Hacker News Reader

Comment by burtonator | Hacker News Reader

I've been on Adderall for 5 years ... I'm 43 right now.

It really HAS changed my life. What I've found is that over the long term you're able to perform much much better.

By the time I was in my 30s I had developed coping skills which worked for the most part but I would find myself getting demotivated and defocused sometimes on long term priorities and sometimes unable to recommit to them.

Adderall totally changed that. I'm able to focus on tasks long term AND even if something bad happens in my life I'm able to keep right on track.

It's also helped me stay more positive knowing that projects get completed and there's nothing preventing me from accomplishing what I want to accomplish.

There are some downsides though:

- Adderall is illegal in most countries so you're not even allowed to travel with it in some places. I didn't really know this at first and I wish they would tell you. Most countries will overlook it but if you're China they could totally use it as an excuse to harass you if they wanted.

- It's very addictive. If I forget my meds it's basically impossible to function.

- It's VERY hard to get since it's a controlled substance. I'm only able to get it 72 hours ahead of time and if they're out of stock sometimes I have to wait. DO NOT wait until the last minute. Get it as early as possible.

- Some people have problems with off brands of XR (extended release) that has a different formulation. There's no standardization on the XR process and I think it's vendor specific.

View on HN

I literally just got diagnosed with adult ADD a month ago. I'm 46! It... explains a lot of things, both for better and for worse. I never even realized I was developing coping skills vs. just developing normal skills, if that makes sense. I definitely have had the same types of problems as you describe.

I've been on Ritalin for a few weeks now, and the difference is remarkable. If this is how normal people feel most of the time, I don't know... I am both relieved to have a name for what was causing me problems, and also feel the need to grieve lost opportunities in life. It's a complex mix of emotions.

I'm a little bit younger, and pretty much the same on all of this (except vyvanse for me). I really wish I'd figured it out in my teens or twenties.

Also, every time a post on here comes up about elaborate methods of achieving focus the comments are full of people typical-minding what really might actually be ADHD (the whole "everyone is like this right?" thing) and I'm just sitting there like.. maybe you should look into this it probably shouldn't be that hard.

Of course if you post that you get a bunch of replies from people who insist that, "no, actually, it's cell phones' fault" or that it's totally normal to absolutely loathe doing any mundane task.

>mundane task

That's why we invented shell scripts and cron!

On a serious note, what type of tasks would you consider mundane that you attribute to your ADHD to cause you to not want to do them that any non-ADHD person would also not have procrastination problems? Are these specific to work like filling out time sheets or other TPS reports? Home tasks like laundry/dishes/trash? All of the above? As a non-ADHD person, I hate all of the above tasks and only do them because it's part of adulting. Can't get paid without time sheets (this is my biggest hate). I'd rather do laundry (folding/ironing) than fill out time sheets. I have no rational explanation as it is a rather simple thing.

I'll try explaining this one and maybe why you're being downvoted.

The difference is that buckling down and focusing... Don't always work for me. That's the fundamental difference that normal people don't get. That rather simple thing is basically the problem.

I'm pretty good at "adulting" and otherwise coping with my life but I hit roadblocks that other people sail by. I can do very complicated, difficult and tedious tasks but sometimes get stuck doing simple things like paying a parking ticket. I know how to do it. I know when it's due. I know I'll pay a penalty if I pay it late. I think about it all the time. But doing it is like lifting an incredibly heavy weight. Normal people don't feel the weight and think I'm lazy.

Sibling's explanation is pretty good really. I would also have trouble doing timesheets (have thankfully never had a job that required them) but not because of adhd, just because they seem pointless and like they bring no value to my life at all. Standard adulting things are only an issue in so far as they are often out of sight out of mind, and that's a common struggle for people with ADHD (drawers are our enemy).

Mundane is probably not exactly the right word tbh, but it's hard to find the right word. I think it would be more accurate to describe it as things with a lot of upfront planning involved. If I can basically react my way through something to completion I can get into hyperfocus and just blaze through it.

A lot of the time the way I've gotten around this is to force it to be an emergency so I can't think about it too much. Either by leaving it to the last second or just convincing myself.

And that's a really common pattern you see in people before they get ADHD diagnoses.

>As a non-ADHD person, I hate all of the above tasks and only do them because it's part of adulting.

The difference being my wife breaks down in tears every 3 months because she woke up to dishes in the sink _again_ and wasn't able to use her coffee cup because, though I meant to do them and said I would, I wound up not doing them.

That was the first 5 years of my marriage. Repeat for laundry. Repeat for trash.

For work I was on a list of 5 people out of 1000 person company who's names had gone all the way to the CEO for not filling out timesheets correctly.

I hope that makes the problem a little clearer for those who think "but everyone has trouble with that stuff"

^^^^yes. it's different than procrastination. it's MORE than procrastination. if part of my is scared of a certain task (because stress is biologically the same as fear), it's sometimes like my brain wont't "let" me do it. even if i try, I'll sit there thinking about it torturing myself instead of getting it over-with. it truly is crippling at times. I know it sounds dramatic to non_ADHD and neurotypical people, but if you are committed to making an equitable space, you have to trust and believe that the disabled person is telling you the truth.

I am nearly 40 and I have wondered for a long time whether I have adult ADD but have been afraid to go down the diagnostic path, because I'm scared I will lose one of the few true talents I have, which is hyperfocus (or the complete opposite, depending) - that said I think this quality is ruining relationships, so while I can hyperfocus on work or projects, my personal life is a mess. But, I don't know if this is ADD, some kind of anxiety, borderline depression, whether it's something else or whether it's just me.

I didn't mean to reply and talk about myself, I actually wanted to ask (if you wanted to share), about what led you to the diagnosis at that age - what kinds of things were not working for you? What were you developing coping skills for?

Didn’t lose hyper focus.

More that I gained “longer” focus.

THIS!!! it just helps keep me "on a roll" instead of spacing out

I don't want to get in to too much detail on a public board, but the short of it is that several major events in rapid succession (unexpected death of my father, lawsuits involving his estate, Covid just as I was re-growing my IT business, loss of several major clients/income security due to same, a sudden chronic health problem, etc, etc, etc, etc.) overwhelmed my ability to get things done in a timely manner. I sought help, and something in the way I was talking must have piqued my psychiatrist's attention, I got tested, and here we are.

It was a lot of shit, all at once, and it would be easy to shrug and say it would have been hard for anyone. But it was enough of a shock to my abilities that I was able to finally see that I just wasn't firing on all cylinders, even though I am otherwise intelligent and capable.

I have not lost my ability to focus. In fact, it's easier than ever. I've always been very distractible (another common symptom), and suddenly the kids making noise while playing next door, dogs barking, phones ringing no longer wreck the house of cards I'm holding in my mind while working on a problem. It's remarkable.

Appreciate your answer, thank you - really sorry for the loss of your dad, losing mine really changed a lot of things for me.

Thank you for your kind words. I am sorry for your loss as well. And yeah, it was rough.

Hey! I'm 21 and was diagnosed at 11 or 12. I've learned a LOT about myself just in the past couple years by reading up on additional ADHD symptoms that aren't just school-related (since the diagnoses really just focuses on how my disability impacts others, like teachers and parents). I have a 10mg Ritalin prescription that I was supposed to take twice a day in grade school, one in the morning and another at lunch. I've found that it lasts for about 5 hours. Recently, I started cutting them in half and only taking 5mg whenever I need to do work. Not sure if that sounds bad, but I don't have a problem with any of my symptoms when I'm not doing work I'm not passionate about (most homework). The point is, you don't have to always be on meds once you get them, and you can get a low enough dose to have control over it instead of being on it all day every day. Also, just like the other comments on here, I don't lose my hyperfocus at all when I'm on meds. It just helps me stay "on a roll" instead of wandering off to do other stuff or getting super spaced out. 10/10 would recommend getting diagnosed. Anything you can do to deepen your self understanding is going to be beneficial in the long run. I know I'm only 21, but please trust me on that last part, if nothing else. Best of luck:)

Do you have any experience with the extended-release versions? My doctor has suggested I give them a try as well, (started with the dose/type you mentioned) to see which form works best. Of course, treatment management for this is all pretty new to me, regardless of my age, so I'm interested in hearing other's experiences.

I don't have any experience with extended release, and honestly since I'm in college my doctor grills me more and more every time I go in to renew the prescription. I keep thinking I'm gonna go off of it and then I still need it and objectively that might look sketchy, since I some students sell their meds. I'm scared that if I bring up any other type that might look worse? Anyway, this thread has taught me more about extended release and I'll likely look into that when I start working after graduation.

Thanks for the response, and good luck with your studies.

I had a bad concussion when I was 12 that ended up tanking my testosterone levels (and god knows what else). I was extremely tired all the time. I didn’t get it properly diagnosed for nearly 15 years, and in that time I turned down going to Ivy League schools and a bunch of other opportunities. I have to admit going on HN can be a bit of a bummer as I always thought I was destined for the lives a lot of people have here (Silicon Valley, startups, etc).

I still got a degree in computer science but with that path I was put on... I’m now a photographer and still live in the same area I grew up in.

I realize you have more years “wasted” but I’ve had quite a bit of time to come to terms with all of that. I think it’s important to keep in mind we all have advantages and disadvantages in life, and chances are if you’re on here you’ve still had a pretty charmed life. You’re intelligent, in a developed country, etc. Most people don’t have that.

All good points, and worth keeping in mind. I didn't live in the 'states until I was a teen, so I know how lucky I am to be here, too. It's also OK to feel grief over loss at the same time. Like I said, it's a relatively new diagnosis for me, so it's going to take me a while to process things. Overall, I am grateful, though, and that is important to emphasize.

> I had a bad concussion when I was 12 that ended up tanking my testosterone levels (and god knows what else).

Interesting you mention that. I had a Bicycle->Car accident when I was 8 and I've always been told that's when a number of my behaviors started to change (and I became the black sheep of the family I am now.) I didn't get diagonsed with ADD until I was almost 30, but oddly enough my current care doctor also specializes in head trauma.

Brain trauma is scary stuff. Back when it happened to me (the year 2000) the doctors weren’t at all concerned with the concussion. I broke my arm pretty severely and my back also hurt, and that’s all they cared about.

I’m guessing that’d be different now, though I don’t know what extra care they could give. At the very least I think my parents would have thought to tie my sudden energy and worse grades to what happened.

> I never even realized I was developing coping skills vs. just developing normal skills

do you have some examples? i suspect the majority of mine are the former

Sure. I'm happy to share individually, but I don't really want to post them on a public board. My email's in my profile if you want.

how do i see it in your profile?

It, uh, helps that I make sure it's visible to others first. Sorry about that. Please check my profile again.

You know what's totally nuts? Taking Amphetamine daily for years in reasonable doses essentially has no long term negative effects. In that way, similar to coffee.

When I think about that, it's kind of mind blowing.

For that matter, it is also crazy that we don't start giving children coffee at younger ages to help focus — since there are no known negative effects. It's just a cultural trope that it stunts growth, etc. It took ages before people recognized that there weren't really health downsides to coffee. We are so trained to expect that "every up has a down" — but what if that's just a relic of Calvinism and we are inhibiting our full potential because of misplaced fears?

> You know what's totally nuts? Taking Amphetamine daily for years in reasonable doses essentially has no long term negative effects. In that way, similar to coffee.

This is a null hypothesis that hasn't been refuted due to lack of evidence, and not an alternative hypothesis that has been proven by evidence, right?

I ask because I've been looking into this before, and from what I remember there was virtually no evidence on long term use in reasonable amounts.

(There is evidence on short term use in reasonable amounts, and long term use in unreasonable amounts, though.)

Well, it's scientifically difficult to randomly assign people and assess effects for multiple decades. So the ideal evidence won't be available.

But if we accept a "nutrition science" level of evidence, then I'd say there is strong evidence showing the naturalistic longterm use of adhd meds is not dangerous. Especially considering our baysian prior: a person off the street would estimate far stronger negative effects of taking speed every single day.

In fact, adhd meds are correlated with healthier outcomes (of course, huge selection effects. Yes, eating kale will be associated with increased health, but it isn't causal)

Here is the best recent review that I know of: https://www.sciencedirect.com/science/article/pii/S0924977X1...

I'd love to know your take.

> In fact, adhd meds are correlated with healthier outcomes (of course, huge selection effects. Yes, eating kale will be associated with increased health, but it isn't causal)

Yeah, I'd say p much impossible to untangle there without experimental evidence.

> we don't start giving children coffee at younger ages to help focus > we are inhibiting our full potential because of misplaced fears?

I'll argue with the assumption that there is zero long term psychobiological consequences to exogenous psychostimulants (I personally don't buy this, but let's assume it was true). Increasing focus and task salience is only one of the many factors constitutive of human potential. They never give the answer for what to focus on, or whether a task is worth it or not, and rob the person of the opportunity for developing frustration tolerance. They turn people into indiscriminate doing machines, with little wisdom to guide it. Makes one think if prescription amphetamines being as widespread among plumbers as software engineers is truly a coincidence.

I will argue this is because our bioeconomics, our not wanting to do things is also part of our wisdom machinery. Having used for half a decade myself, I can spot some collogues who are on amphetamines; unnecessarily assertive, obsessed with orderliness of code, constantly in need of refactoring, huge bias for action with diminished wisdom to temper it (Well, also pees a lot.). There is a reason they are not being used by fighter pilots anymore because they can get too cocky and make decisions that kill their own.

No wonder everything looks like a good idea when your brain is swimming in dopamine and norepinephrine, but when everything looks like a good idea, how do you find what is the right thing to do in the medium/long term? Is that really the human potential? I would argue far from it. I think it is just enhancing the potential for a particular job description that requires you to sit on your bum all day and plumb boring stuff someone else tells you to.

I’ve read a lot of comments around amphetamines. This is probably my favorite.

Amps turn you into a drone. Any perceived benefit is met with equal or greater detriment.

+1 thanks for this

Feels like every week someone here is touting the idea of ADHD meds being this solution, all these people are just undiagnosed, there’s an unfair stigma against, and I feel compelled to bring up that I bought into that thinking, got a legit diagnosis and took meds as prescribed, they triggered mania in me and nearly ruined my life.

I tick all the ADHD boxes but I managed to make it through college without meds so never should have started.

Psychiatry is broken and handing out prescription amphetamines to everyone who can’t focus is as bad as an idea as it initially sounds.

You might just be smart / high IQ so you could still stumble through college. Imagine what more you could of accomplished if you didn't? Higher abilities need higher standards.

Also you don't have to actually take the medications at all to get an ADHD testing battery. Then you'll know if you actually have ADHD or if you actually didn't. If you don't then your comments are a bit insensitive. Self-diagnoses of various medical conditions by the untrained is notoriously inaccurate.

I mean comments like this are the reason there's such a stigma against medication. It's kind of ignorant to say that "psychiatry is broken", "my meds ruined my life", or "I made it through school without them so I never needed them" as if none of those things had anything to do with you.

Someone in the same situation might feel much the opposite, but they also shouldn't use their experience to convince people that their attempt at treating a condition they have is inherently a bad choice.

Thank you for writing this. As someone who has recently been weighing the pros/cons of seeking treatment for ADHD, this has been one of the best points I've read on the potential downsides to it. Currently, in my career (software dev) I've been feeling increasingly burnt out and like it's impossible to focus on anything. I have to sit back and ask myself, is the problem that I can't focus, or is the problem that I'm doing something that I feel is meaningless?

If I got treatment for ADHD, maybe then I would be able to finally churn through all of my tasks and be a top performer in terms of closing stories. If I didn't pursue treatment, then maybe I continue to be unable to focus and completely burn out, resulting in the loss of my job. Maybe after that I pivot my career to where I'm doing something that I find to be more fulfilling. What's the better outcome?

If anything ADHD medications (ritalin) make me _more_ prone to burning out, not less. Just FYI.

It does help with "boring" tasks a little bit, in a sense, but they're still boring an uninteresting. It's not like I get a dopamine hit every time I do a piece of paperwork.

I usually describe it like this: for me ADHD sometimes makes things that are necessary for human life _really_ hard. Things like taking a shower in the morning or having breakfast, getting up to get water while working etc.

All these things take a toll on my day, I still do them but I feel like I'm doing something that I _absolutely_ don't want to do and at the end of the day I don't have any patient left for stuff that actually require my effort (e.g. listening to my wife when she's frustrated with me).

With medication I feel better about doing these necessary things so I can get to the end of the day without hating myself. That doesn't mean I'm gonna eat all the bullshit that gets thrown to me at work!

It's also not all roses, Ritalin is hard to manage, at least for me. I need to make a conscious effort to not devote too much of my attention to uninteresting details, etc. But it's not like it takes away your free will!

I'm not sure that the affects of stimulants for ADD are across the board, as you describe. That is, for lots of people, me included, add meds seem to boost my executive functions.

Without them, I actually have no problem focusing on certain things, but it's usually some unimportant problem or project that I become distracted by.

With meds, I find it much easier to step back and get a clear picture of not just my work, but my whole life. I become more attentive to my family, less irritated by distractions. And more a able to get important things done, like my taxes, that before would plague me.

I know some people seem to react to the meds by turning into a worker drone, But it doesn't do that to me. It does make me more excited to make progress and get things done right.

I might have over-emphasized the worker drone persona. But I think the potential for self-deception and long term foolishness is still there across the board.

> With meds, I find it much easier to step back and get a clear picture of not just my work, but my whole life.

Executive function boost is non-negligible for sure, but it is still bound to operate in the short term.

Think your bioeconomics as a ledger, your energy levels as income and what you want to do as payments. Stimulants alter this ledger and as long as you can use them you will think you have a lot more income and you can sign up for more things to do. But do you really do have more income in the long term? Are you borrowing from your future income? Your future dopaminergic system? Your future neuroticism levels? I know the research is either missing or contested, but everything from evening crashes to need for increasing the dosage to long term dependence risk suggests that we are borrowing something from somewhere.

> I become more attentive to my family, less irritated by distractions.

Let me play the devil's advocate for a second: How do you know being more attentive to your family is the right thing? Maybe they are real assholes taking you for granted and getting irritated with them would make them get their act together and have a better chance in long term sustainable relationship. How do you know the distractions are not irritation worthy? Maybe they are things you need to get to the root of instead of enduring continuously.

I am exaggerating to make a point, and I'm sure you're mostly fine, but the danger is that thinking you have more "income" than you do will affect all your decisions in a way that accumulates and might not be long term sustainable. It can make you more conforming, and this will be praised by your family, boss, for the case with kids, their parents, but can we say with certainty that being more conforming all the time is really in one's best interest? Anger, irritation, anxiety, depression and even boredom, they are not there just as human failings but also as normal processes that can counter-balance over-exertion, over-exposure, weakly defended personal boundaries, meaninglessness, resentment.

Only way to know how continuous stimulant use is affecting you is to take a long break after multi-year use and evaluate where your life is, which for some people can be too late.

I think you are probably right that "conforming" may not always be the best way to handle things. But most people that end up being diagnosed with ADD are already very non-conforming and they want to just be nudged closer to average.

Now, if your goal is to swing for the fences and try to hit a home run, get to the top of your field, make a grand discovery, then ya, most of those kind of people are very non-coforming. But many are/were also very unhappy personally. In fact, many of the greatest outliers in our history suffered from manic depression or ADD or other mental issues.

Personally, I'm not swinging for the fences. I'm going to bunt if it means I have a much better chance of getting on base. Steve Jobs was very non-conforming. He was always very irritated and unpleasant with everyone around him. And sure, it seems to have had results. But I have no interest in becoming the next Steve Jobs if it means having what appears to have been an unhappy life with an early death.

Very well put. Focus is a double edged sword.

Focus and discipline is very useful when solutions to problems are known.

But put someone extremely methodical in charge of R&D and they will take a zillion years to explore a large search space. Meanwhile a neurotic will run around randomly and stumble upon all kinds of things on the map. The down side with the neurotic mind, is after a prospective gold mine is found and a lot of methodical, disciplined work is required to exploit it they flake out.

Now if you pair them up interesting things unfold.

We are quiet good at identifying people's strengths and weakness. But we spend a lot of time exploiting weakness and squandering strengths of people.

If only the opposite happened more.

With better and growing understanding of how different minds work, I think we will see people compensating for each others weaknesses more.

>> "I think it is just enhancing the potential for a particular job description that requires you to sit on your bum all day and plumb boring stuff someone else tells you to."

Agreed! Not that this is going to make me stop taking it as needed because this is the society we live in (and I'm currently in college), but yeah. I was just talking to a parent of a 5th grader the other day and they were telling me all about how often their kid got in trouble at school (like I did in elementary school), and how she read up on the neuroscience and decided medicating was appropriate. They had me thus far, until they went on about how they didn't tell anyone at the school (it's beneficial t share this with teachers...) until the staff sent emails regarding the kid's improved behavior. One person even reached out and said "your kid hasn't been himself all week." SO I THOUGHT THE PARent was going to say that's what made them change the dose, BUT THEY DIDN'T!!! They took "your child hasn't been himself" as a COMPLIMENT. Something is very wrong here and it's not the parent's fault, it's our priorities in America regarding an outdated school system and long work week. Obedience is valued more than creativity. How are we supposed to improve with that mindset?

> For that matter, it is also crazy that we don't start giving children coffee at younger ages to help focus — since there are no known negative effects.

Might as well, we already load them up with sugar, which does have known side-effects.

Sarcasm aside, maybe not a direct negative side effect, but if you suffer from poor sleep, drinking too much coffee or drinking coffee too late in the day has correlation and lack of sleep certainly has negative side-effect.

Personally, I'll keep my kids off coffee and other drugs until they're old enough to buy it themselves.

In some cultures it's common to give kids coffee. My parents didn't give me coffee when I was a kid but my wife's parents started giving it to her at an early age. My kids both drink coffee. My older one started on black coffee when he was 2. It's just a routine part of his day. Coffee at breakfast and then at cafecito in the afternoon.

Coffee has been shown to reduce the length and quality of REM sleep, which is very important for early brain development. Read the relevant section in ‘Why We Sleep’ and you may change your mind.

> You know what's totally nuts? Taking Amphetamine daily for years in reasonable doses essentially has no long term negative effects. In that way, similar to coffee.

Wow, that is truly amazing. I'm glad to learn about that.

I notice a slight depression if I stop taking my ADHD meds for a few days (perhaps up to a week), but after that I'm back to my old (ADHD-driven) self. So in a sense, it's not addictive at all. The depression can tempt one to get back on it, but that's about it.

One side effect of Adderall though is ED, and it's pretty bad. I guess it depends on the person, but for me, the ED was quite bad. The ED does go away after getting off of it.

> So in a sense, it's not addictive at all.

You definitely have a withdrawal from adderall. A few days (up to a week) is typical of most drug withdrawals.

> One side effect of Adderall though is ED, and it's pretty bad. I guess it depends on the person, but for me, the ED was quite bad. The ED does go away after getting off of it.

The drugs for that are very easy to get these days - you can get a prescription online by taking a survey and the pills will be mailed to you without ever talking to a human.

They are also ridiculously expensive.

The big popular ones that advertise (Hims and Roman) are very overpriced. I found Blink Health sells a generic version for much cheaper ($2 a pill).

Well, the drugs for ED (e.g. Sildenafil) are quite bad / not really good for your health.

It's probably a lot better in the long-run to use exercise as a cure for ADHD.

(Instead of slamming your system with drugs upon drugs. With one drug taken to mitigate another's side effects, etc.)

I had the same problem with Adderall. So I switched to Ritalin and my life has been much better. Adderall also made me constipated, sweaty, unable to sleep... my circulation got so bad my hands would freeze up at my desk, so I would layer on clothes and sit there sweating with frozen hands and feet. I don’t know how the seemingly most popular ADHD drug could give me so many side effects.

increased impulsiveness and sleep quality are know negative impacts

Some children are given coke, pepsi, mountain due or other soda drinks with high caffeine content.

> Most

Fair point, I have no idea of the real numbers, so I edited to say "some". My point was more to say that there are other beverages and foods with high caffeine contents, so when you take them all into account, there's probably more children being given caffeine then we think.

None of those drinks have anywhere near the caffeine of coffee, though. An energy drink of some kind probably does though.

That’s not true. ~100mg in a cup of coffee, 40mg in an espresso shot, the same 40mg in a can of Coca-Cola (and ~60mg in Diet Coke).

Caffeine in an espresso shot (and conversely one cappuccino) is ~63-77mg[1], and one can of Coca-Cola & Diet is 32mg & 42mg[2].

[1] Nespresso is 63mg (5g of coffee), "average" espresso is 77mg (7g of coffee) https://www.caffeineinformer.com/caffeine-content/espresso

[2] https://www.coca-cola.co.uk/ingredients/caffeine/the-caffein...

It would seem some espresso do have the same caffeine as a can of coke, some even clock in less, but ya on average it seems to have about double the amount.

That said, most coffee shop serve double espressos as standard, so if you factor that in, it seems on average your cup of cappuccino might have four time the caffeine than a can of coke.

That's true, forgot about that part (and why I take them into account as "2 shots" in my max daily coffees).

There's also a couple Nespresso (maybe Keurig and others, too) capsules with double the caffeine content: Kazaar and Napoli.

I drank coffee for several years (around 4 cups a day, not later than 4pm) and suffered from insomnia and didn’t know the origin. Since I stopped caffeine intake, my insomnia is basically gone and I feel a lot more functional because of better sleep.

So my impression (yeah I have to admit it’s a study of size 1) is rather that caffeine is more dangerous than I thought.

I wonder what it means if I can drink 4 espressos before bed and sleep like a baby... does anyone have research on caffeine metabolisms and ADHD / other diagnoses?

Not everyone is the same. I have heard of drug addicts who could only drop heroin by replacing it with massive amounts of highly-caffeinated energy drinks, in quantities that would be objectively bad for most regular folks.

Wow that explains a friend’s monster energy intake

I only managed to drop drinking a shit tonne of Red Bull once I started Ritalin.

Yeah I know several people who tell me the same like you... Again not proper science but it seems that caffeine tolerance and metabolism is quite different from person to person.

Ok, I'll try to jump in here.

a) There are downsides to coffee. I know of a clinical neurologist (Steve Novella) who, when working with a patient with chronic headaches, will always ask "how much coffee do you drink." Always remember, if a "medicine" is doing good, it will have side effects. Period. Note that homeopaths simply love going on about how homeopathy doesn't have any side effects - spoiler, that's because it's not actually doing anything at a physical level.

b) Yes, daily use of stimulants in people with ADHD has been show to be pretty much ok. In fact, there are studies showing that kids who are not medicated are more likely to end up as substance abusers, largely because they're self medicating (remember, drug abuse is a symptom++). However, the kids who were treated with stimulants? No more risk than their neuro-typical peers.

c) The above says NOTHING WHATSOEVER about neuro-typicals taking it daily.

++ Source: my partner, currently doing her neuro-psych masters on addiction.

I started taking it in my late 30s for ADD and it was life changing. Over time though it was making me super angry so I stopped taking it. I now focus on sleep and exercise but my career really accelerated while I was taking it.

Same here. Super angry about some random guy wearing a blue sweater that I didn’t like for example. It made no sense to me why I was that angry, but it went away after quitting... I was seriously afraid to kill somebody if I would continue taking it.

I got like that on Ritalin & quit stims for 10 years.

After that 10, I tried amphetamine which blew holes in my persistent brain fog. I went on Adderall and (as we've often heard) it changed my life.

I'm not advocating you change a regimen that is obviously working for you. I'm just adding another possible plotline to that same story.

I was on prozac with adderall and I have uncontrollable anger. I immediately got off of it. The problem might be with adderall or the mixture (if you're taking other meds).

> Some people have problems with off brands of XR (extended release) that has a different formulation. There's no standardization on the XR process and I think it's vendor specific.

“Aderall” is a mixture of dextroamphetamine and levoamphetamine, in a 3:1 ratio. Unlike some other drugs, both enantiomers have a therapeutic effect, but slightly different effects on the brain.

If one takes pure dextroamphetamine (“Dexedrine”) instead, that is also available as an inactive prodrug lisdexamfetamine (“Vyvanse”). This is different from an XR formulation, in that the drug is absorbed immediately, but lisdexamfetamine itself has no effect on the brain. However, enzymes in your red blood cells gradually convert the lisdexamfetamine to dexamphetamine. The advantage of this, is unlike an XR formulation, there should be no difference between different manufacturers.

I’m currently switching to Vyvanse after 10+ years using adderall. There is no generic formulation (at least in the us) because it came to market in 2007. I’ve had several issues with inconsistent adderall from various generic manufacturers and that issue simply isn’t possible right now with Vyvanse. The downside is, it’s $400 a month without insurance, and $100 a month with good insurance.

Because it’s basically dextroamphetamine with a lysine molecule taped on, the psychoactive effects are really similar, but I’d describe it as cleaner if that makes sense. The “killer feature” of the enzymatic release is it’s basically a fixed timing, whereas with XR formulations of Adderall you have a 50/50 blend of immediate and delayed release 3:1 amphetamines. I believe you are correct, it’s not standardized. This, combined with the acids / bases both hurting overall blood levels (think grapefruit juice) means you just have a wildly inconsistent time over long term use of the medicine. For example, I’ve had pharmacies change generics on me without saying anything, I’ve had an inability to get my preferred generics, and I’ve had days where it’s felt like I took nothing at all. The worst are Nuvo and Mallinckrodt in my experience (IR 10mg 2x/day).

I’ve only been using Vyvanse for a week or so, but I can say it’s a marked improvement for me and the lack of a generic is a huge boon with regards to consistency.

> Vyvanse. The downside is, it’s $400 a month without insurance, and $100 a month with good insurance.

Here in Australia, one month supply (30 tablets) costs 30 USD. The Australian government subsidises prescriptions for all Australian citizens and permanent residents. I believe the actual cost, prior to the subsidy, is around 85 USD. The government negotiates prices with the pharmaceutical manufacturers, and the prices it negotiates are generally less than those that US insurers pay. Manufacturers generally accept less revenue for the Australian market, since if they can't get it subsidised by the Australian government it becomes quite difficult to sell it here.

Here are the prices the NHS has to pay.

https://bnf.nice.org.uk/medicinal-forms/lisdexamfetamine-mes...

28 * 20mg = £54.62

28 * 30mg = £58.24

28 * 40mg = £62.82

28 * 50mg = £68.60

They have a coupon, just so you know. I believe it’s just a form on their website. It brings to copay down considerably.

Do you take the XR version or do you take regular adderall? I've taken regular adderall on and off for the last 10 years. It helped me so much in the past but I started to feel very fatigued by it. These days I have an extremely difficult time focusing and have been contemplating going back on it.

>Adderall totally changed that. I'm able to focus on tasks long term AND even if something bad happens in my life I'm able to keep right on track

That sounds amazing. I can't even imagine that. I've just been diagnosed at 32 this year. Been on Ritalin for a few months but it doesn't seem to make a difference. Maybe 3% better. Things going bad still derails me significantly.

They're fairly conservative with meds in my neck of the woods, but I'm going to persist with my doctor to try them all to find what works.

The struggle to push through actually going through all the phone calls, emails and appointments necessary to get to that point is very un-ADHD friendly. So many times I considered just to give up and forget about it.

I have a friend that I’m positive has ADD. He agrees with me it’s a possibility but it stops there. He was even given stimulants by someone but he hasn’t tried them. He’s not opposed to it, but he’s so bad he never gets around to popping that pill. Actually setting up a doctor appointment is never going to happen.

He’s 33 and has been in college since graduating high school and still doesn’t have a degree, and he’s actually quite intelligent.

Reply on news.ycombinator.com