I’d also say right after the meds kicked in I would do something like get on hacker news and write a long post about how everyone should get their ADHD checked and how life changing meds are. That always felt like the meds talking to me.

Not that anyone shouldn’t try it. I’m glad I did, even though I decided it wasn’t for me, because otherwise I would be wondering how much better I would be on meds. Now I know for me it’s not much better.

In reponse to the original post, I don't think psychiatrists are really the ones who should be diagnosing ADHD. It is again my understanding that neuropsychologists should be the ones administering the tests and diagnosis, where psychiatrists will then manage the medications.

For myself, I was convinced that I had ADHD but went through neuropsychological testing. It turns out that the primary diagnosis is that I just have severe anxiety, which shares a lot of the symptoms but with completely different cause mechanisms.

There are a lot of different causes / paradigms / regimes for ADHD that all get lumped into “ADHD”. Various therapies have hugely different effects on different types of ADHD.

And some ADHD drugs tend to have the same effects on non-ADHD people as they do on ADHD people.

Here is an (also outdated) breakdown of 7 types of ADHD that are differentiable using brain scans: https://neuropedia.com/7-types-of-adhd/ Each show different parts of the brain affected. The "ring of fire" type of ADHD is notable for responding very poorly to stimulants.

I do have a free floating anxiety and that was something the meds helped with.

My therapist obviously can't prescribe, but I have a fantastic relationship with them, and they did convey that they think I'd probably be a better fit for non-stimulant ADHD meds based on some of my other behaviors. My doc, however, started me on Adderall ER because I guess that's the standard medication to start ADHD patients on.

But I got some crappy side effects, kind of how you're describing: elevated heart rate, some nausea (especially if I didn't eat enough). My therapist was worried about some of the emotional intensity stuff, especially with stress and caffeine, but I felt like I was managing that okay.

In any case, my doc wanted to start putting me on _additional_ meds to counteract the side effects. Therapist was still prodding for non-stimulant (but I'm a bit skeptical of SNRIs in general, maybe a bad bias...)

But I really pushed to just....reduce the Adderall dosage. Doc knocked it down twice, I ended up at _half_ the initial dose, and now it's just _awesome_. Most of those side effects have gone away, I'm still getting the benefits I want out of it, and unlike a lot of other meds, I can choose on a daily basis whether or not I feel like I'm going to need it.

Obviously, I'm not your doctor, and I'm sure you did your due diligence far beyond what I'm offering here. But I did want to share my experience in successfully shaping medical decisions with multiple expert and personal inputs. Ultimately, I landed on a medication path that's been EXTREMELY beneficial for my happiness and productivity, and it was one that wasn't initially suggested by either professional.

HUGE +1, since I started working out more even just a few weeks ago, my overall happiness, focus, sleep, etc. have all improved massively.

But I think it's worth noting two things:

1. Almost anyone, regardless of medication or diagnosis, can probably benefit from regular exercise. These benefits are well-documented in the general population.

2. The initial benefit of my medication _without_ exercise was enough of a catalyst to help me finally get off my butt, join a gym, and make the decision to invest in personal training as a forcing function to more regular and high-intensity workouts. Until I started taking meds, I had this illusion that I'd come up with a workout plan, commit to it regularly, combine a wide variety of aerobic/anaerobic/freeweight exercises, and all for free with home equipment, YouTube, and some books. All of that was (and still is) absolutely _possible_, but without medication, I procrastinated it all for the better part of 2-3 YEARS. With medication, I quickly came to the conclusion that the time, stress, and inaction of that plan was not worth the money I could spend on making progress. And now I'm regularly working out.

1: Though it's by no means easy to get ADHD people to exercise; most cardio is boring and there's also: "I'm behind on all of my work and personal projects, and you want me to set aside time for recreation?"

For anyone else taking them both that may not have made the connection yet.

This effect has been linked to polymorphisms on the A2a receptor gene (https://pubmed.ncbi.nlm.nih.gov/12825092/).

Edit: are low quality replies like this appreciated on HN or no?

> Empty comments can be ok if they're positive. There's nothing wrong with submitting a comment saying just "Thanks." What we especially discourage are comments that are empty and negative—comments that are mere name-calling."

https://news.ycombinator.com/newswelcome.html

Adderall and I were just not meant to ever go together. The first dosage had no effect other than a slightly elevated resting heartrate, and when the dose was increased, I was awake for 40 hours straight with mild psychosis.

OTOH, some people respond great to Addreall, and I've heard great things about Vyvanse (a prodrug for Adderall) for an all-day treatment for ADHD in those who do.

my blood pressure is high but I never tested it with specifically caffeine + Adderall, I just know it was high with Adderall.

Also tried Straterra and had a bad reaction to that, so decided to just go without and manage. As a mid-40s adult I feel like I have all sorts of ways to cope that I didn't make consistent use of when younger, esp. using GTD tooling and taking copious notes to keep things on track.

Interestingly enough my 'normal' concentration off these drugs seems to be improved... as if they were training wheels.

0. This is how you treat ADHD based off science, Dr Russell Barkley part of 2012 Burnett Lecture: https://www.youtube.com/watch?v=_tpB-B8BXk0

1. https://chadd.org/about-adhd/executive-function-skills/

The wrong meds can have no effect; be much worse than not taking at all; have benefits early in the day and then negatives later on; side-effects; etc.

They can also be expensive. I know several people for whom medication is coffee in the day, weed at night. Actually cheaper.

My doc also told me that everyone is different, and not all medicine works for everyone and most medicine doesn't work at all for some people.

That's why I didn't put emphasis on medicine alone, but I do think it's important to seek for professional help in general. It was important for me, but now I understand it's not a silver bullet.

Thanks a lot for sharing, as it put some new perspective for me and others in this thread.

I had 3 different types that didn't work for me until I settled on an extended release dose of an aderall derivative.

There are different meds for ADHD. One not working isn't indicative of all meds not working. Neither are they all $300/month.

I always wondered why the aggression - for me it was mainly directed to situations where I needed to advocate for myself (and would "slip" before medications) while being less aggressive overall

One thing that eventually pushed me towards trying medication is that I realized I had already been self medicating with coffee. Sometimes when people say "they aren't a person until they've had coffee", that might be true. The problem is that coffee lasts an hour or so and makes you jittery and hungry, while Adder-all lasts 4 ~ 8 hours and mildly suppresses your appetite(s). They're not wrong: sleep, exercise, diet, being social, etc also improve your emotional state, but when making a sandwich seems impossible, the first step might be to stop drowning.

If you're open to sharing, how has your lifestyle changed beyond the first few weeks? Are you still on medication, and how does it help these days? Has your diagnosis been helpful in ways other than meds? Of course, totally understand if you don't want to share.

Along with ADHD I had a pretty strong depression (mainly secondary, as in created by ADHD, but with some elements that might seem primary). Stimulants, on the lower dose manifactured, lifted that from basically the first days. I still have bad days but they are not as crippling as before.

After a month or so I started to realize that I was much more relaxed in general, and that I was "finally" starting to lose track of appointments (like a normal person does, instead of remembering them all like my life depends on that). I think I had a good deal of anxiety that was completely making up for ADHD's forgetfulness. I think it freed a lot of "computational power" that before was used to make me a human agenda.

I also became much less strict with times and habits - it used to be very difficult for me to create and to break habits, while now it feels much more fluid. I used to not be able to go to bed before my last bedtime, which is incredibly frustrating (if my normal bedtime is midnight and I went to bed once at two, the next day I would habe to go to bed at 2).

I'd also advise against taking meds only "as needed", or skipping the weekends, at least for the first months. Even stimulants, which feel like hava an immediate effect, take 2/3 days to be active and from recent studies seem to be fully active only after some weeks. For me skipping a day is terribly limiting and I still feel the effects after a few days.

There was an interesting point a while ago when I could focus on more, I could handle more, but I still couldn't focus on or handle everything... I was still just one normal person. But realizing that, making sense of it, and making decisions based on it, were also new things that were easier. As was connecting with the people in my life. Medication wasn't just making me better at work, but at being a human being. Obviously YMMV, but I think that in our society there is too much guilt around certain drugs. If you feel like you need a life vest, maybe try one on. As many people have said, it isn't especially difficult to stop.

Each day I can tell when the medication "switches on" and "switches off" because I start getting more focused and I'm actually getting things done. Procrastination is noticeably reduced as well. Unfortunately it seems the body builds a tolerance because as time goes on, the medication is becoming less and less effective. Also if I take any after 3PM, I get insomnia, so this means I only take it the first half of the day.

The IR version lasts about 4-6 hours. I usually take it around 10am so I can focus for the core hours of work. This is kinda crappy because my family doesn't get the benefit unless it's on the weekend when I don't work.

I totally understand that "do I really need these?" question. I was the same way for a looooong time. I viewed ADHD as an advantage for the first 30 years or so of my life. Then things got to a point where I couldn't even do the bare minimum and that's when I got desperate. In my opinion, it was a bit naive to ignore being medicated for so long. I should've started treatment years ago when I first started experiencing difficulties. You may or may not feel the same eventually.

Very much this. The nice thing about stimulant medication is it provides more of the ADHD brain regulation with a lower impact on your body (jitters, increased heartrate, etc).

Also, decongestant medication, though Adder-all is a mild decongestant so I don't use separate decongestants very often.

And then there's the inevitable "you run out of meds and have to navigate all these hurdles without being medicated" gauntlet that makes you cry in frustration.

If I didn't have a non-ADHD spouse, I doubt I'd be able to maintain it.

I've lost hair and I've gained significant weight from the stress. Adhd medication has probably added years to my life. I can actually proactively accomplish things for the first time in 30 years of living.

From a programming standpoint, sometimes the drug makes me more confident and enthusiastic, which results in me spewing out a few hundred lines of well written but ultimately misguided code. I guess self-doubt and anxious overthinking has a purpose.

I had done the same in the past and was prescribed Vyvanse which I liked much better than Adderall. Adderall was enjoyable & worked but it also felt really good and I wanted to take more when it was wearing off for the day.

Vyvanse seemed to be even more effective at helping me focus, it would last its 8-10 hours and then I didn't have any desire to take more for the day. It did make my stomach hurt for a short period when it was wearing off though(not for the whole day or even very much of it).

After a couple Iraq tours I had such difficulty concentrating and became someone who procrastinated & then got days worth of work done in a few hours once the deadline was there. Vyvanse really changed things for me as I was able to not be in such a rush slamming out work and that made me so much less anxious and less depressed. I learned a lot of my depressed feelings were because of my anxiety from knowing I was behind and not doing the things I needed. So getting my ability to focus improved helped me immensely in more than just the one way.

Long story short: the culprit was sleep apnea. After a sleep test, I got a CPAP machine. After a bit of time to adjust to the equipment, it made a profound change to my life.

The next year or so was perhaps the most productive of my life. My boss & coworkers remarked it was like I was a different person.

Good quality sleep is important, it turns out!

(Side note: I dropped into REM sleep before my CPAP machine, with lively dreams and stuff. So I didn't really think I had apnea. My faulty mindset of apnea was that you basically couldn't dream at all. But once I had the CPAP machine, my dreams turned into unreal, epic sagas, as my brain started to repair and catch up on all the REM sleep it had missed over the years. My dreams are no longer so crazy, but that first 3-4 months was really interesting)

Sleep matters.

It was hard enough finding a therapist (and retaining them -- my therapist dropped me because the office only allows them to see someone for 1-2 years max).

If anyone has tips on more effectively finding therapists and psychiatrists, I am all ears. (I'm in the US if it helps)

interesting. I've never heard of that happening.

I found my therapist on PsychiatryToday- just added a bunch of filters and scheduled a couple phone consults (most offices will do these for free). Went with the one I found that had availability and seemed to work well with me. They referred me to a psychiatrist.

It's definitely easier if you have a plan that doesn't require a PCP or anything, I think mine is a POS so I just call up any providers I need, no referrals or anything.

> I went a different route. I went through my primary care doctor. I told him I'm getting in trouble at work due to procrastination and lack of attention. I also said my wife and friends/family have been complaining that I never listen anymore. I asked if I could be evaluated for ADHD. He sent a referral to a provider with https://lifestance.com. It was only two appointments with the LifeStance provider to get a diagnoses. Once my doc got the diagnoses back from LifeStance, he's been in charge of prescribing the meds.

Before I was on meds I was all over the place, could hardly write code even though I knew what needed to be done. Got booted from company I started because of ADHD/Depression. Didn't graduate high school. All the signs were there. I just started seeing a psych from Stanford and he dismissed a lot of my preconceived notions around taking medication.

I was almost homeless before I started and thinking about working construction. Started meds. Got a FAANG-tier programming gig without even studying for the interview. No harm in trying things out if you're having trouble.

I can take an Adderall and take the best nap of my life which is the exact affect it should have.

Some things that have worked for me:

* Less medication. I dropped my Concerta to 36mg which avoids many of the side effects.

* Frequent calendaring, even for personal life. This helps visualize time commitments.

* Use of a pen and paper notebook throughout the day, reducing cognitive load. I've tried a lot of digital note taking tools but I end up spending too much time fiddling with them.

To encourage myself to take notes I just have a loose structure of one page a day.

I also created a habits tracker. Everything I'm supposed to do every day, plus common stretch goals. Spreadsheet format, with days across the top, and tasks along the side. Kind of inspired by Seinfeld's "don't break the chain".

Posted under my real name because I'm beyond sick of this being some kind of a taboo. No one's ashamed of talking about, say, thyroid meds.

After I found a few, I was brutally honest with them. I told them about how I truly felt, as for example, when overwhelmed with things around me my mind blanked and I lost complete focus on anything.

I settled with one that had a more balanced view, listened to me, gave me practical advice, and didn't rely on the on just meds or the strongest med.

When it comes to specialists, it pays to search. Although the first consult can be expensive. It's also good to do prior research on their name, my specialist had mostly very positive reviews on many sites, and the reviews didn't seem bots or friends and family.

I have issues with focusing and prioritizing work.

What helped me is getting a work with absolutely floating work time. For example today I went to work office at 19:30 and I'm going to leave it at 7:00 or something like that. It doesn't matter. What matters is: I work prolonged hours (because I still procrastinate, but I've found out that I start to focus on work after 4-5 hours or something like that. And I can sleep as much as I need, without any alarm clock or calls. I usually sleep 8-9 hours, my whole day is something like 25-27 hours, so it's slowly rotating.

With these weird conditions I'm starting to unleashing my potential and it makes me feel so much better than before. When I'll get to work "late" to 11:00 in a sleepy state, will procrastinate until 18:30, when office is closed I'm going home without completing good work, then work overtime to finish sprint, getting burned out and this cycle repeats again.

I don't think that my current life style is sustainable and I plan to adjust it to a "normal" style slowly, but it's important to feel that I don't just slack at work and I actually do enough work to warrant my salary. This makes my soul happy and then I can move on with other things. Because when I feel uneasy, I can't really proceed with anything.

I don't trust psychiatrists, but it's just me. I prefer to find issues and ways to solve those issues. I tried to visit psychologist, but I felt that it's absolute loss of time and money.

One thing to try is melatonin (0.3 to 0.5 mg). Take it around 8:30 PM, then stay up past the point it makes you drowsy (it will kick in in about 30 minutes after taking). Got to bed at a normal time like 11:00 PM. You’ll probably wake up around 7:00 and be wide awake, and have much better focus during the day.

Doing this will help you align to the rest of the world’s schedule, which like it or not, is really when most people are expected to be working and available, and will also help to align your social schedule with others.

It's a risk v reward decision, one which I fell on the "nope" category. :)

That didn't work too well for me, since I'd hyperfocus on one thing (my heading, rate of turn, altitude, etc) and develop blindspots to the other 5 instruments. Not to mention radios and checklists and visuals and maps, etc.

And god forbid I had to use my flight computer (the rotary slide-rule type, ipads didn't exist then). That thing was pure crack to my brain.

Instrument flying is when these weaknesses became most apparent to me. VFR was enough like driving a car that it wasn't as much of an issue.

1: https://news.ycombinator.com/item?id=25996306

I simply needed to do maintenance on the base levels of the hierarchy of needs to keep the upper levels intact. It may not work for you, but most of your effort should first go into evaluating whether what you do still works in your favor.

I know someone who was diagnosed around age 8. Her parents declined to give her the speed that was recommended. When she was 12, she went for a run one morning and found that it made a huge difference in her ability to focus and maintain emotional equilibrium. She ran as many days as possible since that first run and runs ~12 miles a day (in addition to doing multiple team sports and weightlifting). She is doing great in life - about to finish college and is generally happy. She's quite dependent on her exercise though and if she misses a day for some reason, she is pretty miserable.

I'm not a doctor and have no idea if this would work for anyone else, but I have to think that there are better solutions than giving people speed.

My point is that if there is a chance that a reasonably healthy habit like running could possibly alleviate ADHD symptoms, wouldn't it be clearly better to try that before giving kids drugs of any sort?

*Common adverse reactions of methylphenidate include: tachycardia, palpitations, headache, insomnia, anxiety, hyperhidrosis, weight loss, decreased appetite, dry mouth, nausea, and abdominal pain.[5] Withdrawal symptoms may include: chills, depression, drowsiness, dysphoria, exhaustion, headaches, irritability, lethargy, nightmares, restlessness, suicidal thoughts, and weakness.[1]

Isn't amphetamine = speed?

Adderall is adderall. Why be this way?

https://en.wikipedia.org/wiki/Speed_(disambiguation)

To reiterate from elsewhere in the thread: My point is that if there is a chance that a reasonably healthy habit like running could possibly alleviate ADHD symptoms, wouldn't it be clearly better to try that before giving kids drugs of any sort?

I am stating that as an opinion - not a fact.

> long before Breaking Bad and Meth

Your world seems a bit one-dimensional. Running helped one kid. So, we tell every kid to run? What do we do for kids that don't want to run? Force them? What happens when you run out of things to try?

You're perpetuating a world in which humans can't get the right help for their issues because "they should just try X!" It's incredibly tone-deaf.

By the way, Methamphetamine existed long before BB. It was used by Nazis to keep them in fighting shape.

I always recognize myself in those testimony and I think it's time to do something about it. So thank you for your message!

My theory is that it is a general increase of awareness around both ADHD and autism (and some other neuro-divergencies) in mainstream media. Fueled by the pandemic/lockdown situation which seems to have surfaced a lot of pre-existing ND problems for many people.

I'm in Europe and before COVID, going to a therapist was often viewed as only necessary for trauma. During and post-COVID everyone and their dog is seeing a therapist for focus/burnout/anxiety/motivation issues. Which could lead to an increase in diagnoses, which in turn leads to more people talking about it. Feed that into the Twitter/TikTok/Insta feedback-loop combined with the media jumping on it and we get the current situation.

It's either that or the vaccines do cause autism... /s

But I'd love to hear from people who have been sticking with a drug for over a year (or conversely people who tried a drug but it didn't stick for a full year)

Which is to say that without meds, I can't concentrate long enough to use a coping method, or the coping method just doesn't work.

"You can't sit down until you do X" doesn't work when you're bouncing all over the place, or hyperfocusing on Y - when your brain can't concentrate enough to view sitting down as a reward.

Firstly, I only loosely fit the diagnostic criteria. I am more inclined to think that that which they identify as ADHD is just me being a lazy and impatient asshole - I could probably act differently if I cared enough to try, which I kinda don’t. I can make myself focus myopically on practically anything, which is, as I understand it, contrary to the core facets of ADHD. My life is a garbage fire on a train wreck, but that’s ok, it takes me interesting places.

Which brings me to secondly - I have a problem with even accepting that ADHD exists. So many kids at school would go get diagnosed as ADHD or dyslexic or whatever, when they patently weren’t, so they’d get the extra time and grade bonus in exams. So many other kids would be forcibly diagnosed and drugged, when all that was wrong with them was that they were being bullied. It feels like the psychiatric industry invented a new product to sell, and needed a diagnosis to stick it on. It’s convenient for schools, as you can label and drug anyone who shows any hint of individuality, and likewise for parents, as it allows easier management of vivacious children. For adults, it’s convenient as an explanation for failure to meet one’s own expectations in life.

Me, I just accept that I am a bit of a disappointment - “If madaxe would only apply himself, he would be an exceptionally brilliant pupil”, said everyone, ever - and I do not like to apply myself, as as I said, I am a lazy asshole intent on coasting through life.

A colleague was struggling with what he self diagnosed as ADHD, but after being dragged to the doctor by his wife, he was actually having blood sugar problems.

I know your post isn't money-related, but let me digress. What is the point of fixing your procrastination? What goal are you really trying to achieve?

If you can't pay attention in project meetings, so what? It's not like you'll get a $100,000 bonus for doing so.

If there was a $10 million gold bar in the bottom of your backyard pond I don't think you'd procrastinate learning how and going about recovering it. It would probably occupy all your attention.

In my opinion the solution is to change your focus in life to things that pay out higher rewards. I.e. instead of paying more attention in meetings, do the minimum to not get fired and figure out ways to make more money (find another job, start a business, etc.). If your job is already high-paying then focus on things that are high impact on impressing your managers.

If the result of fixing your "procrastination" gives very negligible long-term financial benefits then it's not really worth it.

I also often don't listen to my wife - unintentionally - but it's because she often says things without a lot of substance. So it's hard for me to keep focus.

I've had lifelong procrastination issues too. Maybe I have an attention disorder as well (but undiagnosed). But I have a few million in my brokerage/retirement accounts, and my own startup with millions in funding, so do I care? Nope not really.

Anyways, my advice is to figure out where the metaphorical gold bars are and go after those instead.

I was also actually diagnosed with bipolar - around the same time as the bad procrastination - but I stopped taking my meds a decade ago (against the wishes of my doctor) and I'm basically fine now.

Yeah, but you also won't get that promotion if you can't focus on meetings, even though every part of you wishes you could.

Thanks so much for posting this! I went through a similar journey about a year ago. I was told I had been able to work around my executive dysfunction until I had kids. But even “working around” it, ADHD was holding me back. A manager at one point described me as being “stuck in second gear”. I may not be in fifth yet, but I’m definitely moving faster.

I have been prescribed (generic) methylphenidate, but the doc essentially told me "Take the tablets twice a day, good luck!". The medication does give me more mental energy, but it's much closer to "being on a rollercoaster" where you're being flung around than driving a sports car that you're in control of. (I haven't received any particular guidance/therapy etc.)

To give an example, if I take my dose when getting ready, I'm probably going to be focusing too much on moisturizing my face or arranging my bag, rather than using the energy boost to "just" get off my butt and move out. I should probably add that I don't have very good structures/schedules in place.

I really would like to help "tame" the med and would be grateful for any HN'ers help/suggestions!

- I initially started on Concerta but found that I was burning through the dose way faster than advertised (4hrs vs 8hrs) and experiencing an unpleasant crash at the end where I felt zoned out, emotionally flat and unable to focus at all; and this was with the supposed holy grail Janssen variant.

- IR was slightly better but the rush up and crash down wasn't stable enough for me throughout the day, and managing the doses is an imperfect science / requires awareness of time (obviously not my strong suit).

- Going onto an XR variant (generic for Metadate, capsule with extended release beads) has been the best so far. It lasts throughout the workday, has a smoother onset and "landing" that for the most part doesn't send me into a crash, and is available to me as a very cheap generic.

- I take it first thing in the morning, take my dog out for a walk (~30 mins), and the timing works out perfectly for when I get back and get started with work. If you have a gauge of how long it takes to start working, then maybe work backwards and build a routine around that (e.g., when you arrive at work, before you leave, etc.). Ideally it's latched to something in your existing routine so you don't forget.

- Regarding the period where medication is wearing off, this tends to align with when I finish up my work throughout the day (which the proper dosing should achieve), and I usually go to the gym to lift weights shortly after. This works for me as a transition to doing something productive / good for my health, and the exertion seems to help with the slight withdrawal sensation during this period. Otherwise I tend to trail off into mindless internet browsing once I check out of work.

- Organization-wise I just maintain a simple to-do list so I have it on hand when I get started with my day. It seems to work best when I have it updated from the day before so that I can just sit down and get started without having to figure out what to do first. Granted I do still have a tendency to jump around between things throughout the day, but having that reference on hand definitely helps me to stay productive instead of going down rabbit holes.

- I also somehow semi-quit social media after years of trying to no avail. Namely Instagram, which for me was the lowest resistance / easiest to slip into an endless time-suck on, as well as my Reddit homepage (I only check two sports subreddits which don't move that quickly). I hid Instagram from my home screen, and created two browser bar bookmarks to the individual subreddits to avoid going to the homepage so if I have an impulse I can take a quick break, but won't have enough content to stay on for long. The endless scroll is a son-of-a for folks like me. YouTube time has gone up, but at least with the content I watch there I'm learning something related to my hobbies.

- I'm sure you already know but always good to mention food and water, I went through a short stint where I had to take antacids because the combination of medication + some acidic foods (I think it was greek yogurt) were messing with my stomach.

Definitely still doing some fine-tuning myself, but the medication has been so helpful in the sense that I can actually implement lifestyle / habit adjustments without them immediately falling by the wayside. Currently my main issue is managing my sleep schedule - I've always been a night owl but also know that I feel much more calm when I can wake up earlier and get a good start to the day. Seasons have also always hit me pretty hard energy / mood wise, especially during the daylight savings transitions. I use light therapy to help stave that off.

I think there is certainly a spectrum of ADHD. Those with severe ADHD literally cannot function in society, they can't hold jobs, they can't get university degrees, without medication. Then you have the mild ADHD induced tech worker which is becoming more prevalent. Yes, meds are going to help as well. Possibly less social media, less dopamine hits, more exercise, and better sleep would help too.

Another thing to keep in mind is that burn out symptoms look an awful lot like ADHD symptoms. And burn out is very common in our industry.

1: https://www.fda.gov/drugs/drug-safety-and-availability/fda-a...

edit: Updated to be clear I mean people being diagnosed with ADHD as adults, not everyone with ADHD who is an adult.

Do you know someone really close to you affected by ADHD?

I am really frustrated by regular people with affiliation to the tech industry at best and stories about chemically induced productivity enhancement "lifestyle" experiments to question the existence of the condition.

I am right there with you when it comes to criticizing prescribing stimulants to anyone on a whim.

I can say that here in Germany any typical diagnosis includes submitting early school year report cards to establish the fact that what the patient is describing as lived experience was already recognizable during child/ early teen years.

I can say that getting the diagnosis and access to medication has been absolutely life changing. I am 30 years old.

I can say that having talked to other adults who were diagnosed late, they mostly share this perspective.

People are really suffering and anyone discrediting that fact is piling on top of said suffering for literally no reason.

What I'm skeptical about is the rise in ADHD cases only diagnosed in adulthood. I think there are likely other explanations for it rather than ADHD.

What I'm observing is: there is a sudden rise in adult ADHD diagnoses. Big pharma is pushing marketing around ADHD, there are viral themes on TikTok etc. about ADHD, and you have the rise of subscription services like donefirst.com. Social media sites are being flooded with posts exactly like this one. What is going on exactly?

Maybe there really is a large number of undiagnosed ADHD cases that are only now getting diagnosed, as people are being made aware of the symptoms? Are there really people, aka "normies", who don't procrastinate, and can just sit for 8 hours doing intense knowledge work without any kind of stimulant?

As such I'm not working in tech but I love technology and doing things related to it. I'm highly knowledgeable and highly competent.

I don't social media anymore. I'm out of shape but I'm not fat but I don't exercise so I'm not strong. I get decent sleep but I also do whatever I want with my schedule for the most part, but I get at least 6 hours of sleep and it's good sleep because I don't force myself to sleep when I can't sleep.

The biggest symptom for me with my ADHD isn't focus. It's not attention. I have both of those things with and without my medication probably more than anyone that I talk to on a day-to-day basis and that's because skills I've learned over time to change the way that I approach my environment.

The biggest issue I have with my ADHD is motivation. It's task starting. Even self-goal-related task starting.

The second biggest issue is frustration and anger and impulsivity.

Now you can get told your whole life when you have ADHD that you're not focused on things. And then you develop methods to make sure that you are focused on things... Then through no fault of your own it appears as though that you're not focused on things because you're not *doing things*. You have no fuel in the tank even on a good day to actually sit down and do something that you want to. You're not depressed. You're just not doing the thing.

Even the common medications available today don't address this. But one thing I will say is that stopping dopamine hits doesn't help this. Dopamine fasting is a fucking myth. You need dopamine when you get in situations like this because you're just already at a low baseline and you're desensitized and depriving yourself of more doesn't actually lower that needle on the compressor to use an audio analogy. So, most of the time what gets me out of this funk is to get frustrated at something external. If I'm watching someone play old games on twitch in the retro category maybe I'll get frustrated because they are using dosbox when they should be using PCEM and the accuracy that they are getting is wrong and they're showing the game wrong so then I get motivated to get up and actually play the game correctly while they're doing it wrong or something. Or I'll read a hardware review for some computer part and I get frustrated that they aren't benchmarking this shit correctly anymore and if I have the means to have that hardware then I'll try to start writing a review and doing testing methodology for it. Those are just some small examples. I say jokingly that spite is a motivator for me.

Edit: diagnosed at the age of two and medicated around that same year and I'm 34 now. Also a side diagnosis of extremely high functioning Asperger's.

Also some extra little things I guess...

The world frustratingly operates on delayed gratification and delayed punishment. And by delayed I mean more than immediate. This doesn't work for me. You aren't doing me a favor if I did something wrong and you don't tell me right then right there in a constructive manner. You also aren't helping me if you are withholding reward for longer than exactly when I did the right thing. I'm not saying I'm a spoiled little brat that needs things as soon as possible because everything is about me me me... I'm saying that my brain literally will not process these things the same way if you involve a Time component.

Edit again: anyone who thinks this long scrawling comment is the product of an amphetamined up brain. I just woke up and rolled over turned off the sleep tracking on my phone opened up edge went to hacker News as is my usual morning routine. I'm completely unmedicated right now. Most likely this comment wouldn't exist if I had my medication in my blood right now because I would have thought about what usefulness commenting might have and then thought better of it. IE I would have had less impulsivity. So I'm not saying this is medical advice but if when you take your Adderall for your new found out ADHD diagnosis and you find that when you take it that things are going quicker and you're doing more things possibly impulsively then... I'm just going to say that we don't have the same ADHD or you just don't have ADHD and you're just tweaking right now instead because when I take my 30 mg of instant release amphetamine salts I am extremely calm and extremely collected and I don't do half the stuff I usually do when I don't have my meds in my system.

One way that I cope is by doing something tangential to a big task or not really effortful. Like if I need to do something in the workshop, I'll wander down there without necessarily intending to start the project, or maybe I'll just clean up or sweep for a minute. By the time I've done that, it's less friction to do the thing.

Or I'll figure out the smallest unit of effort to start a big task. At my job this is easy because there's usually a docker compose, so I'll spin up the stack and setup tmux, and by then I'm already 'working' on the problem (and reminded of what I'm trying to solve) so I might as well try the first solution that comes to mind. Then I'll follow from that to the next thing that occurs to me.

I think I got this technique from Terry Crews, who said he got over his mental block for working out by changing his goal from "I will work out at the gym every day" to "I will physically be at the gym at this time every day." Which means if he was truly not up for working out, he could read a book or something, separating the hard part of the task from the logistical part of the task.

Up until now, every day was an uphill battle, causing me tons of stress and anxiety. I, too, self-medicated.

I never thought anything of it because I was always able to work and finish stuff. It was my normal.

Now I know it shouldn't be that way.

I did try many other options before starting meds. They helped a little bit, but not significantly.

Nearly anyone will respond well to a stimulant.

As I understand it, caring for someone diagnosed with ADHD, the response to stimulants is quite different in people with ADHD.

When a neurotypical person with control of their executive function takes stimulants it will increase their energy levels but it will also interfere with their executive function. They will lose impulse control, have intrusive thoughts, difficulty focusing.

An ADHD person has difficulty regulating their executive function to begin with. All the different parts of the brain that have to work together in concert to perform a task have a leader that is easily distracted and they have a hard time controlling the leader. They start with confused thoughts and it can be struggle to maintain their focus on long-term plans/tasks. When they take stimulants it appears to help them regain control over their executive function. It increases their energy levels a bit but they way they react is quite different -- it can seem almost like it calms them down.

So no, we don't all have ADHD. And not everyone will respond the same way to stimulants. They're one tool that can help people who have trouble regulating their executive function.

Edit: parent replied snidely to me, then deleted the comment. ¯\_(ツ)_/¯

And not all ADHD meds are stimulants.

It's very real, and it's a royal pain in the ass. It's also an exceptionally common issue for those with ADHD. And yes, meds help with it.

If I'm going to take drugs, it's going to be to feel good not to work hard. I'm not taking drugs so that I can fit into an insane world's view of what a productive member of society looks like.

I agree with you. These things seem to be handed out like candy to whoever says the right things to a shrink. I think every single one of my neighbors has an addy script from willy wonka internet docs.

When I was a kid, my parents were told to put me on meds as I didn't want to participate in school activities that I didn't find interesting. They smartly ignored that advice.

I played with pharmaceutical stimulants in college and they are absolutely amazing, which is why I don't touch them any more. It's not a thing I would ever want to become reliant on.

And I still have problems doing things I don't find interesting, which is also known as a normal state of existence.

No shit buddy! It's amphetamine! Put it in the water supply to strengthen our GDP.

It's hard to describe to people what it's like to not be able to do something you actually want to do. Every night before bed I'd tell myself, "tomorrow, I'm going to get out of bed and get ready for the day in 30 minutes" and I would constantly fail at this simple thing. I would stay in bed for 2 hours awake wanting to go and do things but it was just so hard.

Though my root cause was ultimately physical (pinched nerves in my spine), addressing the mental health aspects is also required. The kinds of stuff addressed in the book The Body Keeps the Score. The skills and knowledge I learned from Swedish Pain Services were the missing puzzle pieces for me.

My life advice to all other patients:

1) You must have a patient advocate. Life coach, fights for you, keeps you accountable.

2) Never accept "no" or "I don't know". Someone, somewhere has the answers you need. Keep digging.

I did worry the stimulant effects of the medication led to me daydreaming "fanciful" ideas that I questioned whether I would have found as profound if not on it. And my wife felt that it made me "snappy". But otherwise I found it helpful and the benefits well worth the side effects.

Why I ended up going off the medication came down to the inconvenience of filling it monthly culminating in not being able to get it. I don't know if it's like this across the USA or just my state (or just how my doctor's office did it?), but I was required to obtain a handwritten/hand-signed paper prescription chit from my primary care provider every month. I couldn't get 90 days' supply, I couldn't use the Pharmacy drive-thru when filling it, and my wife couldn't pick it up. I had to physically go in the doctor's office and pick up a piece of paper with a scribble on it and physically go in the pharmacy to fill. Even medicated, remembering to do this every month is challenging for a person with ADHD.

It came to a head when my primary care provider hired a new office worker whose job it was to be a middleman between the doctor and managing prescriptions. There ended up being some sort of communication breakdown and my prescription chit wasn't ready, then the doctor was out, then I thought the middleman guy was reassuring me he was going to get it taken care of by Friday, but he was actually telling me I needed to get it taken care of before Friday - something like that. By that time I had run out a couple days before, and as often happens with Murphy's Law, it was going into a long weekend due to a holiday so it would be four days before the doctor was back.

I ended up going through cold-turkey withdrawals which were pretty awful. By the time my doctor's office was open again, I was fed up with everything. I had already gone through the worst of the withdrawals by this point. Instead of restarting the medication I decided why not just finish getting over it and never have to deal with this again.

Even though I don't take ADHD medication anymore, I still feel like the experience of having once been able to know what it's like to be able to sit down and pay bills or get boring work done still helps me. It's harder now, but just knowing that it is possible to do is like the difference between seeking a scientific discovery you don't know if it exists versus trying to engineer an experiment you know what the outcome could/should be.

While it's trying having your 'personality' shown to you as just coping mechanism of your disorder, but it's nice to feel so included too ;)

First of, I suggest you talking to your doctor about the medicine. For me, I use Vyvanse 30mg, but the same medicine can have a much different impact on you.

I do recommend therapy and really opening up to your therapist. I started out with current struggles, how I felt and handled, and then I talked about past events, formative stuff from my childhood and teenage years.

I also covered topics about inadequacy and frustrations with how I manage my time, my attention and my energy.

Before each sessions I make a list of certain topics I want to cover and I use it as starter, then I let the therapist guide me through some stuff.

Know where I can do that in a reasonable time frame? Because I've been trying to find a psychiatrist to check my work on my Bipolar 2 self-diagnosis and of the 5 clinics I found only 1 ever got back to me about appointments, which are several months out for availability.

Unfortunately it also made me more annoyed so I stopped taking it after taking it a long time.

Still think it's super shitty that it was so difficult to try it in the first place.

My point is, there are lots and lots of different kinds of therapy, and lots and lots of variation in therapists. If you are having problems seek help please! You're not in this alone and it's important to take care of yourself. My advice is to try several different therapists until you find one that helps you.

OP got lucky, the psychiatrist they met didn't try to have them committed or anything gnarly like that, and it sounds like they got good results from the weekly therapy with a psychologist and some medicine.

You might not be so lucky.

Start with diet. Most of us are making ourselves sick by eating some kind of crap.

Check physical things: are you getting enough sleep? Too much light or noise at night can act like slow poison. Or you might have sleep apnea!?

Is your house next to a freeway or an airport? Some chemical source?

Does your spouse or child or neighbor drive you crazy? Your commute is too long?

Next, try mechanical interventions: massage, Rolfing, etc.

If it's not food, environmental, or something in your muscles or bones, then maybe just maybe you might need therapy of some kind.

Scientifically, we are no better off than witch doctors and fortune tellers. Psychiatrists are trained as medical doctors, which is strange when you think about it, because they don't use any of that training in the practice of psychiatry.("Psychiatry is not a branch of medicine." is "funny" because it's true.)

(E.g. When you go to a psychiatrist they do not draw blood. There's no point because there's no tests they can run on your blood to know what's wrong with you "psychiatricaly" (because that's a word that means "Western-flavored voodoo".))

So, to sum up, if you got problems get some help. But beware of psychiatrists because they are even more crazy than most therapists and they often have leverage with hospitals and police to do really messed up violations of your human rights if they get the idea that you have "demons in your blood" (demons with names like "Schizophrenia" and "Bipolar". They can conjure with these names to put you in jail for days or longer even if you have committed no crime or criminal acts.)

I saw a grief counsellor that really helped me get through the bad event in a way that my untrained friends were not able to. Did I care in the moment about reproducible studies? Probably not.

But would I trust the same professional to medicate my children based on some hyped-up diagnosis? Also most likely not.

What did therapy look like? What were the most impactful things for you?

Before I was diagnosed I had a good exercise habit, ate well, used a calendar and a todo list and my life was still a mess. After getting diagnosed and medicated I see a steady gradual improvement in all aspects of my life.

What I can be sure of is that many people do have a debilitating condition, and these medications help them live a normal life. This "ADHD is fake you're in control just snap out of it" bullshit is offense and idiotic.

Based on some unfortunate personal experiences I have to emphatically agree. I would also throw cut down on social media / porn / addictive games as very important if you’re identifiying as ADHD.

Amphetamines like Adderall have issues with long term tolerance and can have adverse effects on your cardiac health and mood, both of which I unfortunately experienced.

They mostly work by spiking dopamine which there are non pharmaceutical ways to accomplish such as cold water therapy and being more cautious with your baseline dopamine levels (hence the importance of avoiding cheap , easy spikes of those levels).

It’s obviously a complex issue still being figured out by scientists but there is a zeitgeist pushing people towards pills as the simple solution when increasingly the science demonstrates that lifestyle change is both more effective long term and lacks adverse side effects.

I do think psychiatric meds can be appropriate in extreme circumstances and in cases where they temporarily help people “course-correct” . But people viewing them as a panacea because someone’s having a stimulant honeymoon should dig deeper.

Finally, I get ADHD meds advertisement on Facebook constantly. There is simply a financial incentive to push people towards pills over lifestyle change and it’s irresponsible to pretend that doesn’t impact any narratives.

This is simply a lie.

Use your imagination and have some empathy. Some people are not in control. Like every human characteristic people exist on some part of the bell curve.

Telling people they are in control is like telling someone that is on the autism spectrum to just get over it, or telling someone that weighs 130 pounds and is 6 ft tall that they can be as big as Arnold Schwarzenegger with a little hard work and protein.

Those things absolutely help, but your comment is dismissive of real issues that are controlled with medication.

Yesterday we finalised it and I got the diagnosis, I have ADHD. When reading through resources like this: https://invisibleup.com/articles/27/ I could relate to an extreme extent to a lot written there. Both in the blog post as in some of the further resources linked in the end.

I've gone downhill since the pandemic started, it was bad before but I've definitely tumbled down (and hence why I also started searching why I was like that). Initially I thought it was just some bad behaviour: being lazy, being tired and/or that my anxiety was getting worse due to the pandemic. I never had major issues with anxiety before but it runs in my family and I started feeling it physically.

Yesterday I finally understood myself better. I've felt guilt and shame through my whole life for simply not being able to perform with the same work ethic as my peers. Guilt and shame for feeling overwhelmed when I have tons of messages from friends and family to answer. Guilt and shame for procrastinating seemingly mundane tasks, being a time optimist when planning my day, not being able to organise myself with to-do lists and long-term planning, etc.

I did very well in school but could never do homework, or any kind of school project I wasn't interested in the subject. Just sheer pressure from stress could move me to do the minimum to get a decent grade. On the other hand, the projects I had an interest about the topic were always a breeze, I'd go above-and-beyond the assignment because I had so much fun with it.

I collected many hobbies and always thought that was fun and exciting, lately I've been more overwhelmed by the feeling of never actually finishing a project or getting as good as I would like to in some skill/hobby.

At work I've always been productive in the end. I've always delivered the projects I've worked on but I learned strategies to do it. If it's boring work I'd fiddle around, with bouts between procrastination and discovery work, to find exactly why something was requested, how that ties to a larger vision. Then I'd develop a personal vision for the project matching the "why"s of requests/plans with my overarching story and view of a codebase or product, just so I could have a thread that made sense to me and kept me interested. When I found those I enter a hyperfocus state and just work until the vision I created in my head is achieved, I've been very good in finding ways to match my visions to the overall business needs, and also being able to pushback on things that I believe don't make sense when considering all the constraints and needs. This ability to pushback has been praised multiple times in my career.

I think the near future holds for me a slow discovery of many facets of myself, facets that I always treated and viewed with shame and guilt for feeling inadequate and not living up to expectations, not being able to just do work on boring tasks that others seemingly do with a breeze without caring too much.

Just sharing my experience as it's extremely fresh in my mind and life, I'm still going through the acceptance that I might just have a brain that works in a different way. It's a little bit refreshing and relaxing while at the same time still making me think that I'm just faking it. That I'm actually just lazy, disorganised, etc. It's a strange feeling, like I'm gaslighting myself.

Only doing this investigation I discovered that my parents and siblings always saw these behaviours in me, my therapist interviewed them and the way they talk about me as a child ticked so many boxes. I might not be the cliche rowdy boy that never keeps quiet or stays put but I've always seek stimuli, I've never had a moment in my life where my mind was actually quiet.

I don't think negatively of our condition though, it's part of life. I chose to look to change it because of how it impacted my relationship and because I wanted to regain some agency of how I use my time.

But I believe I did fine with it for a number of years before.

I'm glad I sought for help when I did and the short term impacts have been extremely positive for me.

I hope you continue on your path, and I'll be rooting for you.

Exactly, it's good to talk to a professional and see your options. I believe each person can have their own healing mechanism, could be a therapist, exercise or even spiritually related.

I understand everyone is different, made differently with unique physiology, mind and needs.

Sometimes medication can help or harm, for me it's been a positive but not the focus.

I hope it'll work for you long term and not create any side effects.

I'm worried for you in terms of medication you mentioned. As an extreme example taking cocaine/amphetamines for 1 month would probably make you best dad ever, best coworker and best husband straight away - but would fuck you up totally longer term.

Pure FUD.

ADHD meds, taken in prescribed doses, have been proven in studies to not have negative impacts on either your cardiovascular system or your brain.

I'm convinced that prolonged use of Zyrtec makes me angrier for example. I've experimented with my allergies, and when I'm off Zyrtec, I'm sniffling and sneezing all the time... But generally happier and healthier from a mental perspective.

Every medication you take, especially with prolonged use, should be considered an experiment IMO. Even if the studies are show safety and efficacy... there are plenty of other side effects that could diminish quality of life.

Allegra doesn't have this problem for me, so I just switched to that.

Earlier this year I discovered Xyzal (expensive, but does have generic versions, too), which appears to be a close relative to Zyrtec. Interestingly though, they recommend taking it at bedtime rather that in the morning, the idea being you'll get a better night's sleep from not being congested AND you'll sleep through the worst part of the fatigue from it. This has worked out well for me - my allergies have bothered me less this year than they have in the last ten years or so, and I sleep better at night (I've had problems with insomnia off and on for ~20 years).

RE: the OP, I'm in my mid 40s and have always had some issues with following through and not procrastinating, and my sister was recently diagnosed with ADHD, so it's probably something I should at least discuss with my doctor at my next physical.

Other stuff like Ritalin is also potent stimulant - like probably all ADHD medications - with withrawal symptoms ie. suicidal thoughts, depression and other mental and mood changes etc. It's serious shit.

It will make you feel amazying. At first.

It most definitely wouldn't. After just a couple of days/a week, the negative effects would be noticeable, at least if we're talking about recreational dosage every day.

Long-term prescribed medicine doesn't have nearly the same effect as stimulants people use recreationally, although you could for sure use prescribed medicine above the prescription dosage and end up with stronger effects.

Most ADHD medications are amphetamines.

ADHD medication? No. Ritalin, Vyvanse, et al. are are legalized forms of speed. They mask the issue and will erode your reward system's ability to work naturally.

> Following advice from my wife, friends, father, and here on HN, I looked for a psychiatrist to understand what was going on. After a lengthy consultation, the doctor told me I most likely had ADHD, and it got worse due to a more demanding lifestyle.

To a hammer everything is a nail, why did you not see a psychologist first to see if the condition could be improved with lifestyle changes?

---

I am concerned because I have worked with so many people in tech that are on legal speed and I believe that this medicated state of productivity will become the norm in our industry as we continue to lose focus on the aspects of life and work that make us human.

I spent 24 years of my life without the meds. When I started taking them, I didn't become substantially more productive at my workplace. I became substantially more able to deal with my personal life, my chores, my upkeep. That's it. And I felt like I had been wasting so much of my life looking for coping mechanisms, like I hadn't fully lived until I started taking them.

Or to put it briefly, the fact that I wasn't medicated made me feel less human, made me less able to enjoy the aspects of life and work that make us human.