Comment by siva7
4 months ago
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.
Wow I could have wrote this exactly excepy for a 1 year difference in diagnosis.
It's hard to reconcile with how difficult it was previously. Life on hard mode is a term ived used too. I try to think that it was all to make me stronger for the second half of my life, but I still regularly wonder what could have been.
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> 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.
Wait... Do I have ADD? I've never thought so, because I have three close friends who do (diagnosed and medicated), and they've never described it like this. And, like, they're always starting things they don't finish. I have massive trouble starting things, just like you describe, and have built (effective, I'll point out) systems like sibling commenters describe. This whole thread has bent my brain a bit.
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Does it mean you DON'T have ADHD if you get a stimulant affect from Adderall?
No. Brain chemistry is complex and different stimulants hit different people different ways. It took like 5 medications to find one that didn’t make me feel like a tweaker.
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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.
Interesting! I'll be sure to ask my doctor about those options
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Hey, just popping in as a psychiatrist:
Speak to your psychiatrist about atomoxetine, viloxazine, guanfacine, clonidine, bupropion, desipramine, or protriptyline. Probably in that order.
My wife had some serious problems with the stimulant meds, and atomoxetine did the trick for her.
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.
I can take pretty high doses of Ritalin and sleep as long as it’s not the extended release. The lowest dose extended release medications didn’t touch my symptoms and reduced my average sleep to about 4 hours per night.
My wife gets good results with atomoxetine, which isn’t a stimulant.
If you can’t sleep, for sure avoid extended release meds like Concerta. Stick with immediate release with no afternoon doses. Take it the second you get out of bed. You want to time things so it wears off after your work day and you begin to get tired.
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.
How does that work? You just sleep 1 hour less?
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> 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.
I might agree in principle, but aviation pilots are glorified bus/truck drivers. It's the farthest thing from a job that might cater to a typical "ADHD" skills profile. What you really want in that role is people who can be dependable without relying on intoxicating substances that might have weird side effects.
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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."
> but some bullshit that it actively increases cognitive deficits?
It doesn't look like obvious "bullshit". A number of ADHD medications are well-known intoxicating substances; it's not unfathomable that they might induce some kind of cognitive or behavioral impairment (not necessarily the same kind one might get diagnosed for, either).
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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?
You know, enough symptoms will start to match.
Then you just don't get it officially diagnosed - then it doesn't exist! (officially)
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.
I wouldn't necessarily recommend nicotine. It works and alleviates ADHD symptoms at first which is great but that also makes it really addictive. I can't comprehend the level of discipline I would need to use nicotine without becoming addicted and I'm not prone to addiction generally.
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Lol I will provide a small anecdote as a warning from my own life. I was at a point (pre-diagnosis) where I felt my caffeine intake had reached an addiction-like level and had decided to wean myself down to a more sustainable level. I’d read about adenosine receptors and the different substances that can act as stimulants/inhibit adenosine. I was starting to get a bit of a caffeine headache + drowsiness and the good idea fairy told me “hey why don’t you have some chocolate instead? Theobromine is an adenosine-receptor antagonist so it might help without consuming any caffeine”
This led to what was probably the worst headache of my life. I don’t know enough pharmacology to understand how exactly that worked, but it was terrible. Having a cup of coffee reversed the effect pretty quickly, luckily.
> plus potentially tobacco
You know… I feel like my symptoms were not so bad when I used to have cigars
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.
I posted elsewhere in the thread about my late diagnosis. When I was much younger than when I was diagnosed, I was on Bupropion for smoking cessation and it had a pretty significant positive effect for me with respect to my ADHD symptoms (which I didn’t recognize as ADHD at the time). Definitely worth exploring; it doesn’t work for everyone but it can be quite effective if it does work for you.
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I have to say, buproprion had severe, life-threatening side effects for me. I'm not in a typically high-risk group for psychotic symptoms, but it caused me to become quite agitated and delusional.
It feels strange to type that now, and I know these side effects are quite rare, but I can't help but warn people when I see it mentioned. It was genuinely the most terrifying experience of my life.
It happened about 6 weeks into treatment, quite acutely. I wasn't even aware it was happening.
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.
Thanks, but Bupropion and Modafinil are also banned over here. I’ll look into the other two.
Caffeine perhaps? Yerba mate? Also CBT therapy on its own is pretty good.
Yes, caffeine works but I’m very cautious not to build up tolerance, i.e. I’m afraid that if I start drinking tea/coffee regularly, it’ll loose the jolt it gives me now and I’ll just become addicted.
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.
Nicotine is amazing... for a week. Then you will be chasing the dragon forever. Tolerance builds up crazy fast and doesn't meaningfully lower even when you cease smoking for years.
Plus pretty bad for your health and crazy addictive. Absolutely not a good recommendation.
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It wasn't till I quit nicotine that I began to struggle with undiagnosed adhd. I wish there was a way to make nicotine safe and non-addictive. I think it was far more effective to spike my nicotine level and tackle a task than adderall twice a day has been. Vaping was huge for controlled nicotine consumption.
You are being down-voted by people making big claims ("pretty bad for your health and crazy addictive", "nicotine is ridiculously addictive") without any proofs. In fact, I challenge anyone making such claims to reference a scientific study proving either of major addictive potential or significant health concerns of _nicotine patches_ since OP specifically mentioned "not the smokeable kind" of nicotine.
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nicotine is ridiculously addictive. everyone is likely to get addicted to it
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Khat?
Khat will wreck your teeth if you chew the leaves. And it's about on par with caffeine as far as stimulants go, so personally I'd stick with coffee or tea instead of khat.
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?
They can for some people on some days or parts of days (my anxiety peaks when stimulants are wearing off). But like the other poster said, its more that they do nothing to solve it. I found a beta blocker in addition to stimulants was good at unlocking my productivity. YMMV.
Additionally, the boost in dopamines rewards anything you happen to be doing, so it can lock you into your avoidant behavior that day once you start doing it.
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No, not that (though I'm sure they can cause anxiety under certain circumstances, consult your physician etc.) It's just that IME they do basically nothing one way or the other about anxious procrastination, so if that's the thing that's killing you ...
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Medication alone won't do it. Talk therapy, so that you have someone to talk about your anxieties with, and get at the underlying emotional issues driving that, are requisite. Stimulant medication alone won't stop you from reading Reddit for 6 hours instead of doing what you're avoiding doing. You'll just get a really intense Reddit session out of it. Don't draw the wrong conclusion here, which would be to not take it if you are so affected because it won't work. They do, but that it's something to be aware of. There's no quick fix, it's gonna take work.
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FWIW ritalin reduced my anxiety a fair bit. It changed my brain from one with multiple concurrent streams of thought, often negative and never truly going away, to focusing on the task at hand.
As a direct outcome it means I don't have bad thoughts and feelings sitting in the back of my mind when trying to do something else 24/7 so I'm generally more balanced. Indirectly, it was helped by actually getting stuff done and feeling less shit in general and not putting myself down as much for failing.
> 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...
Heh, the psychiatrist who diagnosed me laughed a little when I showed up rushed and late to my first appointment.
The good news is that after you’ve been diagnosed, getting near the bottom of the bottle of pills is a great reminder to call the pharmacy for a refill. Plus… shortly after noticing that you’re almost out happens to coincide with the medication taking effect, so you’ll be in the perfect place to make that call!
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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.
The parent is explicitly endorsing stimulants. Those work well to some extend for treating ADHS, but in general evidence is rather weak for then improving academic achievement, while evidence is rather strong for behaviour changes that makes it easier for teachers to deal with kids, see e.g. https://pubmed.ncbi.nlm.nih.gov/38871418/.
Pharmacology is not my main area of expertise but I used to do a lot of work in cardiology, and anything that increases the QT interval in the ecg increases the risk of Torsades de Pointes.
Rule of thumb is 5–7% more TdP risk per 10 ms QTc.
Quite a few adhs meds do this moderately, not enough to make an ecg mandratory.
I still believe that making medications the default for adhs is not warranted given the side effects, especially since in many cases it’s not clear if it treats the condition or just makes the lives of education professionals easier.
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So many drugs that unequivocally improve people's health have minor negative side effects. I think this person needs to find a way to connect with their loved ones and understand how the medication they are taking is love changing. I know it is for me.
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?
I always thought any kind of SSRI or alike will make it much worse, as many people on reddit indicate they caused it for them.
I seem to be in opposite camp where SNRI actually lift like majority of visual snow syndrome, but that was not the only syndrome I had. I believe I had something more like HPPD.
Believe me, I was scared as hell as I thought these meds will make it worse, and I am really glad now that I did try them and they did work for me. I still have a really small amount of snowing, but I can ignore it entirely and carry on with my life.
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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?
You are the one that is ignorant of the reality.
> As a thought experiment, insert "type 1 diabetes"
This is an apples to oranges fallacy flawed example, how about we do something that isn't apples to oranges, like heavy metal poisoning. How about we insert chronic low-level mercury poisoning in place of ADHD.
Here is a shocker, the symptoms are the same, and there are many other such environmental based issues that lead to these symptoms. The diagnosis is still ADHD/ADD which is made regularly because its a catchall, and so its the same label but its not the same thing.
So that ADHD diagnosis is ADHD, and its automatically neurological changes, or is it really Heavy Metal Poisoning, which then isn't being treated?
Are my sentiments causing real world harm to people when that diagnosis has been misdiagnosed? Really? This happens on the regular because of exposures that occur but aren't recognized or achieve testing thresholds.
The diagnostic label for spectrum disorders has been for decades incorrectly applied to people, in effect treating symptoms as a catchall.
How ridiculous do you sound in my particular example? Your causing harm to people because they thought they had ADHD because of the symptoms but actually were being poisoned because of a misdiagnosis that isn't questioned (which happens in centralized systems). Who is actually the one causing harm here. The one supporting that system and its consequences, or the one questioning the underlying truth of the matter (which has real anecdotal experiences backing this across a group of afflicted people).
Blood testing doesn't work well at detection of chronic low exposure without causing acute poisoning through a chelator, something that isn't done that regularly. Most doctors won't even order the test even after requests to do so.
Seriously, this kind of armchair theatrics and polemic is why the world is in such a horrible state today, but by all means continue shouting down people that actually know a thing about what they are talking about.
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> ADHD isn't something that people can just willpower their way out of.
I think conflating structured meditation practice with "just willpower your way out of it" is a pretty severe misconception of its own. That's not at all how it's supposed to work. (In fact, if you struggle with focusing your attention in a meditation setting, you're taught not to apply willpower at all; just "notice" that your thoughts have drifted away and comfortably bring them back without judgment. You wouldn't expect this to help, but apparently it does.)
> The best thing for managing this is meditation, and a disciplined lifestyle regiment.
What would be your reaction to the numerous comments on this page where people are saying that they tried and failed to "discipline" themselves for years or decades, only to discover medication later and find that it instantly turned everything around for them?
I'd say they weren't addressing the core issues, or they think discipline is something that it isn't, and then kept trying ineffectively.
Here's what discipline is and isn't.
Discipline is an extremely simple concept to develop but few actually know how to do it in any reasonable way because of so much misinformation out there, and malign influence seeking to take advantage and increase suggestability, and by extension addiction.
Discipline just like meditation is really a fundamentally simple practice.
Just like with meditation, where you don't use willpower, but instead simply focus your thoughts back towards a single point, and then relax that focus slowly, which stills your thoughts.
Discipline is simply the repeated practice of limiting when and where you choose to change your initial decision or choice, for all of the choices you make.
You take your time considering before making a choice, and once made you only change it when there is some new information that becomes available after the fact, whether that is a new consequence you didn't consider, or completely new information you received later.
Its a simple rule. You don't give yourself the choice except under those circumstances. When you are tempted, you remind yourself you don't have the choice. When you cave and fail, you don't beat yourself up because that destructively interferes with your psychology which only works towards outcomes framed in the positive. If you make a mistake you examine what led to it right away, and mitigate those circumstances moving forward. You imagine what you will do next time, with a successful outcome a few times that day.
With this repeated ritual comes an understand that willpower is always finite, and you pick and choose what you will spend that on each day. You recognize when its running low, and defer important decisions pigeonholing them for a later time. With repeated practice in everything this become a unconscious ritual with good outcomes.
You do what you say you will do, and you don't compromise yourself, and people recognize that level of discipline. It becomes easier with each successful choice, and its so damn simple.
These two things together make a world of difference in coping with everything. It places the locus of control for your life within your grasp.
> only to discover medication later and find it instantly turned around everything.
First, medication in most cases in psychology doesn't instantly ever turn around everything. You still have the problems that led to your mental state, they are often subtle which have built up over time. You are just better able to cope with them where you weren't coping before, and following the initial euphoria of relief you still have those problems.
I know quite a number of people that have been diagnosed and use medication to cope with professional burnout. Eventually you pay the piper.
Sure you can take a drug, and maybe you feel better, but also maybe you feel like everything is 100x worse and to relieve the pain and suffering you end yourself; (a known sideeffect) or you have a chemical reaction that ends up in sudden death (a known sideeffect). Few actually consider this, minimizing it.
There is no panacea. Soma is just treating the symptoms. What you do, and things you choose to live by are far more important, especially in contrast to the fact that many medications make one more suggestible. For good or ill.
>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.
Your view is quite distorted, biased, and blind.
> Good. This is a good thing. Treating symptoms is a good thing and we like good things.
You frame this in fallacy, false dichotomy circularly. For a refutation, is treating poisoning with something that masks the symptoms of poisoning without resolving the cause a good thing?
The poisoning is still there its having a detrimental effect leading to harmful outcomes, and you don't know its happening because you masked the symptoms thinking its something else.
A concrete example? Chronic low-level exposure to heavy metal poisoning was quite common 20 years ago. It came largely from silver fillings which were in-fact 50% b/w, mercury amalagam. It was claimed stable and thus fit for us in dental fillings, but later found in the presence of acidic beverages to leach into your systems, and this is not the only exposure. Mercury has also been used in the efficient production and manufacture of Soda beverages, you have to dive quite deep in industry literature to find these facts such as they remove those chemicals after production, and label them as contaminants. No chemistry is ever perfect at removing things. They have been found present in many cases, and not all processes use this but the cost effective ones do. Similar environmental issues are neglected, such as lead paint and other products, arsenic from the water; you get the drift.
Ironically, these can easily fall into the same diagnostic criteria as ADHD/ADD and blood tests aren't sensitive enough because those substances binds so easily to remove it from the bloodstream rapidly (into tissue) to protect you. It bio-accumulates. You literally have to cause induced acute poisoning through medication (chelator) before taking the blood to get an appropriate test result.
> The gaslighting is pushing shitty wellness cures.
Ad Hominem, and lacking in facts.
> I literally had to fight to get access to my ADHD meds...
Ancedotal.
I've met quite a lot of people who initially thought they had ADD/ADHD because that is what the doctors decided. Once you have a label, there is no need to look at anything else that suggests otherwise, a common bias of your average doctor.
These people found that they actually had low-level poisoning, and half the battle was finding a doctor willing to order the chelation tests to prove it. Upon completion of rigorous chelation therapy and removal of exposure sources, and related lifestyle changes they were medication free without the symptoms. They, in effect, cured their ADHD/ADD, and some of them had been to hundreds of psychologists/psychiatrists, all being told they had ADD/ADHD.
Blind trust in centralized systems has an indoctrinated bias that some aren't able to overcome. Nothing is perfect, and some things are the worst possible solution of any solution.
The label in these cases was a classic authority based fallacy. The patients eventually did figure it taking their health into their own hands because the system had failed them, basically saying its all in their head. (Gaslighting).
It was a journey for many of them because they were repeatedly given false or misleading information from the vast majority of so-called experts. Desperation doesn't make things true.
Mind you not all experts are like this, there are some very decent and intelligent experts out there that know exactly what they should and act accordingly; but in the grand scheme they are almost impossible to find or differentiate.
What makes you blind is you assume the diagnostic label is automatically the disease, and that simply is not true in aggregate, or the correct way to approach these things.
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> The best thing for managing this is meditation
The research support for this claim doesn't seem to be very strong.
[citation needed]
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
My apologies if it read like I don’t think medication is ever an answer. I merely disagree with it being the first tool one should grab.
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...
Turn your ADHD obsession into doing the perfect schedule. Turn off your phone and computer. Add reminders of your schedule everywhere. Hang it on your walls. Post-it notes on things you have to avoid. BE BORED for hours without social media, music, podcasts. Use strategic fasting and breakfast to stick to bedtime (same trick used to adjust for jetlag). Get out of your house and walk in silence for an hour. Write with pen and paper everything that keeps you mind over-excited. Add drawings to engage your whole mind.
You have to train your brain. If you always walk with a crutch you will never walk properly. IMO, you should only try drugs once you can sort of stick to the schedule and you are still not reasonably productive.
If you start with drugs you'll become dependent and will need more and more. There is no magic pill.
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