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Comment by georgespencer | Hacker News Reader

It’s clearly not the case for everyone, but I struggled for an extended period of time with a few things in my personal and professional life:

1. Remarkable focus in topics which interest me and remarkable lack of focus in topics which do not.

2. Leaving “must do” tasks in areas of little interest until the very last moment, resulting in a predictable lack of excellence in execution.

3. Periodic deep dives into topics which go beyond the aforementioned “areas of interest”.

4. Driven by a motor in meetings: itching to get up and walk around as we talk, feeling more comfortable with any kind of low level motor action happening concurrently to my thinking and speaking. Also led to me leaping to the end of a person’s sentence and others experiencing me as highly impatient / excitable at times.

5. The need to have a TV show or other media playing as I fall asleep. Ideally something I’ve seen before and which is enjoyable but not too engrossing. Almost like one of the cores in my processor couldn’t be idle — it actually made it hard to sleep. (Conversely I always fell asleep watching films with my partner.)

6. Various odd elements of disorganisation — never at work but eg. losing my keys and documents.

If you’re reading this and hearing elements of your own experience, and in particular if this is familiar to you from childhood (“Why can’t you apply yourself to X like you do Y?!”) then I would encourage you to speak to a serious psychiatrist about the possibility that you have ADHD.

Not everyone has it and I accept that many are probably misdiagnosed with it. My experience of clicking every link on HN with hacks for focusing and not procrastinating was actually a very sad one and I didn’t realise how profoundly it had affected me until I sat in the office of a psychiatrist and he rattled off a range of specific experiences he wagered I had had during my life.

It’s been a remarkable process for me of feeling emotional relief as well as receiving medication which improves my life.

Again if you’re looking for a productivity hack you do not need to consider that you have any sort of chemical disregulation, but I did not consider the possibility of a medical condition and found myself often in rabbit holes of productivity hacks feeling deeply unproductive.

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Whilst furloughed from my job during lockdown, I found myself bouncing off the walls at home consistently enough to finally seek out the ADHD diagnosis I’ve always suspected.

I’m 29 years old, and one of my earliest memories is of my parents (lovingly) threatening to put an electric fence around my seat at the dinner table. I’d be up and down like a yo-yo after each mouthful.

For the last 5 years, “my friend” has been obtaining prescription pharmaceutical meds from the dark web to treat “his” symptoms. They’ve been life changing — one day of medication leads to more productive output than would ever be imaginable the rest of the week without them.

But they’re a double-edged sword. Like another commenter says, overdoing them leads to one feeling like a shell of their former self.

But at least you have something to show for it.

I put off my diagnosis for years, because I was afraid. I was terrified I would be told I didn’t have ADHD — at which point I would have no answers or excuses any more. If it’s not ADHD (that I know I can treat), then what the hell else is wrong with me? Or, worse, I feared I would be told that I was simply drug-seeking. I felt like I’d entered the Matrix — you take the red pill, you stay in Wonderland.

I’ve had 3 appointments with a psychiatrist so far, and, finally, my prescription begins next week.

If you seriously think you have ADHD, don’t make the same mistakes I did.

Life is too short to waste time fighting against yourself.

Just because you don't have "ADHD" doesn't mean you don't have a problem. If someone is hesitating for the same reason you were, they should seek help because there is something wrong, even if it's not what they thought.

> I put off my diagnosis for years, because I was afraid. I was terrified I would be told I didn’t have ADHD — at which point I would have no answers or excuses any more. If it’s not ADHD (that I know I can treat), then what the hell else is wrong with me?

This is an amazing thing to share. Reading some of the other replies in this thread from folks who are now motivated to seek help because they experience the same range of symptoms others are expressing, I bet your comment is going to have a direct and positive impact on someone's life.

It's not easy to share things like this and folks will definitely feel supported by you. Thank you.

> But they’re a double-edged sword. Like another commenter says, overdoing them leads to one feeling like a shell of their former self.

I firmly believe that self-medicating in the manner your friend did exposes you to a heightened risk of this sort of experience. As noted elsewhere, there are so many variables to consider with the various medications that it really does require a committed, serious doctor to collaborate with you during titration. My journey so far has been four different drugs, with seven different dosages, and 4 different timed release / instant release formulations.

> I’ve had 3 appointments with a psychiatrist so far, and, finally, my prescription begins next week.

This is really wonderful news. I've found that the process of ironing out the right medication can be a frustrating one, because my doctor is a careful and methodical person and my instinct is to say "hey let's skip from 18mg to 54mg". No advice, but sharing my story just in case you experience the same thing. I've found that it has gotten a lot better, and I was surprised by the different experience of the different medications.

28 years old and just got diagnosed.

Do it - it makes a difference. I was amazed how much meds helped me. I'm far more productive doing tasks that are boring.

Happy to hear of your success, and thanks for sharing and helping other people feel supported.

which meds are you taking?

Ritalin, and only 10mg. Twice a day.

It's remarkable the difference it makes for me. I have gotten more work done when needed to, have improved in my hobbies, conversations are much better, I stay focused on tasks...it's incredible the difference.

I got diagnosed at 29 also and had almost an identical experience to yours and the person above you. I often think of what a difference it would have made to know earlier (in so many ways).

>>Life is too short to waste time fighting against yourself

Str8 facts

Ok serious question: Every one of these points is very applicable to me, especially 1,2 and 3.

I haven't been to a doctor in years outside occasional emergency trips. How do you bring this up without seriously. I don't want to come off as the guy who compulsively self diagnoses based off what they read on the internet.

Go to a psychiatrist. Report your symptoms. They will give you a diagnostic and make the call. As long as you go in without stating your suspected diagnosis, you're not "diagnosing."

Do you have a PCP? You just say that you want to get referred to someone to get tested for ADHD because of x, y, and z and you think a diagnosis would help you

There's nothing wrong with using self-diagnosis as a way to inform a professional inquiry. In my unqualified opinion, you probably have ADHD.

No problem, serious answer:

This is the DSMV criteria: https://www.cdc.gov/ncbddd/adhd/diagnosis.html

Doctors are typically screening with a quiz that looks something like this: https://psychcentral.com/quizzes/adhd-quiz/

It's perfectly reasonable to say "I think I may have ADHD based on what I've read online, my symptoms match and people who know me have suggested I try adderall".

Some doctors are fine with letting everyone have stimulants, because they're pretty harmless unless you're really binging on them, and they won't give you enough to do that for very long.

Other doctors would prefer to put you on an SSRI or SNRI or wellbutrin or some other "non-addictive" medication (which ironically are more addictive, dangerous, and less effective), so avoid those IMO. You may have to shop around a bit, but your primary care doctor technically can write the prescription, but some prefer not to and you might need to find a specialist.

Contraindications for stimulants are if the patient has a history of heart conditions, complains about racing heart rate, excessive sweating, trouble sleeping, trouble eating, etc.

You generally want to start with a low dose of "instant release" as opposed to "extended release" pills, so you can have more fine grained control over the dose. IR pills can be broken in half, XR cannot. Some doctors are more nervous about IR than XR because they think it has more abuse potential (not true, but it's a common belief).

With all that said, stimulants will fix the problems OP described, but don't mistake that for a pleasant experience. The truth is that amphetamines are extremely mentally exhausting, and if you don't take good care of yourself (planning proper meals, staying hydrated, resting at appropriate times, not taking more pills when you shouldn't), you can quickly spiral out of control. It's hard to explain to someone that doesn't do drugs, but stimulants can leave you feeling like a shell of yourself, and it's really disconcerting. It's sort of like being over-tired where you're awake but your judgment is clearly impaired and you don't feel like "you". If you stay on them long enough, you'll start to feel like a zombie just going through the motions (successfully, mind you), but without identity. I make sure to take weekends off to preserve their efficacy for the work week and to make sure I don't become too dependent.

I'd 100% recommend having stimulants in your toolkit, and chances are you're already supplementing with worse stimulants (like mountains of coffee or soda), so do give them a try, but be careful.

> IR pills can be broken in half, XR cannot

You can always take the XR pill apart and split it into blank capsules. Or you can just dump a little out and take it without the capsule.

I think this depends on the actual formulation of the drug, right?

For example two of the titrations of Concerta (XR methylphenidate) which I have experienced first-hand are a hard candy-like tablet, and the pharmacokinetic result is that you receive 25% of the dose within a couple of hours, and then over the course of the rest of the day the remaining 75% hits your bloodstream.

But I now take an XR lisdexamfetamine which looks like it would be possible to split into smaller doses, but it's a prodrug so it's a totally different experience.

I know it's a luxury some folks can't afford, but there really are a great range of optimised formulations of the treatments for ADHD out there, and rather than guessing yourself, it'll be better to have an honest conversation with your doctor about the ability to mix XR/IR in a way that works for you.

This is correct. Concerta is interesting because it's a laser-drilled time release. Vyvanse is interesting because it's a prodrug of amphetamine that releases chemically over time.

The XR part is usually the particles inside the capsule. To make them faster acting you also have to pulverize those.

> I'd 100% recommend having stimulants in your toolkit, and chances are you're already supplementing with worse stimulants (like mountains of coffee or soda), so do give them a try, but be careful.

I'll second this. I've got an old friend and former coworker who clearly has serious ADHD and self medicates with tons of coffee/soda/cigarettes. He's killing himself and he knows it, but hates doctors and has a negative view of shrinks.

Anec-data: I cut out carbs and only eat during certain windows and that has done wonders for focus and stick-to-itiveness. Coffee and alcohol hit me extra hard, and I've cut back on them.

> I've got an old friend and former coworker who clearly has serious ADHD and self medicates with tons of coffee/soda/cigarettes. He's killing himself and he knows it, but hates doctors and has a negative view of shrinks.

This describes me to a T. I will not take amphetamines of any kind, so what's the point?

> Anec-data: I cut out carbs and only eat during certain windows and that has done wonders for focus and stick-to-itiveness. Coffee and alcohol hit me extra hard, and I've cut back on them.

I've heard other people say this. I really need to try it.

Intermittent fasting is a lot easier with black coffee. I can usually make it to dinner time (~5pm ish) with nothing in me but coffee and water.

Use decaf if you don't want the double whammy of an empty stomach and more coffee than you might otherwise drink to smash your brain with caffine.

This answer chimes the most with my experience. Particularly:

> It's perfectly reasonable to say "I think I may have ADHD based on what I've read online, my symptoms match and people who know me have suggested I try adderall".

Spot on! (Except for suggesting a prescription: the doctor will be able to establish whether, for example, a prodrug like lisdexamfetamine is better than adderall, or methylphenidate might be a safer starting point (I believe it's been studied for longer).)

But yeah: there is zero shame in going to a doctor and stating that you are experiencing symptoms which you recently learned to be consistent with ADHD, and would like a professional opinion on the severity and potential treatment options. Reading the traits commonly associated with ADHD, you'd almost expect someone to have done a great deal of research about the topic.

> It's hard to explain to someone that doesn't do drugs, but stimulants can leave you feeling like a shell of yourself

I've found (40mg lisdexamfetamine, but also previously had IR/XR Adderall, 2x titrations of Concerta, and an abortive attempt at Medikinet which is a different XR timed release formulation of methylphenidate as I understand it) that this is true to an extent. I don't dose on the weekends and have found that Mondays are a blur. It's 4pm before I know it and I'm wired and working on spreadsheets well into the night.

The closest thing I can express to how I know the drug is effective is that there is almost a directional cone of focus which I need to very consciously redirect to a new area of focus. If someone comes to speak to me I'm able to context switch, but moving from one task to another can require effort.

When I didn't eat enough or appear to have a faster metabolisation of the drugs than normal, I can have a feeling of focus for focus's sake: I'm blind to what's going on around me and uncommunicative.

For me, however, in the main the medication has been a pleasant experience. It's helped me to regulate my moods and dark sides -- particularly under stress. This will not be the case for everyone, and a good doctor will be up front about the fact that your body will react differently to different drugs. They'll have a preferred starting point for treatment which they know well, but they will not be afraid to switch it up in order to find you a solution which works well.

BTW I'm really glad that you shared in as much detail as you did given the empathy I feel for OP's potential need to battle ADHD symptoms without treatment in order to even get to treatment. It's really kind of you and I'm glad there are so many people on HN who have been through similar experiences to me. After experiencing 30-odd years of thinking I was deficient in some way, feeling the resonance of other people's similar experiences has been a huge boon for me. So thanks.

I know it’s splitting a hair but I didn’t find Effexor addictive. The withdrawal symptoms are terrible. But they motivate you to kill yourself, not take another pill. I never wanted to take two pills or increase my frequency. I would often forget to take one. So I don’t consider it addictive. For reference, I’ve been addicted to cigarettes and alcohol before.

That's a worthwhile nit to pick, but I stand by it :)

IMO what you describe is common and the worst type of addictive. You get all of the withdrawal and none of the desirable effects.

I think that is what is being said. Effexor is not addictive in the ‘traditional’ sense addictive drugs are, but you’re brain and body become dependent on them in ways you don’t realize until you’re trying to come off of them. And because it is a process to find the right medication, you don’t want to be starting and stopping those kinds of medications over and over. A stimulant may be seen as more addictive (due to the potential for abuse / dopamine release), but starting Ritalin then switching to adderall, then say vyvanse, is a less invasive process than starting Effexor then coming off and switching to Wellbutrin etc

IR does have more abuse potential. You can't snort XR.

> I'd 100% recommend having stimulants in your toolkit, and chances are you're already supplementing with worse stimulants (like mountains of coffee or soda), so do give them a try, but be careful.

Have you heard of anybody managing their condition with caffeine pills or nicotine lozenges?

Very well put. My primary care doctor was happy to prescribe at the recommendation of my psychologist. When I spoke to my psychologist initially, I took the approach you mentioned about suspecting I had it based on the symptoms and what others around me had told me.

Shoot me an email if you wanna chat about my experience in more detail! Email address in profile :)

I was in a similar position. I did a bunch of reading on ADHD, convinced myself that I probably had it then I found a clinical psychologist who specialized in ADHD and reached out for an initial appointment. Apparently this is a pretty common story for people with ADHD who weren't diagnosed as children, so a specialist won't be particularly surprised by it.

The initial appointment is probably going to be an in-depth interview with the specialist, coupled with filling out some self-assessments and, possibly, getting somebody who knows you well to fill out an assessment as well. (Apparently people with ADHD usually drastically underestimate their own symptoms, which is why a third-party perspective is important.)

After I got diagnosed, the specialist gave me useful advice, learning materials and resources, including recommendations for psychiatrists to reach out to for treatment. This is pretty important because a combination of psychiatric treatment with learning new skills, coaching... works better than only doing one or the other.

If you can afford it or it works well with your insurance, I would highly recommend reaching out to a specialist instead of (or in addition to) talking to a normal doctor.

> this is a pretty common story for people with ADHD who weren't diagnosed as children

This was an extremely meaningful datapoint for me in feeling "seen". One of the steps was to ask my mother to fill in a survey recalling how she experienced me as a child.

When I told my mother it was for ADHD diagnosis she laughed, and said, "You didn't have ADHD. You just liked to run around. In my experience 10% of kids are just wired that way."

Cue the psychiatrist telling me that ADHD prevalence is now thought to be around around 10%.

A good psychiatrist will not diagnose you with ADHD unless you have it, and they will not sit on the fence and say "maybe" if they believe you have it. Mine was emphatic with me.

> Apparently people with ADHD usually drastically underestimate their own symptoms, which is why a third-party perspective is important

Absolutely! The way people experienced me was totally different to the way I thought that they did.

> Apparently this is a pretty common story for people with ADHD who weren't diagnosed as children, so a specialist won't be particularly surprised by it.

This is very true. And it's not even just due to lack of access to mental health care as a child: everyone over a certain age will have grown up before "ADHD" was a recognized disorder, and thus couldn't have been diagnosed with it no matter what their symptoms were.

It's a lot better recognized and studied than it was in the 80s and 90s. Especially the recognition that while for some it goes into remission (somehow???) or at least becomes sub-clinical, there are a large number of us who continue to struggle with it our whole lives. It's kind of demeaning when it's seen as a children's disorder.

When you're a kid it's not that bad cos you have structure provided for you and little to no responsibility. You're just a constant pain in the ass. That's why it's named after all the things that piss people off about it and not named after what the lived experience is like or how it affects us internally. When you're an adult and you are responsible for structure and getting things done and holding down job it can silently and slowly crush you. It's a much bigger problem once you're an adult.

> You're just a constant pain in the ass

Not as much with inattentive-subtype. Then you just spend lots of time reading and are somewhat disorganized.

Until you get to adulthood.

If you are like 30 and employed they don't dick you around about ADHD the way they do with college students

Obviously you feel the medication is useful, but do you think just knowing vs the medication has any positive benefit? I have read dozens of articles online, and replies like yours and can always relate extremely well to all of the symptoms. Taken the online quizzes and all that. I am pretty much certain I have ADHD. And I have known for years. But, I have educated myself on it, understand how I work (or don't work) and just kinda roll with it. But I have been thinking about it more lately, and wonder if its really worth more steps and medication.

There is definitely a deep, abiding sense of relief and peace at the fact that a lot of things which caused me pain in the past now make sense.

That doesn't help with the day-to-day of things, but it does contribute to an overall happiness which I do not think the medication alone would offer me.

Agreed 100%

Emotional relief like "I'm not a shitty selfish person after all and it isn't my fault".

But if you employ a tonne of ADHD coping mechanisms and they work for you it'll improve things a decent amount.

I haven't tried CBT but it's a recommend approach. I'm trying (painfully slowly because it's not super interesting) to teach myself DBT to help with it too.

Dx is only strictly required to get Rx but an additional benefit is they do a differential diagnosis so they make sure it isn't down to depression, anxiety, sleep problems, trauma etc. All of which can cause some of the same symptoms.

There are a tonne of people who get diagnosed with depression and anxiety and the recommended treatments just don't work that well for them. Then they get diagnosed with ADHD, everything falls into place and they can get their life together so they're not anxious they're going to constantly screw things up nor depressed from shit life syndrome and the depression and anxiety go away.

Yes, thankyou for mentioning the differential diagnosis stuff, it's definitely a good idea to rule other things out. :)

I was wondering if I had ADHD; in all the online tests I score in the ADHD or borderline range. But it's just symptoms of my anxiety which is particularly bad at the moment. If I'd done the tests a year ago, the result would have been completely different.

There are a range of interrelated symptoms and experiences (e.g. autism, dyspraxia, dyslexia, anxiety), and part of the job of a good psychiatrist is to pick through these and make a determination.

An analogy you might be experienced with: imagine you're a product manager and you want to make a customer service person in your company twice as efficient as they are today. If you ask the CS person what you should work on for them, they might be able to give you some direction, but they don't know the full range of possible things that you can do for them. E.g. they might think "Well, I've got to type emails to customers so it would be useful for me to have a new support ticket load on my screen as soon as I'm finished with the last one." But you -- an expert -- might say "We can actually auto reply to some of these emails for you using a canned template!"

Self-diagnosing, and in particular self-diagnosing mental health and neuroatypicality issues, is a hard ask.

I was diagnosed with ADHD almost twenty years ago as a young adult. In my experience learning about how your mind works and spending time to come up with the best system and techniques to keep yourself on task is absolutely critical and should be worked on by any adult with ADHD. I would say that long-term it is more important than medication.

With that said, medication is also quite helpful. In my experience it provided a quick and independent support to my feeling better and productive. I found them critical when the controls I had built for myself proved insufficient or had collapsed. For example, when I moved from an office job to remote work I found the change and the lack of societal pressure to be focused on work left me in disarray. Medication helped me stand myself back up and find the routines and structures that worked in the new environment. As I built these support structures up I found the need for medication was reduced and stopped taking medication for many years. Years later, after a cross-country move which came with the loss of local friends and community I found it necessary to restart. I prefer to not take medication unnecessarily so one day I may be at the point where I stop taking them again, but I'm not there yet.

My advice would be to try medication if your gut says you need it but if you already feel fairly happy and productive then it may not be necessary.

Medication has been truly life-changing for me. The ability to actually follow through on things within a day is amazing.

Very well written!

Recently I was diagnosed with severe ADHD. The struggle finally became too much. Perhaps the effects of the health crisis on my work and finances gave me the final push, I don't know.

My life is so much more enjoyable now I am medicated and have had some very minimal therapy.

In hindsight all the tricks and strictness I forced onto myself to be able to keep up were very unhealthy, unsustainable, and not even that effective. The psych even seemed quite concerned when I did a show and tell.

To anyone else struggling: Just make that appointment and find out what's up. Even if it doesn't turn out to be ADHD these people can help you get so much more out of your life. Nothing ventured nothing gained, right?

So glad you're in a better place now. This:

> To anyone else struggling: Just make that appointment and find out what's up. Even if it doesn't turn out to be ADHD these people can help you get so much more out of your life. Nothing ventured nothing gained, right?

Is great advice and lots of people reading this thread are emailing me to say how supported they feel by hearing others' stories. Nice one for sharing.

Thanks, I really appreciate that! Good to know people are getting something out of this.

With #1, someone told me 90% of K12 education is supposed to help you get over this. School is supposed to train you to focus on and produce work on subjects that you have zero interest in. I was pretty good at that before, now I think I'm just burnt out.

Heh, didnt work for me. I just failed the classes I didn't give a damn about.

I think that's probably right in neurotypical folks! Maybe I wasn't clear, but I exhibit what people characterise to me as a remarkable ability to focus and remarkable ability to not focus. Huge deviations from the mean in both directions!

The other thing to remember is that whilst ADHD is likely overdiagnosed, that doesn't mean that many kids who have it will simply not respond to K12 education as an environment which conditions them. This is not something which can be corrected with hard work and thought, although people who do not experience ADHD often (understandably) say things like "just sit still!" or "don't interrupt people it's rude!". The crux of ADHD is that it's a neurodevelopmental disorder and a disregulation of dopamine and chemicals designed to help regulate executive function, focus, anxiety, etc. It is generally not possible to see significant results with therapy, although there is some limited evidence that early intervention through medication has long-lasting effects in children who are able to move off medication in the medium term.

Getting diagnosed this year changed my life too.

I'm sure at some level the standard science and advice still applies but it's truly as those mechanisms aren't likely missing in our brains, but it's truly remarkable how the developmental delays change your brain such that things really are different for you and it's not just a matter of "trying harder" or "applying yourself".

I was absolutely stunned at the profound impact it had on my life once I was able to connect the dots together. Equally stunned at the drastic improvements I've been able to make without following the standard advice but by following what works specifically for ADHD e.g externalize information, externalize decision making etc.

> Getting diagnosed this year changed my life too.

This is awesome!

> following what works specifically for ADHD e.g externalize information, externalize decision making etc.

I bet everyone would love to hear a little more context around what this is, and how it impacted you, if you have the energy to share. (Me most of all!)

Don't leave it up to yourself to decide what to do and when. Find a way to put the environment in control.

Pre-diagnosis I would try this and it wouldn't work that well or it would work for a short time then after the novelty wore off it'd stop working. Things like set an alarm/reminder for throwing out the rubbish. But then eventually you ignore it and swipe it away or you're dealing with something urgent that day etc.

Getting diagnosed allowed me to commit my being 100% to that strategy. I reexamined it and found that it works reliably if you're able to layer systems several layers deep, so that they reinforce one another and act as failsafes.

Alarmy plus the barcode mission has been an absolute revelation in my household. I'm now able to throw out the trash, do the washing, use a calendar and mark things off on my to-do list.

I finally became able to use a calendar as I have a whiteboard in my kitchen that I put a barcode on that alarmy makes me scan once at night. That kicks off an hour dedicated to maintenance tasks. It starts with a habit stack of basic self maintenance tasks one of which is "check the calendar for the entire week".

Things like that aye. The difference is huge. I'm getting healthier physically, and my marriage has improved a lot as I'm not constantly getting yelled at for letting my wife down or putting too much of the housework/parenting on her.

This is fantastic. Thanks for sharing. Do you have any recommended further reading? You could write a great essay on this, I bet.

Well, you've convinced me to go back to the doctor. I was on the cusp of taking one of the ADHD tests but my insurance couldn't tell me how much it would be and the doctor's office said they couldn't either. I was told it would be between $200 and $900 and couldn't afford the $900 risk. I ended up being billed $200 just for the initial visit of course.

But the longer I wait the more damage it's doing to my life. Out of your list I'd say 5/6 affect me, 5 being the odd one out as I can't sleep with anything but a fan on.

I'll be making my appointment today...well, probably tomorrow now. Let's hope I don't procrastinate.

I'm glad you're doing that! Feel free to email me (mistergeorgespencer+HN@gmail.com) if it would be useful for you to hear more about my experience or for you to share some of what you're experiencing. I have an iCloud note with every shared symptom I see someone else describing on the web, and it's getting pretty huge -- and makes me super happy that other people have had the same experience.

I put off the diagnosis process for a year and regret it, but don't consider that a pressure for you to do it. If you have ADHD, one of the things you can't really know (in my experience) is the feeling of a balanced ability to focus and be productive. Feeling compelled to seek a diagnosis is a big step.

I had a lot of serious conversations with the doctor about the impact of medication, the causes of ADHD, potential neurotoxicity, neuronal elasticity, etc. before I committed to taking medication. Here if you want to talk!

Yes, do it now, make appointment today. Stop everything else and do it. If you have a doctor that hems and haws about it find another doctor. I got my diagnosis and prescription without any formal test. I have stopped seeing my psychiatrist but once a year since my general practice doctor decided they could fill my prescriptions. The medicine, even the expensive stuff, has payment help programs. Like print out a PDF payment help program easy.

If you want more pushing or personal story my email is in my profile. Best single thing I've done in my life to date.

$900 is a small price to pay for a lifetime of better earnings, assuming that’s the problem.

If you suffer ADHD, I strongly recommend reading Scattered Minds, by Gabor Mate. I found it enlightening

Thanks! I have a fortnight off coming up shortly and have added it to my queue. An area I spent a long time discussing in multiple consultations was the tension between genetic predisposition and environment.

Interesting for a few reasons: firstly there’s some limited evidence that early treatment with medication can have a permanent positive impact on the condition in children. Which to my pea sized brain is suggestive of the possibility that we have sufficient elasticity during our brain’s formative years to consider this, sometimes, an illness not a condition.

Secondly there is some evidence to suggest that other disregulations such as dyspraxia and dyslexia are linked to ADHD. A common question in diagnosis is about family history of those conditions.

I was also concerned when my doctor and two psychiatrists told me that therapy was certainly an option but highly unlikely to be successful for me. It seems like this book may paint a different picture.

Thanks for the recommendation! If you suffer from ADHD, do you mind sharing if the book changed your approach to treatment?

While Scattered Minds does a good job describing the “experience” of ADHD and will likely resonate with people who have the condition, a lot of its conclusions are not scientifically supported.

ADHD is a nuerodevelopmental disorder, it has strong genetic components and the only strongly supported intervention that improves life outcome is stimulant medication. Unfortunately medication doesn’t work or cannot be taken by all of those with the condition.

That said, Scattered may help someone work through other common comorbidities of ADHD (depression, low self esteem, etc). It may shine light on the complex interactions between ADHD, the family and society in a way that’s helpful for understanding ones own experience.

It didn't change my approach to treatment, no (I continue to take vyvanse)

However, the description of behavior of people with ADHD, made me say "oh, shit, that's 100% me". So, it was nice to know that I am not alone. It's comforting to know that some of my weirdness is from ADHD, and not inherently "me"

Hah, reading through that list I thought 'hey this is my ADHD', and sure enough that is where you went with it.

After 30-odd years of feeling alone on this front, it's always lovely hearing that others have had similar experiences. Thank you!

If all you have to go by is the popular stereotypes, you will be shocked by the number of engineers with ADD.

I think #2 is actually great. Without this trigger things never got done for me. University taught me that failure is okay, which removed the trigger for me. End result was that things got even worse.

I hope one day I'll be able to find a replacement for it.

> I think #2 is actually great.

Remember that there are a range of intensities to all of these symptoms!

A lot of people I know find that leaving things to the last minute can help them focus and they're good at assessing the time required to deliver something high quality.

For me it results in disaster more often than not.

> University taught me that failure is okay, which removed the trigger for me. End result was that things got even worse.

Ah sorry to hear that. Do you generally exhibit other symptoms consistent with others in this thread, or do you think it's just one area which you suffer in?

>Do you generally exhibit other symptoms consistent with others in this thread, or do you think it's just one area which you suffer in?

I think I exhibit pretty much all of them. From the chronic lateness to being unable to start doing something that doesn't interest me to being unable to put something down that does interest me. This was just the one thing that I didn't realize how useful it was until it stopped working for me. Sure, my work was shoddy compared to what it could've been and I could never feel pride in it, but at least I had something to show for it.

You sound very similar to me in that respect. I found it a real grind and pretty demoralising in general. Is there anything I can give you comfort on regarding the process of speaking to a doctor or psychiatrist about it? Or is it something you feel is not having serious enough downsides in your life to warrant the time?

I do think it has had a large negative impact on my life, but I've lacked insurance for the past couple of years and have been unable to see a psych. Things kind of spiraled away a couple of years ago. At the time I did see it coming and went to see a psych, but I had no idea what ADHD was. Was treated for depression, but obviously it made little difference. I did find out about ADHD at one point and realized it described me to a T, but I had an old psychiatrist at the time who essentially said that only kids have ADHD (I'm from a former Soviet state so that might've been the prevailing knowledge at the time). Eventually when I get insurance again I'll try to see one. But thank you for the thought.

The main thing is that I'm just not sure how much of it is ADHD and how much laziness or something else. It just seems like all of the things ascribed to ADHD could come from other things.

Why see a psychiatrist? Are those really things to 'fix' on the whole - given the upsides?

I'm incredibly energetic. I can't sit down for long - so I just stand in meetings. TV is a waste of time, so is social small talk, I do what I care about (and it rewarded me well). I've just felt like the speed, risk tolerance, freedom it provides me, and intuition make a powerful combination.

I'd say the ADHD (if it is) makes you unique. All the world needs is more conformists... [I may be conflating ADHD with my incredibly independent personality]

To expand - why not use it to your advantage? Consultants for larger, competitive companies do well w/ ADHD. Leaders do well. Founders do well (if they can stay focused on the opportunity).

I have a CompSci degree, and loved doing algorithms, etc - but can't be bothered to sit behind an IDE for hours. So what - enough of people can do that well. I've found leadership to be the best use of skillsets where these 'symptoms' appear.

I think this is a really interesting, nuanced point. It's one I talked to my doctor about because it was a concern I felt (and feel). Thanks for sharing it here! HN is usually a good space for contrarian opinions, but even so this sort of thing might get shot down a good percentage of the time.

The way I would express it is: ADHD medication curbs the downside of ADHD, but many people report and experience significant upsides to their condition too. The traditional view of ADHD medication is also that it turns children into "zombies". Do I run the risk of losing my 'edge' as a person?

I'm not a scientist, and I'm not a doctor. With that said, here are my notes from my doctor when we discussed this:

  1. I feel that oftentimes negative and positive personality traits in people go hand in hand, outside of ADHD. For example, the calm, methodical, detail-oriented people who make excellent assimilators and "deliverers" in startups are often a necessity to building something incredible, but can also be the very *worst* people to have around you when you're trying to "yes and" about fragile ideas, because they live relentlessly in the real world. Do the traits I exhibit in my ADHD also make me a more effective leader? Do I simply not understand the upsides because they exhibit as personality traits?

  2. Dr. X: There is little in the way of conclusive evidence, but he believes that it's possible that ADHD medication can curb traits that are either perceived as positive or genuinely positive in ADHD patients. This is why a key assessment is the extent to which negative traits manifest themselves. If you have ADHD but do not suffer from life-deranging consequences in some material sense (executive function impaired to the point where your career, relationships, or emotional wellbeing are suffering), then it's often not necessary to take medication at all.

  3. Dr. X: the common impression of ADHD medication -- and in particular Ritalin -- seems to be magnified by the fact that parents are in general deeply worried about their children and the sense that their personalities are altered in some way. In adults, the available treatments do not appear to have serious long term consequences for personality and cognitive function. So it's completely permissible to take XR/IR medication for ADHD on days when you especially need to focus, for example, and not worry about "missing" a day. Equally, if -- in consultation with your doctor during titration and your family and friends -- you feel that there is an untenable negative consequence of medicating, then you can of course stop.

  4. Dr. X: Anecdotally, ADHD sufferers frequently both underestimate and ignore the consequences of the disorder in their lives. Sometimes it's necessary to have them tell stories about areas of their relationships and personal lives which they find are surprising or hard which are unrelated to their ADHD, and very often doing so reveals that their ADHD manifests itself in ways which are wholly unsurprising but not visible to the patient.

  5. Taking the time to find the right medication and dosage is vital. Diagnosis is step one, and after that it is very often months of tweaking, talking, and collaboration with the doctor to establish the right dosage level (strength), formulation (XR/IR, and within that e.g. prodrug is an XR which is a sort of "prequel" to the chemicals you need -- so it stimulates the body creating them rather than dumping the chemicals themselves into your system), and brand (e.g. Ritalin, Concerta, and Medikinet are all methylphenidate, but Concerta is commonly a 25/75 release, Ritalin is available in IR or XR although XR is less popular than Concerta XR, and Medikinet is a 50/50 timed release). Finding something which works for you takes time, and is not an easy feat.

It's fantastic that you're not experiencing significant downsides to ADHD! I'm glad you were as clear as you were in your articulation of your concern, I worry that when some people express things like this they cause unnecessary worry in those who are experiencing meaningful downsides which put them off seeking medication. The tradeoffs are different for everyone.

Thank you for sharing that.

i have a history of failing to meet deadlines because of my procrastination. this disqualifies me for most leadership positions because i am labeled as unreliable.

i am happy for you that you have been fortunate with your path.

No idea if I am ADHD, I could just have a lot of energy - because I focus well.

Because it is extremely difficult to control ADHD to your advantage. It is your entire experience of reality.

> I may be conflating ADHD with my incredibly independent personality

I think you are, to a degree. Serious ADHD is AWFUL to live with and there's barely any upside.

> I can't sit down for long - so I just stand in meetings.

It's nice that you can mitigate not being able to sit down for long by just standing, but for many people with ADHD, not being able to sit for long is more than just stance. It's because they can't focus on the task they need to do in front of them so they feel the urge to physically leave and seek out more interesting things.

Before I began medication, meetings were a nightmare to me. I was constantly zoning out every few seconds and absorbing absolutely nothing. Even if I did pay attention for a few seconds, I would forget everything a few minutes later. So I tried writing notes, but it became completely impossible to listen to people when I was actively writing. It was extremely humiliating to walk out of a 2 hour meeting knowing I wasted the entire thing.

> TV is a waste of time

Again, I think this is separate from ADHD. If anything, people with ADHD are more likely to seek out distractions. This does depend on the individual, though.

> I've just felt like the speed, risk tolerance, freedom it provides me, and intuition make a powerful combination.

Speed? It took me 3 days to find the motivation to fill out a simple 1-page form.

Risk tolerance? I think you may be referring to impulsiveness. The main difference is that being risk tolerant at least acknowledges the risk, while being impulsive means using an exciting new mental stimuli as an excuse to make rash decisions (often with poor consequences).

Freedom? ADHD is incredibly suffocating. It's wanting to start doing something but feeling overpowered and locked-up. It's wanting to achieve long-term goals but feeling like you're constantly self-sabotaging yourself. It's making a plan in the morning, being unable to accomplish anything during the day, and furiously kicking yourself at night in an endless cycle of self-hatred. For me, ADHD is the complete opposite of freedom. It's a prison.

I apologize if I'm disregarding your experience by citing my own experience. But please don't suggest people to not see a psychiatrist, or that ADHD isn't something to fix. For most people, ADHD is a constant and serious detriment to school, work, relationships, and just everyday life.

The minor upside has been I just don't do what I don't find interesting. So, my life has always been interesting. Often that's not been in a good way, like boss phones "why aren't you at work?" and I reply... "I could probably make it there by like...11". This was at about 9am when I was supposed to be in at 8:30am. It was some factory job I fucking hated. The wall of awful struck and I couldn't seem to attempt to get myself there any earlier than 11. That's what my mind was telling me. He didn't know what to say, so he hung up the phone. He called back 5 mins later and told me not to bother coming back to work. I was relieved and terrified all at the same time. Relived cos I just couldn't do it anymore anyway. Terrified because I had spent the last 2 years freeloading off my girlfriends mother who i later learned took out loans to support me and I'd only just got that job 6 weeks earlier after not working all that time.

Life was fucking hell in my early 20s. In my early 30s I'm a successful software engineer (thank fuck) and it tends to manifest in me bitching about how the software should be, daydreaming of it being that way, then endlessly pursuing side quests at work to make it so. Turns out that is actually a valuable way to be as a software engineer as I tend to make the software better at a much faster rate as compared to my peers.

> Freedom? ADHD is incredibly suffocating. It's wanting to start doing something but feeling overpowered and locked-up. It's wanting to achieve long-term goals but feeling like you're constantly self-sabotaging yourself. It's making a plan in the morning, being unable to accomplish anything during the day, and furiously kicking yourself at night in an endless cycle of self-hatred. For me, ADHD is the complete opposite of freedom. It's a prison.

This describes my life with haunting accuracy.

Can't tell if you have a diagnosis or not. If it would be useful to chat my email address is in my profile and a few people have already reached out. I'm not a doctor and can't diagnose you but I'm happy to hear about your experience and share where it chimes with mine.

wy35 - well answered response. I don't know that I am ADHD, so your experience trumps mine!

Hashtag nailed_it

ADHD has a wide spectrum, people with real ADHD cannot function without medication ( speaking as a parent with a child who has it). Yes, without medication he would either be not focussed or hyper focussed. But, the biggest issue is lack of executive function, which is debilitating. And, no matter what, real life needs you to be able to follow instructions, and do things in order. If a 7 year old with a simple life cannot function, think what it can do to an adult? The medication helps, but it's a process, and you have to find the right one and the correct dosage. Added to that, you need a competent psychiatrist, we lucked out after a few tries. Basically what the medication is doing is strengthening the neural connections, so that executive function becomes a habit, to the point where you don't need it. If you do it right 50% of people with ADHD won't need it. And, you can be a genius but if you lack executive function, you can't do basic everyday things, let alone complex tasks. Somehow the media has started painting ADHD as some kind of superpower, when it's a serious debilitating condition.

Thanks for sharing your experience. Really valuable to me and many others on here. A question and a quibble if that's OK:

> what the medication is doing is strengthening the neural connections, so that executive function becomes a habit, to the point where you don't need it. If you do it right 50% of people with ADHD won't need it.

I had understood that this only applied to children who are young enough to have developmental neuroplasticity. Is your understanding different? Appreciate your steer as it sounds like something you have understood in more detail than me.

Quibble:

> people with real ADHD

I don't think you mean to, but this is a little clumsy. As you say in the previous sentence, ADHD is a wide spectrum. You can have ADHD but function, there is no "real" ADHD, only various degrees of severity.

From what I understand, the brain never loses its neuroplasticity, but early intervention is always better. You hear stories of people who got diagnosed as adults, got the right medication and therapy and their lives improved tremendously. Again I want to stress that it is a combination of medication and behavioral changes. For a child, it means a lot of repetitive suggestions, patience and accommodations at home and school. For adults, I've heard Cognitive Behavioral Therapy and meditation working well.

When I said "real ADHD" I was responding to the earlier comment, where the person was trying to say how ADHD is some kind of superpower, and there are a lot of folks I hear say they have ADHD when they clearly do not. It is a large spectrum, but even folks at the lower end of the spectrum find it really hard to function. To give you an example, my son would be at the lower end of the spectrum, but we saw him struggling as he started elementary school. We were less worried about academics, but we started noticing that he was losing confidence because his peers would get what the teacher said while he did not. And, all that was leading to a loss in confidence.We read a ton of books, tried behavioral changes and recommended suggestions before we tried medication. And it simply did not work. We tried 3-4 different medications before one worked with no effects. It was a painful and heartbreaking journey. And our psychiatrist told us we were right to intervene early, because once the kids get to 3rd grade, the academic pressure increases and they are already behind their peers. I recommend Russell Barkley's you tube videos, they are excellent, and really helped me understand what ADHD is.

a big question is how does one find a therapist/psychiatrist?

a seemingly simple yelp/google search yields a sea of anonymous faces and trusting these strangers with your brain already feels daunting.

i'm in san francisco and am on a PPO if anyone has any recs. email in bio, thank you!

This was daunting for me too.

I had a series of private evaluations in London, and the proxy I used was to seek a consultant psychiatrist (just about as senior as they come) who had a longstanding relationship with his local NHS trust (hadn't jumped from one area to another), looked him up on the GMC (registry of doctors in the UK which would report malpractice or other issues), and asked for a telephone consultation to discuss his work in this area and his approach. I appreciate many of these will not be possible in SF, so I would try to move back in stages towards a person you trust. Do you have a good relationship with your regular doctor? If no, do you have a trustworthy friend who does? Etc.

hi george thank you for your response here and elsewhere in the comments. i have found them very helpful.

i did indeed just reach out to a friend who recommended i talk to my primary care provider (PCP) and go from there.

now that i'm looking into all this, mental health is a luxury in america. sessions are approx $200/visit here in san francisco.

It is not that much better here in the UK for specialised things like mental health. My local private specialist for ADHD charges around £1500 for the consultation, and it is hard to justify risking that much money to just be told you're lazy.

I would avoid a specialist ADHD centre.

What you're really looking for (in my opinion) is a consultant psychiatrist (i.e. a senior, experienced psychiatrist) who supplements their NHS commitments with locum-style private practice work. (You know how you can use Babylon Health to speak to a real GP on the phone immediately for £10? And they can give you a prescription? Like that, but obviously clinical psychiatry requires meeting in person a lot.)

I think specialist ADHD centres run the risk of having a hammer and thinking every patient is a nail, if you know what I mean, and they also are geared up for the kind of deep clinical assessments which are often not required in adults (imagine the nightmare of trying to diagnose ADHD in a child with comorbidities).

Once you have titrated you can move from a private prescription to an NHS prescription which reduces ongoing costs significantly.

> just to be told you're lazy

Do the research into other people's experiences and think about your own downsides and consequences of e.g. inaction/inattentiveness/inability to focus. You can also check out the DIVA assessment which many psychiatrists will use. A good psychiatrist will also cut through the crap and tell you whether they think it's likely you have ADHD early in the process. They do not want to glean hundreds of pounds for you in order to say "Yup all fine here!".

Ping me on email and I'll share specifics of my consultant.

It's relatively expensive in the UK too (my initial diagnosis was close to £1,000), but I believe the benefits are very noticeable.

Here is what I might do if I wanted to cap at $400 (assume $400 is two hours) before finding out whether I need to do any more.

Before I book the appointment:

1. Find the most commonly used clinical assessment tool[1] and commit to undertaking it, with a specific emphasis on any corroborative components (i.e. friends and family who have known you for years helping to share experiences of you in childhood)

2. Research qualitatively: e.g. read essays from people who have had diagnoses and treatment and see how much of it chimes with you.

3. A useful experiment I did was to go to the ADHD subreddit and, ignoring the ebullient teenage blogger-type posts, make a list of posts and experiences which closely correlated to my own.

4. Write down your own summary of your experience and why you're seeking some help. Not necessary ADHD-specific, but what are the things you're aware of that you want to improve on in your life? What are the consequences you experience from those areas?

At the appointment:

1. Explain that you are aware diagnosis of most conditions requires a multi-stage evaluation from a psychiatrist, and that you am committed to taking the process seriously but have concerns about both the cost (hence doing a lot of research and being very organised, which runs contrary to some people's expectations of ADHD!), and the risk of getting a doctor who simply writes prescriptions without a second thought.

2. Tell the psychiatrist that you would like a preliminary recommendation from them on whether it's worth continuing with assessment and/or treatment after two sessions, and you'd appreciate it if they could do their work as methodically as possible but sensitively to the fact that you don't want to initially deploy more than $400 to the task.

3. Share with them that you have researched DIVA or another clinical assessment for ADHD because it feels like the symptoms of that chime with you, and you wanted to be sure it was worth your time coming in at all.

4. Tell them you're giving them this information because you don't want them to think you're doing stage management or trying to score some drugs, and commit to letting them run the session from there.

5. They will likely ask you to explain what has motivated you to attend in the first place. What 'thing' happened to get you off your ass and into their office?

I think it's very probable that you can find someone who understands that this is a debilitating condition in many people and which also needs a sympathetic approach to diagnosis.

The other thing to remember is that there are multiple clinical assessments because many people have comorbidities and it requires unpicking. If that isn't the case for you then you don't need hours and hours of assessments.

Feel free to reach out on my email (in profile) if you have Q's or I can be helpful.

[1] E.g. in the UK it's DIVA https://www.advancedassessments.co.uk/resources/ADHD-Screeni...

For those of us in the UK, would you be able to recommend the consultant/practice?

I have a private practice locally that specialises in ADHD but I've no idea about their reputation.

Sure! Best thing would be to email me on mistergeorgespencer+HN@gmail.com if that's OK! (And same goes to anyone who wants more detail.)

nicely written. that point-2 totally resonates here :(

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