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Comment by blakesterz | Hacker News Reader

ADHD sucks. I mean, it ain't cancer, but it sucks. I was never officially diagnosed, but when my son was at 7 is when I realized what ADHD really is, and that I'm an ADHD guy. Some how I made it through 40+ years with it and never knew it. I struggled though college, took me 9 years to get my BA. Somehow got a masters. Somehow managed to get a series of better jobs after my degrees. And I've somehow succeeded in life (my definition of succeeded) with ADHD and without any help or anything. I struggle with it every day still. ADHD sucks, I have no idea how I got to where I am, but I know I'm lucky. It's also made me a better parent to my ADHD kid, I know what he's going through, it's taught me patience and kindness that I never had growing up. If you don't know much about ADHD , it's not what you think it is.

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ADHD doesn't suck. Forty years of 9-5 jobs, mortgages, university degrees, and elementary school sucks when you're the type of person who can get diagnosed as ADHD. The world discriminates against people who don't have the temperament to fit in to its patterns of society.

We don't quite know how to pursue ἀρετή, virtue, eudemonia, excellence, whatever you want to call it in life because modern life was built for another kind of person and the animal life we left behind is far gone. Advice about "fixing" ourselves is mostly about finding effective ways to fit square pegs into round holes (like Adderall)

ADHD is objectively a bundle of true deficits, not just a set of traits society frowns on. Certainly these deficits weren't as much of a disadvantage in early human evolution, but if you can create metrics and show that people with ADHD perform worse at some generic tasks vs. average human beings-- and you can, we have-- this is not just a world that has been created that is inhospitable to them.

The ugly thing I've found, which accords with what you have said here, is that the best treatment for me is as many hours of sunshine as possible and several hours of vigorous exercise a day. (Thanks for teaching that, Marine Corps.)

But of course there are very few jobs with security, brain exercise, and mobility that give me this, and essentially no jobs that are compatible with it (that it is, where I could take this time off per day and still retain a job).

So of course I use medication and stick with jobs that drive me nuts, jobs that are terrible for me but pay well. I feel for the ADHD people who weren't gifted as decent a brain as mine, as if it weren't for that I doubt my employers would have been as indulgent of my other flaws from ADHD.

Read The Selfish Gene and https://www.economist.com/science-and-technology/2008/06/12/...

There is doubt that a set of behaviors which is so prevalent in the population is just an accident and a disease. Evolutionary pressures exist to optimize gene expression ratios in a population. Put differently, when a certain gene becomes rare in a population individuals with that gene have a significant advantage in life and reproduce more – when the same gene becomes over prevalent individuals with that gene have a significant disadvantage and reproduce less. There are traits which have pressure to be a certain proportion of a population.

ADHD or whatever else you may call it could very well be that. Ancient societies which had a small proportion of a certain kind of person thrived because their different behavior made them successful. It doesn't have to be a disease to not fit in to a certain society.

Nonsense. We have all kinds of highly prevalent maladaptive traits.

Evolution is blind.

Genetic mutations are blind. Natural selection is its walking stick.

We don’t live in ancient society. We live in our society.

Not to mention, not all traits that survive evolution are positive.

I guess you can either think the individual is deficient or society is deficient.

I can think society is deficient all I want (I do, but not for any lack of consideration for my ADD). It doesn’t change the fact that I need to work, and that to work, I need the ability to control my concentration. To do that, I take meds.

I can’t be anything but thrilled that society has given me a tool that gives me some control of my concentration.

These sorts of arguments tend to fail to result in a meeting of the minds.

Some people manage to make lifestyle changes and/or dietary changes and/or ditch people who were part of the problem and see substantial improvements in how they function and in quality of life. They try to spread the good news and people feel like they are being told they don't have a real problem or something and both sides get mad.

I used to see this a lot on parenting lists. People would suggest homeschooling because it had made their lives so much better. People who didn't want to consider homeschooling would feel judged rather than feeling like they were being given options and hope.

Cue everyone getting hot under the collar.

I do the same, but I'm not thrilled about it.

There is the person I am and the person I have to pretend to be.

I'm with you on that.

I cannot stand to be in corporate offices - it's a hell for me - but what choices do I have to earn a decent salary and feed my family? Not many :-(

I've just quit my 3rd job in five years because it got too much.

Aah, yes, that round hole called “work”. All the creativity, all the beauty of being a square peg is absolutely useless in the face of having to make money to survive.

PTSD. Constant stress. Having trouble just keeping promises to friends. Failing to even keep up a hobby. The inability to control your own concentration.

ADHD most definitely sucks.

What I'm trying to say is that there's nothing wrong with being what you are.

Instead there is something wrong with a society that discriminates against it (and living in that society sucks). Trying to fit in to it is what sucks and the solution is not being better at fitting in.

Wtf man. ADHD very nearly ended my marriage and my career. I think you are being very insensitive to the issues adhd people face.

I am not. I experience them and suffered the consequences.

ADHD people suffer because we don't meet expectations. Either there is something wrong with us or something wrong with the expectations and I choose the latter and want to help fix it. Saying "something is wrong with me" and wanting to fit in, for me, is the problem. Constantly not meeting expectations is the problem but I deny that not meeting them is the fault.

The world and I do not get along. I do not want to shape myself for the world, I want to shape the world for people like me. Fuck everyone who wants me to be different.

Saying ADHD is a disease is just as offensive to me as saying homosexuality is a disease to be cured.

Its not about other peoples expectations though, its also about our own.

Maybe you are okay with never finishing any project you start. I am not. It feels awful to me to start 10 Projects a month and never finishing any. It feels awful to me to be very sensitive to rejection, even though I realize the other person did not mean it like that.

> Saying ADHD is a disease is just as offensive to me as saying homosexuality is a disease to be cured.

You can not compare these like this. One is a sexual orientation, and the other is a inability to regulate yourself the way you want.

There's some massive irony in him telling off others for treating ADHD as a disease, all because he doesn't like others imposing things on him...

Inability to sustain concentration is not a temperament. It's a neurological impairement.

Adderall isn't going to do anything unless you are actually functioning suboptimally. It will, however, most certainly decrease your attentional/executive performance if you are at an optimal state. Look up the U-shaped response curve.

If you've got great executive function you're probably doing productive work instead of chasing black-market Adderall and reading a thread on How I Run a Company with ADHD...

ADHD medication is widely abused by people without ADHD.

And guess what is the most common diagnosis in users of illicit stimulants?

Just reading this thread should be sufficient.

ADHD does suck. It's not about fitting the patterns of society, it's about being able keep your shit together and get things done.

No matter how you live with ADHD there will always be distractions pulling you away from what you need to do. There will always be things you should remember but don't, things you should have done at a specific time but were distracted and forgot.

It doesn't matter what society you live in or what the cultural norms are, those of us with ADHD are lacking some basic functions that makes life harder. And it sucks.

As someone who also has it: have you tried medicine like Adderall?

I’m so torn on it. On one hand, it makes me so productive, but on the other, it makes me so unemotional and cold and abrasive.

It also makes me sweat, increases my heart rate, and has a terrible comedown when taken often.

I was diagnosed at 16 and was on it for years, eventually moving up to 4x the dosage as my body grew resistance.

I’ve stopped it for the past couple years, and now am back to the lowest dosage on rare occasions I take it, but still unsure how to feel about it.

Yes, you pretty much summed up all. Don't forget sleepless nights if you took it after 11 am or later. Also: Heartburn, dry mouth, and severe dehydration, loss of appetite (yay for this one actually). And flushing (pee pee pee all day).

IF you are working from home with minimal contact, it works. Never EVER answer a phone call when you are on it (this is to whoever planning to use it in the future). God knows, how many times I argued with a client just because of Adderall.

It forces anyone using it to keep the communication to a minimum. And when a client calls (usually oblivious, but demanding), you will end up arguing at some point.

Adderall = never do anything social including phone calls. I am serious.

Looks like your dose is way too high...

Usually people take 20-30 mg pills. This happens anywhere after 10mg. I see lots of sleepless dudes in tech industry. All angry and intolerant :)

My prescription is 30mg of Elvanse daily, which corresponds to 12mg of Adderall _spread through the day_ (Elvanse/Vyvanse is an extended release form). Taking it all at once would surely lead to all that effects.

> Don't forget sleepless nights if you took it after 11 am or later.

Medication that keeps you awake for 16 hours leads to sleepless nights if taken late into the day, more news at 2.

Depends on the dosage, while he mentioned Adderall those are the exact side-effects I had with Ritalin, and that comes in all forms: "normal" (4 hours), long-last (8 hours), slow-release (also 8 hours-ish, different chemical implementation), and more I don't remember/know.

The shorter durations (4 hours) are more effective than the longer, but also require taking it several times a day. And I think neither 4 nor the 8 keep you awake for 16 hours. Occasionally I'd even get the side effect of making me drowsy, and I had to take a nap right there. Thankfully that usually happened when I would take Ritalin for studying at home later in the day, rather than at school.

True, 16 hours was over the top. I think my concerta bottle (methylphenidate, same ingredient as ritalin but extended release) says something around 12 hours.

My point however was that if you take medication which can keep you awake for X hours less than X hours before bed, you could have a bad time.

> Occasionally I'd even get the side effect of making me drowsy, and I had to take a nap right there.

I've read about this, for some taking ritalin actually helps them sleep since it makes the brain shut up and be quiet, instead of racing all the time

Obviously. On the other hand, if you didn't take it before 11am for reasons (some of which may be bullshit!) you then get to make a Sophie's choice between being productive and sleeping.

I think nearly all of us that aren't secretly abusing medication feel that ambivalence.

For me and I assume for others, it is not a fully adequate treatment. Some symptoms it fixes, some it helps with, some it does nothing for, some it actually makes worse. (In particular, impulsivity and inability to task switch accurately.)

Then there are the side effects, and the comedowns after tolerance builds.

Nevertheless you must still learn coping skills, still pursue other treatment (exercise, decent diet, sleep, CBT if needed), still struggle as the square peg.

I have used medication for roughly 5 years ish of 30 some years of life, intermittently. I'd say taking it is better treatment than not, but honestly, like you, I feel a deep ambivalence towards it. (Even resentment, sometimes.)

Work with a psychiatrist to try other meds. There are non-stimulant meds that work with ADD too.

Adderall is not the only option; it didn’t work for me. It took a bit, and I ended up with Dextroamphetemine. The physical side effects dulled down to the occasional restless leg, and the mental effects work well.

Adderall and Dextroamphetamine are almost the same. They're both amphetamine (speed) with just slightly different ratios of the isomers.

Dextroamphetamine is a pure enantiomer. Adderall includes levoamphetamine, which has stronger peripheral effects.

Personally, I was on methylphenidate (generic for Concerta) from eighth grade until very recently, when I switched to an Adderal ER. The difference for me was more what happened when I came off of it- on methylphenidate, I got super irritable right around the same time I got home, which was not good.

I haven't noticed anything weird with this one, but for anyone reading this, I would highly recommend "shopping around" for ADHD medicine if you can.

It definitely helps the day to day but I cant help but think it is a horrible idea long term

I don't have the research handy, but Adderall has been proven very safe for long-term use when taken at "normal" dosages and with oversight by a doctor.

I've been on it for 20 years and with the oversight of responsible doctors, and I have never had to increase my dosage (in fact I've reduced it 25% in the last 5 years). All my heart/blood/* tests come back good and I'm not a particularly health-conscious person. I regularly take week-long breaks to assess if it's still the right regimen for me. (Like the parent post says, the days off of it can be brutal but avoiding tolerance and assessing its true impact are invaluable.) I don't "like" Adderall but it is the only way I feel sane.

My point: don't be afraid to seek meds that help just because you may fear some long-term effects. A doctor can help you decide if the long-term effects are worth the gain, and there may not in fact even be the long-term effects you're worried about, especially if you talk about those worries with your doctor.

Nobody will ever admit it but memantine and/or dxm maintain effectiveness of amphetamines.

Even as much as fully resetting tolerance in some cases.

Not worth it for the potential brain damage

How does it cause brain damage?

I've never had Adderall because it's not for sale in .au for some reason. I've tried Ritalin and Modafinil and Dexamphetamines. Ritalin didn't help much and gave me headaches, but Modafinil is much better. It doesn't help with the ADHD quite as well as Dex does, but all the annoying side effects are far less pronounced as well. Unfortunately in .au you can't get it subsidised for ADHD, only narcolepsy, so I've stuck with Dex just because it's so much cheaper, despite it being way worse for you.

I have ADD and sleep apnea, a double whammy of conditions that society likes to mislabel as 'character flaws'. I took ADD for a few years; it helped at first but after a year or so I had to stop because I was becoming very angry when on it. I believe the exhaustion/constant jet lag of the apnea (even with CPAP treatment) and work/kids entirely depleted my patience and self-control and the adderall then exacerbated my temper. I'd much rather be foggy/forgetful than angry.

I was diagnosed with sleep apnea. I no longer need my machine Here are some of the things I tried: cut out wheat, cut out refined sugars, lift heavy things 3 to 5 times a week, do an elimination diet (whole 30 is a good one), get a good supplement stack (Standard Process has good stuff)...

I'm not sure what else I tried. I think the changes in my diet made the biggest difference.

Dosage could be off too. Try going lower and tone release.

Look up titration. The right doctor will help you dial this in and interview you to make the right call.

Try Vyvanse or one of the other high grade, extended release alternatives to Adderall. Lots of people have had issues with Adderall, especially after the patents expired and it started being made almost exclusively overseas as a generic.

Long term usage of those drugs will cause GERD. I know first hand

How long is long term? I have a friend that had problems with GERD until he started taking Adderall. It seems that he is not alone. Something about stimulants seem to help digestive problems for some people.

After about 5 years is when I started noticing the side effects got worse than the desired effect.

Even the first time does it. Addie or others are super strong and mess up the stomach acids fast.

It does nothing for procrastination and so proved useless to me.

Look into nuvigil, and if that fails - wakix (pitolisant/tiprolisant)

> If you don't know much about ADHD , it's not what you think it is.

Honest question, I don't know much about ADHD. What's ADHD actually is?

As someone that was diagnosed with ADHD at 37, ADHD is what society calls it when somebody has very little tolerance for paying attention to stuff they find boring.

But seriously, I agree with the square peg / round hole comments. I don't believe ADHD to be an illness because there are plenty of environments where I could thrive, the trick was it had to involve doing something I loved. Fortunately for me, I loved computer programming.

It a literal brain development impairment. We can look at the bright side, I do too, but it is a biological difference in our brain construction from the norm, and it has wide ranging impacts that go far beyond our ability to do work.

Do you have extreme bouts of emotional distress? Emotional / angry outbursts? Blurt things out that get you into trouble? Experience difficulty with dating? Lose shit constantly? Participate in risky / dangerous / mid-guided behaviors?

ADHD is a big disorder. Look into it: https://m.youtube.com/watch?v=SCAGc-rkIfo

Thank you, it was such a great video. Worth the 3 hours.

ADHD is some degree of impairement in the ability to self-direct your own behavior, also known as executive function.

Yep. This is an interesting article about the neurobiology behind it, getting into dopamine related reward network / neurochemical deficit theories.

https://psychscenehub.com/psychinsights/neurobiology-of-adhd...

Isn't that at odds with your previous comment?

> Inability to sustain concentration is not a temperament. It's a neurological impairement.

The impression the article gave me is that ADHD is more the inability to choose what you focus on, not an inability to sustain concentration?

I don't want to speak for others but that is exactly the way I experience it. I can sink deep into an unimportant but complex analytical problem after lunch and the next time I take note of time passing, it's 3AM and I forgot to drink, eat, go home, exercise, love, and sleep.

The amount of focus I'm capable of is not the problem. The problem is putting it to use where I want to, rather than where it, by pure chance, happens to end up for the day.

It also applies to the small stuff. Someone asks me to bake a cake and I think it's probably best if I know what temperature it should bake at. An hour later they ask me how the cake is coming along and I realise I know a lot about the chemistry of baking but I haven't brought out the flour yet, and I no longer have time to shower, shave, send that important email, and clean up after baking.

I go back and forth between viewing it as an inability to perceive time and an affliction of directing behaviour. Perhaps they're two lenses through which to view the same thing, and I haven't yet discovered their symmetries. (Only vaguely aware of them -- directing behaviour to achieve future goals requires the ability to perceive time acutely.)

Inability to sustain attention/concentration is just one of the most common facets of ADHD.

Yes, you could have more/others impairments in your executive function than just attention. Impulsivity is commonly measured as well. ADHD is really an umbrella term for several syndromes.

I disagree with the notion that "inability to choose" is necessarily a definitive part of ADHD . It often is, and is common, but it's not unique to ADHD at all.

It can also be due to anxiety, PTSD, all sorts of other issues, and people with those issues improve on anxiolytics/tranquilizers, instead of stimulants.

> It can also be due to anxiety, PTSD, all sorts of other issues, and people with those issues improve on anxiolytics/tranquilizers, instead of stimulants.

Is this true? What sort of anxiolytics? I’m pretty sure I’m diagnosable adhd-pi but I have anxiety that decreases with low dosage adderall.

Read up the studies. I'd say it's probably best studied in schizophrenia, they have all kinds of cognitive improvements on antipsychotics, rather very unpleasant drugs.

Dopaminergics like amphetamines, ritalin or bromantane do help with anxiety, it's common knowledge, but I don't think the effect is sustainable long term, at least not that I've heard. More common for that effect to fade away with time on chronic dosages and more of a jitterness surface later on.

> ADHD is really an umbrella term for several syndromes.

That does seem to muddy the water a bit, doesn't it? Thanks for the detailed response!

It certainly does.

In these comments you could see anything from people that think it's not an illness to people who have secondary impairments due to obstructed airway at night.

And they are all probably right to some degree.

This stuff - attention, executive function, ability to self regulate and direct your own attention - meta-cognition, if you will - is very poorly understood. Treatments are very crude, we will eventually see them as barbaric.

It probably is one of the youngest developments, evolution-wise.

Fascinating stuff.

>The impression the article gave me is that ADHD is more the inability to choose what you focus on, not an inability to sustain concentration?

This aligns pretty well with the definition of executive function.

> Some how I made it through 40+ years with it and never knew it.

I can relate to this, and I think there's a potentially large underbelly of society, that many (most?) of us are walking around with undiagnosed personality "disorders" (let's say, traits) like ADHD, the autistic spectrum, agoraphobia, narcissism, sociopathy, and so on - maybe even ones we haven't discovered or classified yet.

The infamous DSMMD (Diagnostic and Statistical Manual of Mental Disorders) is a massive tome, where pretty much every member of human society can find a matching category..

I found out this year, at 32, that I have a mostly-anxious/sometimes-avoidant insecure attachment style.

Some of the bumps I’ve experienced in life probably would have gone smoother if this was made apparent to me years ago and I had the tools I have now to work with it.

In a nutshell, the DSM say anything that sucks is a disease.

What is exciting is that the wandering-in-the-dark of psychology is being usurped by neurology actually understanding how the brain works on gradually higher and higher levels.

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