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Comment by ThrustVectoring | Hacker News Reader

Not surprised at all that caffeine helps. ADHD is, bar none, the mental health diagnosis most amenable to medication. Specifically, stimulant therapy. There's no principled distinction between self-medicating and prescriptions here, other than various legal risks, costs, and side effect profiles. Caffeine is particularly poorly suited to this due to adaptation and anxiety, but it's certainly something, especially if you aren't a regular user. Amphetamine is the first-line treatment choice for a reason, and it makes a night-and-day difference tbh.

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Coffee consumption was actually one of the questions that I was asked when my therapist first suspected that I had ADHD. I used to drink 5+ cups per day (especially workdays) while feeling fairly little effect from it. I'm now on medication which works an order of magnitude better for managing my symptoms, and I rarely drink more than 1 cup of coffee per day.

It's also worth noting that ADHD often comes with other mental health comorbidities; in my case, it exacerbated my depression. I would often fall into a spiral of inability to focus -> feeling bad about myself for not completing work that I was generally more than capable of doing -> even less ability to focus. I still have depression, but starting on ADHD medication all-but-removed my most frequent trigger.

> I would often fall into a spiral of inability to focus -> feeling bad about myself for not completing work that I was generally more than capable of doing -> even less ability to focus. I still have depression, but starting on ADHD medication all-but-removed my most frequent trigger.

I had the same issue!

I told my prescribing doctor this same thing and she trusted me enough to try out Adderall before SSRIs again. Turns out my hypothesis of my depression + anxiety largely being tied to my sense of productivity was right.

After going in for an EKG check-up on orders of the prescribing doctor, I found a fairly benign heart issue that the cardiologist believes may be the cause of my "panic attacks" (eg: my attacks may be heart racing -> panic, not panic -> heart racing!)

All of that from just treating "I feel bad because I get nothing done".

is it normal to get an EKG in relation to ADHD medication? I'm in your boat too. I've tried antidepressants with no results so I'm going to see a doctor about ADHD this time.

>is it normal to get an EKG in relation to ADHD medication?

Not sure. My provider asked me to get one done. I talked to the cardiologist about this and she didn't seem surprised it was requested nor that I was the first to get it done.

> Coffee consumption was actually one of the questions that I was asked when my therapist first suspected that I had ADHD. I used to drink 5+ cups per day (especially workdays) while feeling fairly little effect from it.

Did you get a big boost when you first started with it that reduced as you developed tolerance with habitual use?

I've always been pretty careful with caffeine consumption in order to avoid tolerance, because I didn't want to get into a state where all it did was boost me back to my "normal" (i.e. feeling crappy until I got my coffee, and having to use increasing amounts to get past my baseline).

Not really. Even when I first started drinking coffee (around high school) I never got much of a boost from it. I think your caution makes sense for folks with neurotypical brains, but even now (drinking 0-1 cups per day) I drink it for the flavor and/or social aspects, not because it does much for my energy or productivity.

I would down an energy drink when needing to do long drives and would have a calm, almost euphoric, feeling. Definitely not stimulating.

Similar to the feeling (although much weaker) hydrocodone gave me after I had oral surgery.

What's the comparative stimulant power between black tea and coffee?

I've been toying with the notion that I may be having an undiagnosed ADHD for a while now (I've noticed that about 70% of the stuff in any ADHD thread on HN, like this here, tends to reflect my life or at least resonate with me...). I became more confident of that when, at one point recently, I realized - hey, I'm drinking some 10+ cups of black tea every day, and I did that since being single-digit years old. Turns out I may have been unconsciously self-medicating for as long as I remember.

BTW. I suffered from the same type of spiral you described in the past. I've managed to mostly overcome it for now, though I took it from the other end - I've manged to minimize "feeling bad about myself for not completing work that I was generally more than capable of doing", to the point of preventing the positive feedback loop. I wish I could do something about the focus part, though.

Google tells me that coffee has about twice as much caffeine as black tea (depending on the blend) so your 10+ cups of tea are probably similar to my previous 5+ cups of coffee. Obviously I'm not a doctor and I can't diagnose anyone over the internet, but if you're drinking that much and it doesn't have you wired or give you trouble sleeping then you might consider talking with your doctor about ADHD.

I unknowingly self-medicated with ludicrous amounts of coffee before my diagnosis, but my tolerance got way too high.

After that, realizing that my preferred decongestant was not only helping my cold symptoms, but also allowing me to pay attention when people were talking and complete plans in a "this seems like that thing other people are really good at, but I'm not" kind of way... that was a major tell.

What decongestant was that? Amphetamines originally entered the market as decongestants, and it was the observation that these drugs allowed unruly kids to focus that lead to modern ADHD medication.

> After that, realizing that my preferred decongestant was not only helping my cold symptoms, but also allowing me to pay attention when people were talking and complete plans in a "this seems like that thing other people are really good at, but I'm not" kind of way... that was a major tell.

Interesting. Was it pseudoephedrine? I took Allegra-D every day in high school and college to manage allergies as wells as colds and sinus infections. (I hear that's not advisable, but I didn't know any better then, and somehow my allergist didn't either.) I wonder if it was helping me concentrate also.

I've never been diagnosed with ADHD, but many of the things people are describing here are familiar. Overall I've been pretty successful in life despite this, but I've had my ups and downs. The pandemic has been a down; I'm really struggling with concentration, so much so that I left my job and am taking a sabbatical before finding another. There are certainly valid reasons it's been hard (e.g., I have two young kids, went entirely without daycare for a while, and am helping my son with online kindergarten now) but they seem to affect me much more than my wife, whether that's due to undiagnosed ADHD, anxiety, the different natures of our work, burn-out, or some other factor.

Yes, but in the long run amphetamines will do significant damage to your health.

Only if abused at high doses. I was recently diagnosed with ADD and the adderall XR is incredibly helpful, and at my 10mg dose on an “as needed” basis (since I don’t need productivity every day) I’m not concerned at all.

How long have you been taking it? The cracks will show years down the road, not initially.

Long term studies on ADHD patients do not support this hypothesis.

This is not evidence-based.

Curious if you have any sources for this? I have heard this before and struggled to find data that backs it up.

I have heard it can be bad for oral health due to dehydration. Not sure how much of that ends up being a feeling versus physically needing water, and how dehydration affects oral health, or exactly how I would connect all of the dots there (or if I even should attempt it), but it seems reasonable.

> Not sure how much of that ends up being a feeling versus physically needing water

it does dry out your oral/nasal cavity. It can cause your body to produce mucus to compensate. I commonly feel like swallowing is slow as if there is a thin layer of mucus lining my throat. Even had yellow mucus drip out of my nose as if it were a nose bleed (happened 3-4 occasions), which comes from having a sinus infection.

This is one of the reasons I switch to micro-dosing on an empty stomach and supplementing with coffee to limit exposure to amphetamines.

It reduces saliva production. Saliva helps play a protective role in terms of oral health in basically all aspects, from my understanding.

It's possible for it to lead to increased clenching/grinding of teeth.

With that said....a decent diet and doing all the things you're supposed to be doing anyway in terms of oral hygiene and you ought to be fine. It's not a "you're going to ruin your mouth", it's a "pay more attention to this".

Been taking Adderall XR for >10 years, no cavities or other dental concerns personally speaking.

I personally took it for a long time, have a few pharmacists in my family. General life experience along with many examples witnessed around me lead me to believe that there is no free lunch. The focus you get comes at a price

A pharmacist does not equal a neuroscientist studying effects of long-term stimulant use on developing early onset neurodegenerative disease in any way, shape, or form. Sorry but you need to look at meta-analyses on on the topic and use that as a reference to prove anything to HN crowd at a minimum when making these bold unsubstantiated fear-mongering claims.

Yes but they interact with the same customers over long periods of time. I hate to tell you, but people can come to conclusions about the world. Its not a walled garden. I can see with my own two eyes what happens.

Go ahead and take legal cocaine though, hope your post helps you sleep at night

No need to be rude. Just because you see something doesn't mean your getting the whole picture.

Do you know their entire medical history? How severe the ADHD is? Any other issues they are treating or not treating? If you can point to a study to back up what you are saying then by all means go for it. Otherwise all you have is anecdotal evidence and pretty weak evidence at that.

Correlation =\ causation and exactly what objective conclusion can you draw from a ~5 minute encounter every month as a pharmacist seeing random customers who can go to any pharmacy to get their meds?

I get a new pharmacist every time I fill a script and I never share one iota of my diagnoses with them, they just fill the Rx and advise on contraindications and unusual doses they see.

Can you see into a person's brain with your own 'two eyes' as well? A neuroscientist can actually see our neural activity with fMRI and other tools to study brain science unlike your pharmacist buddies and yourself talking to random customers for 5 minutes in a grocery store.

I do 3-5mg IR so it has minimum impact on health but take on an empty stomach so its effective. My goal is to feel it just enough to get a little help.

Leaving ADHD untreated can do significant damage to your health, too.

This is something people just don't appreciate at all. ADHD is shortens life expectancy by 12 years on average. I imagine it runs the gamut from addiction problems, accidents, suicide, obesity, ignoring health problems until they snowball etc.

I'm certainly guilty of that last one. Since getting diagnosed I've been making a point to never leave a health problem ignored. Sure, it might take 6 months to a year for me to eventually book the appointment, but I'm getting them under control at my own pace.

[Citation needed]

Why would they cite when they can just as easily insinuate?

I am not professionally employable without ADHD medication. I'm willing to that risk for roughly $3m in career earnings.

But just think of all those extra years you could have living in a cardboard box and feeling like a major disappointment! Or missing out on being completely spaced out, depressed, or anxious during major life events in your family!

Except that untreated ADHD shortens life span by 12 years on average, soooooooo there's that.

And even having a family. Doubt I would without the medication. Relationships were impossible before.

Have any sources on neurodegenerative links between ADHD and longterm stimulant use? I think I saw a studying linking increased risk to parkinsons? This terrifies me.

If there is such an association, how would a study differentiate between the underlying condition causing the increased risk, and the medication itself?

Edit: smokers have reduced rates of Parkinson's disease, and nicotine is a stimulant.

I can see how on the outside that might be a concern. How many awful years would you be willing to trade for good years? 2:1? 5:1? 10:1?

Consider

Lifetime Remaining x Quality of Life

If QoL is negative but can be switched to positive at some cost of LR it's not a hard deal to make. Especially in a world with car accidents and deadly diseases.

And that's not even accounting for the beneficial effects on friends/family/society.

Ah well, got to die of something.

If taking Vyvanse most days knocks a few years off my lifespan, it doesn't matter. I'm going to die anyway, eventually.

As we all are, ADHD-medicated or not.

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