2 replies →
Do you really believe there is only one kind of OCD, specifically one you described?
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.
There are many kinds of OCD! There are zero kinds of OCD that aren't a disorder. A helpful mnemonic is: you could imagine OCD stands for "obsessive compulsive disorder".
Yes, "one kind", by definition of being a disorder: https://en.wikipedia.org/wiki/Mental_disorder
"Some people", "commonly" already implies a variety in symptoms and manifestations. But by definition, they all cause clinically significant impairment, or distress.
This is all good advice but it presupposes that you have enough energy and motivation to organize yourself.
For me, most of the time, the challenge is lack of energ and motivation to do anything outright. Even on 50mg Lisdex.
Came all the way down to see if someone has a comment like this. I have tried all possible frameworks but finding the energy to execute them is the hardest part. Has gotten slightly better after I started meds but a lot depends on how my energy and emotions are at that moment
For me, first came the stimulant meds, then slowly and over time the energy, as I started being more organized and putting my day into a routine. Try Bullet Journalling, it was created (discovered?) by a guy with ADHD.
Thank you for this article. I have yet to discuss with my doctor about this. But I have noticed several issues that are severely lacking for me compared to my peers:
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?
Probably all part of possible ADHD, except point 2, which might be a sign of SDAM (Severely Deficient Autobiographical Memory). It’s recent and not well known.
> 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".)
> 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.
That's not what I was asking. Please note both parts I italicized in my quotation, and how they interact.
6 replies →
In Poland, you are basically unable to get diagnosed if you are an adult. You will be treated like drug-seeker.
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.
That's unfortunate. It's not exactly easy in the US, either. When I wanted to get treatment, I asked my family doc, who referred me to a psychiatrist. The psych diagnosed me with anxiety and depression. We tried treating that; it failed. Turns out ADHD causes a lot of anxiety. The anxiety was a symptom, not the cause. I found another doc who specializes in ADHD who finally started treating it, and the change was immediate.
You need to look for a psychiatrist that specialises in attention disorders. You also need to work with them on a therapy -- you don't go to them and ask them to give you amphetamines, but instead go talk to them about the issues you have in your day to day life.
Speaking as a fellow European that until recently had the same views as you.
2 replies →
I literally went through the process in Poland with success. It was back in 2021 though but I don't think much has changed since then. A bigger probablem at that time was just finding pharmacies that stocked the medicine.
2 replies →
Not true,
Source: diagnosed in Poland, see my other comment. Feel free to contact if need help.
3 replies →
It was much easier for me to get a diagnosis than to make my bed every day. I talked to my PCP, she recommended I talk to a therapist that was qualified to diagnose ADHD (among other things). Went there a couple times and took some tests and got a diagnosis. It took only a handful of appointments. Making your bed every day goes on forever.
ADHD diagnosis is extremely easy to get. There are websites that will link you with a doctor that will "diagnose" you remotely by giving you a questionnaire with extremely leading questions. Even with more reputable doctors it's easy: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
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.
2 replies →
Here in Germany people can wait years to get an diagnosis. And I mean literal years.
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.
In the States, frankly, if you are a clearly responsible adult, it is incredibly easy to get diagnosed: just describe your symptoms like missing deadlines etc. The psychiatrist said “yeah, sounds like adult ADHD. If the medication works, clearly you have it”.
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.
Meanwhile in Sweden:
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.
2 replies →
"It's affecting my work, I'm worried about getting fired" -- this'll help, even if it's stretching the truth.
> 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.
If it helps anybody experiencing ADHD type symptoms.
>> The symptoms of ADHD and thyroid disorder are similar.
Ask your doctor to check that first before ADHD.
Definitely make sure to check since it's easy to test and easy to treat, but remember that it could be both. What blows is that some doctors can become really dismissive of the idea that you might have something like ADHD if your chart already carries a different label (thyroid, personality disorders, depression, etc.) so watch out for that, it can be a challenge to get them to take it seriously.
The cognitive bias of humans to "explain away" is one of my great pet peeves.
Generally you’ll have both a blood test for thyroid dysfunction and possibly a sleep study because chronic sleep deprivation also presents with adhd like lack of focus.
My thyroid was checked multiple times and always was fine. Now (recently) I got diagnosed with ADHD.
For those who cannot be prescribed amphetamines, I recommend seeking out Modafinil. It works really well and a regular psychiatrist should be able to prescribe it.
I found it made me think and act sleep deprived even though I didn't feel it and also increased anxiety.
Guanfacine is also an alternative, and it's method of action also makes it anxiety reducing.
Preach, this is a great post. The author has approximated the same system I (and many others) independently found to be working well for themselves. The bad news is that it’s very hard, if not impossible, to teach masses with ADHD all these elaborate, often very personal systems. The good news is you can make an app which will automatically make it work for individual people. Which is what I’m working on right now (not out yet).
I'd be taking my meds if the pharmaceuticals didn't keep having many-month long shortages of the ones I'm taking...
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.
Has anyone used the Todoist app? What are the apps that you find the most helpful in supporting ADHD - I am thinking to get this app, but also have never used Obsidian before, would love to hear what others are using.
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.
(Edited to add: this is an app I use to help with my likely-ADHD, however it is not a note/taking app)
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.
Have possibly tried every single app out there. iPhone reminders for basic personal stuff. Doesn’t scale for work related stuff. At work I operate better when there is a free flowing hierarchical view on my laptop - Workflowy is what I keep coming back to
Obsidian is the best then, it's just text files. You can sync them anywhere or keep them local. It has plugins for todo and daily diaries etc.
Obsidian for todo lists is a bit of a square peg and round hole situation.
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.
1 reply →
question about the first line of advice
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
My doctor in the states was willing to do what she called a "clinical diagnosis". After filling out a short questionnaire, my score indicated I may have ADHD. She prescribed a medication for me to try. The idea was if the medication helps, and doesn't make me feel bad, then it would indicate I have ADHD.
It helped. I do. That was it!
Unfortunately in India it’s nearly impossible to get a prescription for stimulant medication because of “abuse potential” even if the psychiatrist acknowledges you exhibit ADHD traits.
1 reply →
It makes so much sense but the UK is too risk averse to do this unfortunately. Multi month waiting lists for us
I am from India and got diagnosed in my mid 30s. If you live in a tier-1 city it’s not that hard to get diagnosed. Go to a psychiatrist. Reddit has a lot of good recommendations based on your city
On the chemical note, I found glycine supplementation to be actually helpful in avoiding hyperfixation (not being able to stop on a task). In contrast, stimulant meds solve the issue of not being able to start on a task (not enough motivation/dopamine). Make your own N=1 experiments though.
Glycine makes me feel depressive/anxious if I take more than 1-2g per day, for more than a few days. Very calming otherwise. Common effect for many people.
I feel like this is amazingly useful and not only to people with ADHD! Or maybe I suffer from undiagnosed ADHD
Take one of the more reputable questionnaires... they never require a login or anything. If you score high enough, see if you can get proper neuropsychiatric testing done. Really think about the questions and be honest with yourself… is easy to gloss over problems we have that we learned to compensate for, or be too eager to answer yes to everything if we’re just looking for an explanation for having a hard time at work, for example.
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.
could you suggest some of those reputable questionnaires
1 reply →
I read at one place regarding an ADHD drug that is non-stimulant and makes people a little drowsy, which is why it is good to take before going to bed. I don't remember what the drug is called. Does someone know?
Guanfacine.
Yes. That's the one! Thank you!
Way too much information, brain wouldn't let me read it.
As a life long member of the decision paralysis club, this was incredibly refreshing to read. Have been getting better, but reading this has brought it back to the forefront of good habits.
I guess I have some reading to do tomorrow! Which is also a great reminder that I should update my own posts with all my current techniques of managing with ADHD.
if you are on Android, you may use Google Tasks or Samsung Reminder as a simple and good enough Todo app.
Google Tasks has the advantage of allowing you to manage your Todo list through its web interface, while Samsung Reminder is a mobile app only.
> Using OCD to Defeat ADHD
Does this also work in the opposite direction?
https://www.saner.ai is a handy AI Personal Assistant made specifically for ADHDers
This looks good, gonna test this out
Lost me at “salt water”.
For reasons of personal history, stimulant medications like Adderall are a hard no for me. I am curious, though, about non-stimulant options like atomoxetine, if anyone has views.
Stimulants are a front line defense because they pretty reliably treat the symptoms in just about everyone. There are many other medications that _can_ help with symptoms, but their effectiveness is largely dependent on your body chemistry. It can take trialing several drugs to find one that works best with you.
Methylphenidate was a no-go for me too, was emotionally unstable and burnt out at the end of the day. However, this is my second month on atomoxetine and so far, I have only words of praise. There are one or two months to go for full effectiveness but I am satisfied so far. Focus is better, my mind is much more quieter, I've been able to kick some dopamine seeking behaviors and am working on new habits. I really feel positive and ready for change in life -- speaking this as an anxiety ridden person for more than ten years. The only negative is that it slightly increases heart rate, but I think this is supposed to go away too. I'd note that I am on some supplements as well and beforehand I did a simplistic dna check to see my methylation/detox profile (wanted to see why methylphenidate was a no-go).
[dead]
Having a ton of apps is not the solution to managing ADHD.
"One app is better than two: the more disjoint things you have to pay attention to, the worse it is."
Wait... Silicon Valley is the cure fir all that ails!
I searched the article for "meat" and "carnivore". Zero mentions. First paragraph admits that this is a biochemistry issue and then immediately jumps to the conclusion that MEDICATION is needed.
Insane.
Eat a proper human diet, and your ADHD symptoms will mostly go away.