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Comment by throwawaaarrgh | Hacker News Reader

I diagnosed when I was like... 8 years old. From then to 17 I was on various meds, finally gave them all up. So for about 22 years I've coped with ADHD without meds. I am a Staff Engineer and make a good living, respected in my field.

Regardless of anything else, I think the key thing to remember about ADHD is that you do not need to be a high-performing human being, at all, in life. You will forget things and get distracted and not get as much done. So what. You are still intelligent and caring and dedicated and responsible and a hard worker. You probably put more effort in (when you get around to it) than many others without the condition. And you will do about as well as everyone else, on average. And this is fine. Do not put pressure on yourself to live up to what someone else can do. Only do what you can do, in your time, and be at peace.

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I was diagnosed when I was six, and, like you, I dropped all meds at 17. Recently (as in, this year) through a combination of therapy and introspection, I realized that while indeed I was able to have a successful life, career, relationships without the medication, and that, yes, my coping mechanisms were satisfactory, I was

punching myself in the face for no reason

Last month I saw a psychiatrist and got a prescription for stimulant medication for the first time in 20 years. After a week I had to sit down and just cry: stuff which was difficult or stressful was just simple, and at the end of the day I have so much more energy to do things, to be present, to live my life. The medication is an aid, a crutch, sure, and I don't need it, but it makes my life better, easier, less stressful and less tiring.

Why are you punching yourself in the face for no reason?

While meds can definitely help, one month in is way too early to know if the change is long-term positive. This is especially true with stimulant medications.

> one month in is way too early to know if the change is long-term positive. This is especially true with stimulant medications.

Agree. It's important to remind people that the effects of the first few weeks aren't like the effects for the next 10-50 years.

It's especially concerning when people say the meds give them "more energy to do things" because that's more of a side effect that goes away after a while. The focus-enhancing effect is separate from the energizing/euphoric side effect that people experience in the first few weeks.

I’ve never experienced more energy to do things nor euphoria from my stimulant meds. They make me less anxious and allow me to muster executive function that I struggle with otherwise. Not because I’m more focused or productive or whatever else people ascribe to the drug, because I’m less overwhelmed by the world that’s loud and fast and bright and complicated and dangerous. My brain and the world around me are quieter and more reasonable.

Same here. If anything I actually feel a bit tired when they kick in throughout the day.

Same, I feel like I could fall asleep, but I know I couldn't if I tried.

Have you tried? I can take a nap no problem on them. I would even say that they greatly help me falling asleep!

I have tried, and I cannot. They help me fall asleep if I time the crash correctly, but other than I will have trouble falling asleep. If I stop taking them, then I have trouble falling asleep, so I am kind of in a catch-22 lol.

You might be surprised. My first prescribing doctor emphasized that an appropriate dosage wouldn’t disrupt sleep and might even improve ability to get to sleep. He wasn’t right about several other things, but on this he was exactly right. So much so that early on I took a morning nap about an hour after meds kicked in because I couldn’t stay awake. Now with a higher dose I don’t get so lethargic, but I certainly could sleep when the meds are effective, more than I ever could during daytime before.

I guess I am on the wrong dosage then, because when they are in full effect, there is no way I could fall asleep. Stimulants do wonders for my hyperactivity e.g. I turn from Ace Ventura to being able to sit in an office. However, I would never say they calm me down in a mental sense. In fact, they kind of tend to do the opposite sometimes.

> They make me less anxious

High-dose pyridoxine as an 'anti-stress' strategy

https://pubmed.ncbi.nlm.nih.gov/10859691/

Anxiolytic-like effect of pyridoxine in mice by elevated plus maze and light and dark box: Evidence for the involvement of GABAergic and NO-sGC-cGMP pathway

https://www.sciencedirect.com/science/article/abs/pii/S00913...

Same here.

Your description perfectly matches my experience.

“more energy to do things” is directly correlated to the level of dopamine ADHD medication augments in our brains

I disagree with this. For me, the energy is because I have to use less energy doing basic day to day shit. Unmedicated, it takes far more effort and work, and leaves less energy for later tasks.

It’s amphetamine. The energy is from the amphetamine. The mechanism of action (norepinephrine and dopamine reputable inhibition) isn’t far from that of cocaine or methamphetamine. Let’s be real here. Amphetamine is known to skew one’s self assessment of their performance while on the drug.

not everyone on ADHD medication is on amphetamine. methylphenidate and clonidine are other treatment options.

But it's not only perception. If at the end of the day you have done things as opposed to not done things, then the performance improvement is real.

The self-assessment is less to do with how efficient I was, and more based on the fact I get things done sooner, because I don't fuck around and get distracted every few minutes. Completing a task significantly sooner/earlier, because I managed to stay on task has a real impact on the energy and time I have to spend on other tasks.

If I only get 80% of the stuff I need to get done before bedtime, there's no chance for me to do other. If I get the stuff I need to get done well before bedtime, there's time left for other things. Skewed self-assessment isn't really a factor in that.

This is the truth.

And by the way, the effect on dopamine is secondary. ADHD meds work because they affect glutamate leveles. You all do not have low Dopamine, you have low glutamate.

https://www.nature.com/articles/nn0301_275

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966039/

https://www.brown.edu/news/2018-03-12/glutamate

And you all probably just need B6: https://pubmed.ncbi.nlm.nih.gov/24321736/

The active form of B6 is the enzyme cofactor used by AADC:

https://en.wikipedia.org/wiki/Aromatic_L-amino_acid_decarbox...

AADC is an enzyme in the path that converts amino acids into dopamine and PEA/NMPEA (see "biosynthetic pathways" in above link), the latter of which is an endogenous structural isomer of amphetamine.

You're not really making a strong case that this isn't about dopamine or that amphetamine is the wrong thing for it.

Moreover, B6 will make more of these things up until the point that it's no longer the rate limiter in their production, if it ever was. (The rate limiting step for dopamine is ordinarily AAAH converting Tyrosine into L-DOPA). And if you hit a different rate limiter before you have enough dopamine or PEA/NMPEA, what then?

Important note: This is also a thing:

https://en.wikipedia.org/wiki/Megavitamin-B6_syndrome

> Megavitamin-B6 syndrome has been reported in doses as low as 24 mg/day.

Meanwhile people sell 500mg B6 tablets and it has a half life of like a month. Ask your doctor etc etc.

P5P is also the cofactor for GAD1 an GAD2:

https://www.uniprot.org/uniprotkb/Q99259/entry

https://www.researchgate.net/publication/340492849_The_Gluta...

I did not say it is not about dopamine, but it is, at a deeper level, about glutamate. Which is why coffee works so well for ADHD because the stimulant action from caffeine is produced by glutamate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700297/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166758/

Regardless, here is so much evidence that B6 plays a large role in ADHD and what, you all just ignore it?

> Which is why coffee works so well for ADHD because the stimulant action from caffeine is produced by glutamate.

Caffeine also antagonizes adenosine receptors which modulate dopamine. (Caffeine is complicated. Nicotine too.)

> Regardless, here is so much evidence that B6 plays a large role in ADHD and what, you all just ignore it?

The problem is it's the same kind of thing as saying that eating more reduces nutrient deficiencies. It might be more effective than placebo. If you're deficient in one thing and you get more of everything, you get more of that. It might even be the right solution if your underlying problem is actually that you're not eating enough.

But you want the solution that solves the problem as effectively and as narrowly as possible. Unless your underlying problem is actually a B6 deficiency, it's completely plausible that B6 could be more effective than placebo and less effective than Adderall. At which point nobody wants to hear you telling them to give up their Adderall for B6.

zrm, FollowingTheDao, can I just say that I massively appreciate you for sharing your thoughts on this?

The fact that I can read up on this as a civilian compared to your expert level knowledge is something I am deeply grateful for. Truly!

Leading experts on ADHD do not say that coffee works well for ADHD

> It’s amphetamine. The energy is from the amphetamine.

Energy still comes from food, and if you forget to eat on stimulants your body will eventually catch up with you.

Like coffee, stimulants let you better tap into that energy.

> The mechanism of action (norepinephrine and dopamine reputable inhibition) isn’t far from that of cocaine or methamphetamine.

Yep, they’re all stimulants. ADHD meds however, are manufactured in very controlled conditions, and taken in specific doses. Street drugs are more variable in quality, ratios, ingredients and strengths, and so not relevant to the treatment of ADHD.

Methamphetamine is a legitimate treatment for the most severe ADHD cases, it’s often a last resort. It’s sold as Desoxyn. It’s rarely used, but it _is used legally and successfully_.

> Let’s be real here. Amphetamine is known to skew one’s self assessment of their performance while on the drug.

If you don’t need it, stimulants are going to have a different effect.

People with ADHD are in my experience, going to be able to self-assess performance on their meds better than off them.

Don’t assume one experience is universal, especially when we’re talking about neurodiversity. Even among those with ADHD, experiences are not universal. We may rhyme, but we don’t always repeat.

Yep this is common.

Imagine doing the dishes. Unmedicated, thats 2 or 3 tasks. Each with a high failure rate, and high cognitive cost.

1. Stop what you’re currently doing. 2. Decide you next task will be to wash the dishes. 3. Wash dishes.

The spoon theory [0] covers this concept well, and can be a useful tool.

> The spoon theory[a] is a metaphor describing the amount of physical and/or mental energy that a person has available for daily activities and tasks, and how it can become limited.

https://en.wikipedia.org/wiki/Spoon_theory

I knew day one. Three years have continuously confirmed what I knew day one. I wish I hadn’t been so afraid of meds that would help me.

It’s not on you. An enormous amount of stigma surrounds the use of stimulant medication, even if it’s one of the oldest and most studied psychiatric meds there is. And the stigma is continuously reinforced by all the people who don’t need it abusing the meds.

Sure, there’s also some risk for patients using them properly, but for them it does not compare to the sheer benefits provided by the meds.

You are not deficient in stimulants. So using them is not the answer.

Instead, look to nutrition.

https://pubmed.ncbi.nlm.nih.gov/24321736/

That is an interesting paper, as is the co-morbidity of ADHD with epilepsy that they cite. It's also hopeful for some people suffering from ADHD because it is suggestive of the possibility of a more complete treatment for some.

However there's a general understanding of ADHD (and related disorders such as ASD) as a spectrum of conditions with multiple contributing factors. Depending on the person ADHD will manifest with more or less hyperactivity, distractability, working memory issues, and lacking emotional regulation (among other things). Different causes combine to give a somewhat amorphous disorder with a range of common symptoms.

So adding a new treatment with fewer downsides (because stimulants can have a few) is great, especially as it might treat aspects of the disorder that aren't treated by stimulants. But this doesn't mean stimulants won't still be relevant in the future.

There's there's also plenty of research showing specific dopamine receptor dysregulations as contributing to ADHD. See for example https://www.researchgate.net/publication/364120700_Dopamine_...

So unless the research also shows that this is caused by pyridoxine metabolism problems, these hypotheses can both hold at the same time.

Picking some paper that talks about different causes doesn't mean other causes aren't still relevant. It will probably be decades before we can definitively rule out contributing factors.

PS It's generalizations like yours that are very stigmatizing towards stimulant use. We already know many people benefit from them enormously and significant numbers are not getting or taking them due to stigma.

You are making a complicated when it’s effing simple.

Just try taking high dose P5P.

And probably zinc:

https://www.nature.com/articles/s41598-021-94124-5

If you knew the metabolic pathways thus would be as clear as day. We need enzymes to make neurotransmitter and those enzymes need cofactors to work.

These are the cofactors.

If only things were generally so simple. While I'm all for more possible causes that are more easily treated, I’d hardly call this convincing evidence that all we need to treat is zinc deficiencies. But time will tell, as I hope these kinds of research continue.

But did you try it????

Yes, didn't work, stop acting like an asshole. It is very common to check for deficiencies, if people with ADHD had it then likely they wouldn't be prescribed meds before the deficiency is fixed in the first place, you questioning others like this is just making their life worse.

One, I do not beleive you.

Two, If you did, how much did you take? And what type? Pyridoxine or Pyridoxal-Phosphate? For how long? Were you tested for a B6 defieicny, high homocysteine?

Three, it is in NO WAY common for deficiencies to be tested for mood disorders and even less common for a doctor nevermind a psychiatrist to do anything about it.

And calling me an asshole when I am advocating for better health is making everyone's life worse. I do not mind if people choose to take stimulants, but they are not being advised that there are other options.

> One, I do not beleive you.

That makes you an asshole.

> Three, it is in NO WAY common for deficiencies to be tested for mood disorders and even less common for a doctor nevermind a psychiatrist to do anything about it.

Why do you believe this? It is easy and cheap to do a blood test for deficiencies, I have done that many time and they found I lacked nothing. Do you have any evidence it isn't common to check for deficiencies, because to me it seems like that is one of the first thing they check.

> Why do you believe this?

Because I have worked with health care professionals for 20 years and they do not test for nutritional deficiencies unless you ask/beg them to. This is even more true with psychiatrists. I am advocating right now for a woman with a serum B6 deficiency that her doctor will not address. She has an actual serum B6 deficiency and anemia and depression and her dopctor thinks it is not importnat. That is why.

> It is easy and cheap to do a blood test for deficiencies, I have done that many time and they found I lacked nothing.

There are deficiencies and functional deficiencies. Plus there is serum B6 and RBC B6. Have you had your RBC B6 tested? Nope.

And Homocysteine levels will reveal more than serum B6.

And I do not believe you because you did not answer "how much did you take? And what type? Pyridoxine or Pyridoxal-Phosphate? For how long? Were you tested for a B6 defieicny, high homocysteine?"

The pills says just vitamin B6, 1.4mg, more than a year. For zinc I eat way more than I need since I eat mostly vegetarian and legumes contains plenty of it.

Then reason you are an asshole is that you are asking questions that takes a lot of work to answer since most wont know the answer to them on the spot. That is a very common tactic when you try to push your pet theory on others, but you should know that nobody thinks you won the argument when you do that they will just see you as an asshole. Even if you are doing it to be nice, you will be seen as an asshole, so please stop doing that.

Edit: Another part of the label says its this, didn't notice it at first:

https://pubchem.ncbi.nlm.nih.gov/compound/Pyridoxine-hydroch...

THANK YOU for answering. See, this is what I mean. 1.4mg? That is nothing. The dose that use in testing are 50 to 100mg. And you should be taking P5P.

People I know take 30 - 60mg of P5P to feel the effects.

You were not taking high dose B6, just the RDA, and that will not do anything. And it will not correct a deficiency.

You think it takes a lot of work to answer? What about all the work I do looking into this and asking? For who? For you. Instead of calling me an asshole understand that I am helping you, for free, unlike your doctors.

So you cannot say taking B6 did not work for you.

Treatment with stimulants doesn’t treat deficiencies of stimulants. This is immediately obvious with patients who actually benefit from the meds, because they’re generally not stimulated by them. Treatment with many chemicals doesn’t treat deficiencies of those chemicals. In the case of stimulants for ADHD, they help regulate dopamine and norepinephrine intake. In practical terms, results of successful treatment include improved management of executive function, reduced social and sensory stress, and healthier sleep patterns. I can’t say what anyone else’s answer is, but stimulants saved my life because the impact of the things they helped me address were life threatening. Using stimulants as prescribed by my doctor was definitely an answer for me, and I am grateful for the life I kept intact because of that.

Medications saved my life as well. That is not the point. The point is do you keep taking them and not look for the nutritional answer to your problem.

If a B6 deficiency cured your ADHD would you still want to take stimulants?

> If a B6 deficiency cured your ADHD would you still want to take stimulants?

Assuming you mean “if treating a B6 deficiency”, and assuming I had strong expectations that I could expect a cure, I’d consider giving it a try. I’d be cautious about any transition, as it could mean either significant side effects while still taking stimulants, or significant regression without them if the B6 treatment doesn’t work as hoped.

But I don’t even have a strong expectation that I could expect equivalent or better management. The study you linked was conducted with children, and the conclusions based on observations of children’s behavior. Maybe that’s a good indicator that it’s helpful, but I have no clue. I wasn’t diagnosed as a child, my ADHD was noticeable to one adult in my adulthood enough to mention it, and my experienced symptoms are much closer to autism (again as experienced by adults, not as behavior observed in children, although those diverge much less for me). But the things mentioned improving in the study are very much not what I’ve struggled with having ADHD as an adult, nor things for which I sought diagnosis or treatment.

The way diagnosis and treatment saved my life was helping me manage crippling anxiety and helping me make chronic depression manageable. It’s possible that exploring a nutritional deficiency none of my doctors have found with supplements no one has studied for adult ADHD… it’s possible that would benefit me. It’s a very high risk proposition given I have meds which work for me and which present no side effects so negative I’d reconsider.

Moreover I haven’t had a single medical professional raise this possibility and with good reason. My treatment is working. Even if an alternative treatment might be promising… why would any responsible doctor propose disrupting a persistently successful treatment plan?

I don’t know why you’re so motivated to disabuse me of my effective medication, but you’ll have to do better than showing a study which made children more tolerable. I credit my life to the meds that I take now, and there’s very very little I could fault them for. Asking me to reconsider that is asking an AWFUL lot.

You make me assumption that I’m trying to disabuse you of taking your medication. I’m not. I don’t care, take it if you want. But by not being open to other methods of treatment, you aredisabusing people of that choice.

You go on and on about how you don’t think it would work, but have you ever had your B6 level tested never mind your red blood cell B6 levels?

I get it, you don’t care, you found a treatment that works, even though that treatment is not curing the underlying disorder. It’s just a treatment. I get it it works, until it doesn’t. I’ve been working with people with new disorders for 25 years and I’ve seen it over and over again.

So I’m not asking you to stop taking anything I’m asking you to keep an open mind which you seem to not be able to do. That’s OK.

Responding to both your comments in one.

> I mean you did not even bother to search for another paper.

I most certainly did. The search results I got were primarily ads, and few clinical studies I found were, like the one you linked, far less bold in the results they claimed than your claim of a “cure”.

> You make me assumption that I’m trying to disabuse you of taking your medication. I’m not. I don’t care, take it if you want. But by not being open to other methods of treatment, you aredisabusing people of that choice.

Excuse me, how?

> You go on and on about how you don’t think it would work

The studies themselves don’t support your claim of a cure.

> but have you ever had your B6 level tested never mind your red blood cell B6 levels?

No, I haven’t been to a doctor since some person on the internet mentioned this a few days ago. I did have a scheduled psychiatrist appointment in that time, but had to reschedule because il out of state for a family medical emergency.

> I get it, you don’t care

I don’t know where you got that impression. I took the time to reply thoughtfully and, despite your impressions otherwise, to look for other studies more pertinent to my own experience. In my thoughtful response I expressed caution and the reasons for that caution, which you completely ignored.

> you found a treatment that works, even though that treatment is not curing the underlying disorder

That’s right. And it’s important. It’s the reason I’m still alive. I’m cautious about upsetting treatment that works because I would very much like to remain alive.

> I’ve been working with people with new disorders for 25 years and I’ve seen it over and over again.

I don’t know if you mean the disorder is new in the world (it’s not) or in me (it’s also not).

> So I’m not asking you to stop taking anything I’m asking you to keep an open mind which you seem to not be able to do.

I don’t know where you got that impression. An open mind isn’t characterized by immediately accepting life changing “solutions” proposed by random people on the internet, regardless of whether they cite medical studies. I expressed an open mind, I said I’d consider giving it a try.

> That’s OK.

In your own words, I don’t believe you. You have talked past me and several others in this thread, and you don’t seem to want to accept anything other than a revelation that what I need is vitamins rather than the treatment that my doctor prescribes. You have even suggested that I’m preventing other people from treatment (or a “cure”) you think more appropriate simply because I haven’t dropped everything to try your preferred treatment. If this is how you “work with” other people who are hoping to treat their ADHD effectively, god help them. And it has nothing to do with the particular treatment, I felt the same way about my first psychiatrist who was just as zealous about stimulant treatment.

> The search results I got were primarily ads..

Maybe use PubMed and not google?

> you don’t seem to want to accept anything other than a revelation that what I need is vitamins rather than the treatment that my doctor prescribes.

I NEVER SAID THAT ONCE. Take stimulants if you want, but just because that is your choice do you need to be so outraged by the idea that B6 might work just as well?

>> But by not being open to other methods of treatment, you are disabusing people of that choice.

> Excuse me, how?

YOU: Moreover I haven’t had a single medical professional raise this possibility and with good reason.

You: But I don’t even have a strong expectation that I could expect equivalent or better management.

You: I don’t believe you.

This negative stance only feeds on this idea that medications are the only choice, the only answer, and that nutrition never works becasue "there are no studies" or "My doctor did not recommend it".

You are just shooting down the idea that this might be the root of the issue. And yet you have never even had you B6 levels tested. That is just willful ignorance. Have you worked in Nutritional Genomics? Do you even know why treating a B6 deficiency might be important not just for your behavior but your over all health? If you have a B6 deficiency and take stimulants to cover up the symptoms, what about all the other enzymes that need B6 to function?

Over and over they find B6 deficiency in ADHD. There will be no studies showing the efficacy of B6 because there is no funding for products that do not make a profit. You are on stimulants because they work and they are profitable.

Next thing they will get you to take will be Metadoxine. Ha!

https://pubmed.ncbi.nlm.nih.gov/25295645/

https://pubmed.ncbi.nlm.nih.gov/23290324/

Hmmmm...I wonder why they were trying out Metadoxine for ADHD, and wonder why it failed...oh....Metadoxine, also known as pyridoxine-pyrrolidone carboxylate. So they made a funked up version of B6? Why would all these smart science people want to make a funked up version of B6 if B6 was not linked to ADHD?

Do you think maybe they know something they do not want you to know? And maybe that is because ADHD meds brings in about $20 Billion for these companies?

Have you thought you do not want to hear anything but stimulants are the only answer for you? And that I am not talking past you but that there is no one there who wants to listen?

> so outraged

I normally hate to quote this but it fits: calmer than you are.

> You are just shooting down the idea that this might be the root of the issue. And yet you have never even had you B6 levels tested. That is just willful ignorance.

My gosh, you’re being a jerk. I haven’t had my B6 levels tested in the last few days because it’s in the last few days and my medical appointment was canceled because I’m out of state for a family medical emergency! Have you thought about the fact that I literally physically cannot meet your expectations of an open mind and that your expectations are totally unreasonable?

> I haven’t had my B6 levels tested in the last few days because it’s in the last few days

I was asking if you had your B6 levels tested ever, not in the last few days.

You’re reading what I wrote much more dramatically than it is implied. The fact you think I am really telling you to run out right now and get your B6 tested is distorted.

I mean you did not even bother to search for another paper. And there are more than these two.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153567/

I’m exactly the same. I knew 40m in, right when it started to take effect. It was night and day. Like I’d just walked from a raging thunderstorm into a quiet sunny meadow, but I’d thought that I was in a quiet meadow my whole life. It was profound.

There was a decade between me first seriously suspecting it, and that.

Information about it is much easier to come by now, and more people talk openly about it. Without that, I probably would have struggled for much longer.

'Like I’d just walked from a raging thunderstorm into a quiet sunny meadow, but I’d thought that I was in a quiet meadow my whole life. It was profound.'

That is profound. Also says a lot about us as humans. Glad it's not raging anymore

> This is especially true with stimulant medications.

Hard to see how this is "especially true" with stimulants, given they're the rare case of psychiatric meds you can get on and off safely at any time, and the bulk of the effects appear in hours to days after starting the treatment (and disappear just as fast after cessation). Contrast with e.g. depression treatment, where it takes a month or more before it's clear if the drug even works on you, and which of the bad side effects have a chance of eventually going away.

"Long-term positive" is impossible to know in individual, non-statistical sense, whether it's about stimulant medication, SSRIs, moving to another city, marrying, or starting a family - any of those is going to have cascading impacts on your entire life, and even if you think they're positive after a month/year, who knows, maybe few weeks from now you'll think they were negative. That (otherwise stupid) "Farmer's Son" story has a point here.

> psychiatric meds you can get on and off safely at any time

Maybe you can get off them safely, but not always easily. My alcohol/drug recovery group is filled with people who couldn't easily get off them, like my friend N., who rather than swallowing his medication (Ritalin?), he crushed it & snorted it like cocaine.

> Maybe you can get off them safely, but not always easily.

You're implying addiction, but in the more common case, people with ADHD can be apprehensive about getting off the meds for the same reason people with chronic pain can't easily get off painkillers, or people in general can't easily get off oxygen.

> like my friend N., who rather than swallowing his medication (Ritalin?), he crushed it & snorted it like cocaine

That's just drug use, not ADHD treatment. I wonder what your friend's dose was? Snorting instead of swallowing is massively increasing the absorption rate, but even then, I don't think you can get high like this, if you just do your regular regimen through the nose. But doing a week or month's worth of pills this way at once, I guess sure?

I don't have the data handy, but IIRC the difference in dose size between therapeutic effect and drug abuse that leads to addiction is ~100x.

Is it any surprise people get apprehensive about stopping medication? We don’t ask people to not use prescription glasses or leave their wheelchair at home and expect them to be happy about it, do we?

You keep saying this throughout the thread. These are fundamentally different, as someone with both conditions and both prescriptions.

There is no side-effect to glasses, you can put them on or off completely at-will any moment, and they make a very exact correction to one specific parameter (vision focusing ability).

ADHD meds are imprecise and affect many systems in different ways - some positive and some negative. You can only have them on/off daily. It might affect you differently depending on other factors. And treatment is not without risk.

It’s hard to understand how stopping will affect you due to the imprecision. It’s not as black-and-white as glasses.

Absolutely. And that’s something that any good doctor will discuss and monitor. And generally medication is combined with other treatments like CBT to learn to cope better, because medication doesn’t magically fix people.

But stimulant meds still don’t deserve any more stigma than glasses. For those who take it as part of treatment of a lifelong disability.

Edited to add: Btw, try playing squash or go swimming with kids. Suddenly your glasses aren’t the perfect solution that they may otherwise seem to be and they become yet another tool, like having the kids wearing bright swimming clothes so you can spot them in a crowd.

But you’re right, we’d love for ADHD meds to be as effective and universal as glasses, but they’re not. Probably because ADHD isn’t a single condition, but a spectrum of conditions with some overlap. So expecting a single treatment to take away all symptoms is a fantasy.

Depends on the medication. I've definitely gotten high from my meds while trying to figure out the right dose, and snorting it ups the absorption rate a Lot. Especially w/amphetamines.

Anyways, I'm skeptical of that 100x number. Comparing 5mg of adderall to 50mg, I could easily imagine getting addicted to the euphoria from the latter and spiraling. I can't even imagine 500mg of adderall, that's just an absurd dose.

I could maaaybe imagine that the 50mg dose resulting in a sorta psychological addiction and 500mg being more physiological, but it doesn't really line up with the model I've built from my own experience. Of course, everyone's different

> can't easily get off oxygen.

I’m sorry but this is just beyond silly.

So is telling people who are only functioning thanks to medication that the meds are bad for them and they should try to do without.

Having tried it a few times, you can get pretty high snorting methylphenidate.

You don't even need that much - a 10mg pill crushed and snorted (it will make a few lines) will fuck your shit up.

Its not a particularly fun high though, it comes with compulsive redosing, discomfort (skin crawling), and basically feels like the latter half of a cocaine bender - after the fun has ended but you are now just fiending.

Other fun ways to abuse methylphenidate at low doses include exploiting its synergy with alcohol and prozac to get, again, a rather cocaine like high, but much more enjoyable than just railing lines of the stuff, and lasts a few hours.

As for treatment of ADHD symptoms, personally I found dexamphetamine worked a lot better than methylphenidate for me, but its much harder to get prescribed.

> rather than swallowing his medication (Ritalin?), he crushed it & snorted it like cocaine.

I'm having a hard time pinning this on the meds honestly...

Yeah, that's usually something else. You don't go from taking a therapeutic dose of Ritalin to railing lines of it. The effect profile is different.

Having done exactly that (crushed and snorted Ritalin) in the past. I can't recommend it - its not a very good high.

You might not be aware of this, there are 7 variations of ADHD and half of them are the pysch kind in that you have to up your L-DOPA dose to counter having to take 5-htp. Its the 5-htp that is part of the reason why medical treatments include the pysch drugs and in fact you can get off them.

They do not tell you that part for obvious reasons, but if you find the right doctor to explain the biochemistry of how they work it then becomes obvious.

Rhodiola is MAO inhibitors and so is Ginkgo, while 5-htp is the serotonin intermediate and corresponds to SSIs. Not to say that you need not to be careful, that still is required but with other cofactors consumed you can micro-dose.

Note, due to my understandings of what cofactors I need I do in fact micro dose L-DOPA as some recommend 500mg but I only consume 20mg daily.

Cofactors such as aromatic amino acids to increase tryptophan absorbtion across blood brain barrier including Macca extracts and fenugreek and Phenylanaline .

I say it's especially true with stimulants not because of some perceived safety, but because at the start of taking stimulants you will feel great. This generally wears off within a few weeks and never comes back. The test of whether stimulant medications help you isn't if they help you at the start, it's how you feel about them six months in.

edit: feeling great only applies to some stimulant medications and seems to vary from person to person. Personally, I hated the pharmaceutical stimulant experience but they still helped me. I would be taking meds right now if I could afford it.

I think your question is pretty rude. Different people are different.

GP has a good point in that there's an overall stigma against medication, particularly psychiatric medication, in our society.

People say, medication is an aid, a crutch. Well guess what, when your leg is broken, you kind of need that crutch to move around. There's no shame in using a crutch. And if you lost your leg, or happened to be born without one, then guess what, using crutch for the rest of your life is not anything to be ashamed of, and it's rude to suggest it is.

And OP is stigmatizing not taking it, with violent imagery.

Do what you need to do, don’t make other people feel bad for not doing what you do.

ADHD is much more complicated than a broken leg. This analogy is very liable to fall apart.

If, for example, you've been taught to walk without your leg (or if you have three legs, all left feet, whatever), using a crutch doesn't make much sense.

We can't safely poke someone's head and test their dopamine levels. So we aren't good at differentiating what could potentially be learned cognitive behaviors | brain structure | genetics from hormonal neurology. Hell, these could all be the same thing on so many levels, but it takes only one to mark a meaningful difference.

Point is, different people are different. And it's rude to think you know someone's experience well enough to liken it to "punching yourself in the face".

I'm glad the meds have helped you, and I hope other people try them too if they think they need help.

In many cases you just can't get them. My psych basically told me to just give up my career.

I think you are a bit premature in your assessment. The first month usually works for most people. Later on, you may find that it has no effect, worse, you start developing a dependency. People don't give up medication due to ideals or laziness, many find that the disease is often manageable using less addictive approaches like CBT.

That said, if medications cure you altogether, there's nothing better. But ADHD, unlike other conditions, seems to relapse a lot.

Do you wear glasses? Would you say you have a dependency on them? I know my wife does. So what?

Again with the stigma.

There’s little medical reason to expect stimulant effectiveness to change after the first couple of weeks, the “honeymoon period”, during which the mood lifting effects are most pronounced. It’s also that same effect that is the main attraction for abusers because it can give euphoria in high enough doses. And yes, that mostly goes away.

But other than a possible slight increase in dopamine re-uptake due to a long term increase in dopamine (over what’s initially a dopamine deficiency as far as we know), there’s no long term habituation (as far as we know).

If you feel better without medication, that’s fine, but please don’t guilt others into throwing away their metaphorical glasses.

Are you not aware that dopamine receptor density increases over time with amphetamine use? Amphetamine may be a net positive for some folks despite this, but for others it actually exacerbates the condition over time.

Cite please?

I think it’s a decrease of receptors or an increase of re-uptake. But yes, there have been results pointing in that direction, but as far as I’m aware this is not as clear as that. Who does it affect? Is it seen with abusers or with users of (generally much lower dosed) meds? How much? How does this compare to the dopamine deficiency we see without treatment? Etc. But if you have a good and recent source, I’d love to read it.

You're misunderstanding the action of the medication and the defect in the brain of adhd. Adhd is an abnormal density of dopamine transporter.

Receptor density might increase, but that's negligible in the system compared to the starting density of transporters at therapeutic doses.

I have been wearing glasses against nearsightedness/astigmatism since I am an adult.

I already needed them as teenagers, but my mother was against it, because I should not grow too dependent on them. Because she says if you wear glasses, the eye adjust to the glasses, so you see as bad with the glasses, as you did without glasses. Then you need stronger glasses, and every time you get stronger glasses, they make the eyes worse, until they make you almost blind. The opticians are destroying your eyes on purpose, so they can sell more glasses

I only got glasses as adult because it was mandatory to get a driving license. I actually got an anxiety attack in the driving exam and failed the exam, when I had to put my glasses on because I was still convince they make you blind.

I wonder if I have ADHD, too. I am completely unable to participate in classes, but my grades in exams were good enough that no teacher suggested testing. It is like I have zero attention on anything said in class, but then hyperfocus on reading/writing/programming stuff. Anyways my mother would not have allowed me to go to a psychiatrist, because she think that psychiatry is a scam. The psychiatrists are only trying to get you addicted to drugs and destroy your health on purpose, so they can sell more drugs.

Or it might be because I could not see anything in class. Then I had to stare at something and try to recognize something in the blur, and that was taking away all my attention. But reading things in close range worked fine without glasses. Perhaps degraded sensory input is actually a cause for ADHD. The brain diverts too much processing power on processing sensations, and there is not enough processing power left for the actual task, and it makes any sensation (distraction) appear much more important. I still cannot participate in classes even with glasses

For me, I've been on dexamphetamine sulphate for about five years. I had to have my dose adjusted after about a year, because I experienced what you mentioned (decreased efficacy). Once the dose was increased, the effect became pretty stable though (I'm currently on 45mg a day). I wouldn't say it completely negates my ADHD, but it definitely makes things a lot more manageable.

What did your dose look like at the start? & how did it progress over the 5 years?

I believe it was 30mg (10mg, 3x a day) that I started on. Dosage was adjusted after about a year, when I began to notice the dosage wasn't really having the same effect. Was upped to my current dose that I've been on since then.

One interesting point about stimulant meds: they also help people who don't have the ADHD diagnosis. The black market for stimulants is pretty sizeable, not to mention the legit market for things like coffee.

Some people who do black market stimulants are essentially just self medicating. Both is not black and white.

My partner always had a thing for amphetamines, and was more functional under influence. It just took a doctor to confirm and subscribe them to suddenly make it legal. I could not say the same about myself, amphetamines just make me more awake but not more functional.

Coffee brightens the person that has had 8 hours sleep too.

But indubitably, the person on 2 hours needs it much more.

I've tried my GF's meds once to see what it was (and using medication is one of the diagnosis tools they use); I found myself focusing and intetionally task switching for about two hours (that and palpitations), but I wouldn't say they "help"ed me.

If you feel like you need stimulants to perform well in a job, you need to reconsider your career choices. It shouldn't be a rat race.

> If you feel like you need stimulants to perform well in a job, you need to reconsider your career choices.

OR you may have a medical condition such as ADHD where stimulants are a useful prescribed tool to deal with it. Not everyone who needs stimulants to work is abusing them.

>If you feel like you need stimulants to perform well in a job, you need to reconsider your career choices. It shouldn't be a rat race.

Would you say the same thing to someone with a physical handicap? I.e., "If you feel like you need a wheelchair to get around, you need to reconsider going outside the house"

I'm not trying to put words in your mouth, not saying you'd say something like that, but consider it from the medical perspective. Someone shouldn't have to struggle with a handicap just because it's mental instead of physical.

> I've tried my GF's meds once to see what it was (and using medication is one of the diagnosis tools they use);

Medication is a useful diagnosis tool, because the effects when it helps can be utterly profound. For me it was like I’d fully woken up for the first time in my life. My body physically calmed down, and I went from spending the majority of my idle time daydreaming to being calm and present in the world.

Please don’t take other peoples pills though, they’re tightly controlled usually with no buffer. If you take someones pill, that means they’ll have to reduce or skip a day. Imagine stealing someones reading glasses for a day—they’re gonna have to persist and deal with the possible migraine/eye pain.

> I found myself focusing and intetionally task switching for about two hours (that and palpitations), but I wouldn't say they "help"ed me.

You don’t need them. What you experienced is not what your GF experiences.

If you put on someone else’s prescription glasses, would you complain that they didn’t help you?

> It shouldn't be a rat race.

Everyone I know on stimulants for ADHD (myself included) would agree that the stimulants help them escape feeling they’re in a rat race.

A trait of ADHD is know precisely what needs to be done, and being incapable of making it happen. Medication helps with that. It’s not a cure. It doesn’t fix everything. It just makes some things easier.

It allows me (us?) to make conscious change. It didn't fix everything, it allows me to see more than 1 week ahead and make conscious decision to acquire new knowledge and automatism.

I never had a racing heart taking it and it didn't elevate my tension. It allows me to take a nap when I want without those racing thoughts about "life"

>If you feel like you need stimulants to perform well in a job, you need to reconsider your career choices. It shouldn't be a rat race.

If you need Ed medicine to have sex maybe you shouldn't have sex.

If you need asthma medicine to breath maybe you should think twice about breathing.

Seriously, you don't have a clue about what you're talking about. Neuro divergents are almost an evolution good or bad (hyper focus can have it's benefits), most medicine for the brain is liable to do the opposite.

Caffeine and ginseng are like really good cold medicine to my wife she practically goes into a coma.

If you don't think people's brain work differently:

Do you have an inner monologue?

- yes? - talk to someone who doesn't, there's many, I found this absurd because mine is always going. - No? Talk to someone who does... Try to imagine what it'd

Repeat the above for people with synesthesia or aphantasia.

Reality, the brain, consciousness... It all exists within the circuitry of our brain and the flow of electricity and hormones paint your experiences in life

With a deficiency in dopamine which we all mostly have (ADHD), you do need help.

For you, you could end up overdosing on dopamine which itself can cause some major mental issues.

Best to lay off other people's meds.

Hell, I take Vyvanse my wife Adderall, when I ran out I took hers as she's on a dose that about matches my vyvanse but they have different internal mechanism.

Adderall gave me anxiety, depression, and jitters.

Even within ADHD circles it's probably best to stick with the meds you're prescribed.

No need to feel so bad (edited from: be so negative) about meds. They’re a crutch, sure, or maybe a wheelchair. But you wouldn’t begrudge a disabled person their wheelchair, would you?

Or if you dislike thinking of it as a disability (even if there’s nothing morally wrong with being disabled): a pair of glasses.

Do we really think less of people (or in this case likely ourselves) for using a wheelchair or wearing glasses?

I think you're arguing the exact opposite point of the parent (and agreeing with them), they never said they look down or think less of people who use meds, they themselves use meds.

Sure, I agree with them, but I also know there are a lot of mixed feelings around stimulant medication due to the attached stigma. And it bears repeating that using ones prescribed medication is not a moral failing. Especially in people who have stopped using it before and for those who might still be on the fence.

But I've changed my phrasing, just to be clear.

I don't care about stigma, but comparing a drug to a wheel chair is just ridiculous.

I don't want to get addicted to another thing in my life, here in Europe we're quite familiar with (ab)using speed (amphetamine paste) and the idea of being on speed every single day seems pretty bad.

I don't feel "more like myself" on speed and I seriously doubt most positive effect would persist after a year of using and rising tolerance.

> I don't care about stigma, but comparing a drug to a wheel chair is just ridiculous.

Why? Just because it comes in a pill form, instead of being conspicuous, doesn't make it any less of a help for a medical condition.

> I don't want to get addicted to another thing in my life,

The point of this comparison is that "being addicted to" ADHD meds is not in the category of "being addicted to heroine" - it's in the category of "being addicted to a wheelchair" when you could technically just use your hands to crawl around and grab things, instead of aiding yourself with technology.

> the idea of being on speed every single day seems pretty bad

Stimulant medication aren't speed, they're like "1/100 speed". It turns out that with medicine (not just psychiatric), the effects don't scale linearly or continuously with dose size. That's why those meds are helpful and safe to take in therapeutic doses, despite being technically dangerous, addictive drugs in much larger drug abuser doses.

> I seriously doubt most positive effect would persist after a year of using and rising tolerance.

Countless of people who have been treating their ADHD with stimulant medication continuously, for years or decades, will beg to disagree.

Nobody says you have to take meds for ADHD treatment, or that you have to take stimulants (there are other options available, although typically less effective). Hell, on some people with ADHD, stimulants don't work at all, or side effects are not worth the cost. But comparing them to speed is just wrong and irresponsible, as it makes people afraid of trying what could be effective treatment.

And yet I'm seeing here a whole thread of people talking about astronomical doses, reduced effects after tolerance kicks in, negative experiences and so on. So classic drug talk.

Seems pretty strange that I should take your sourceless claims as gospel over theirs.

>Stimulant medication aren't speed, they're like "1/100 speed".

These are literally two identical substances with almost identical effects (the only difference is the ration of amph salts). Difference is dosage.

Can't understand why would you claim what you say, when Adderall is used and abused in the same exact manner as amphetamine paste is in Europe. Anecdotally I hear in USA they throw it at you like candy.

>But comparing them to speed is just wrong and irresponsible,

I stand by what I said, if you saw the numbers of amphetamine addicts on the street in USA the same way you see opoid addicts, you would have a different national perspective on these drugs.

>it makes people afraid of trying what could be effective treatment

Yes, they should be cautions in my opinion.

I personally am not taking any new chances with addiction, even though I'm sure I would have benefits, at least short term.

I'll just hobble along. Using crutches can make physical rehabilitation impossible.

> sourceless claims

Excuse me? There's roughly 60 years of research into the effectiveness of stimulants as a treatment for ADHD. It is probably the single best researched psychiatric drug.

While it's always useful to discuss a proven treatments relevance in the light of newly discovered alternatives, there really is no (significant) doubt in the scientific community about the effectiveness of stimulants. Given the body of evidence, I would say it's more fair to ask you to add some citations to your comments.

> These are literally two identical substances

Yes, they are. That doesn't mean that in patients with a dopamine dysregulation they don't have great therapeutic effect. One could call the euphoria nothing but an unfortunate side-effect leading to abuse in the general population.

> numbers of amphetamine addicts

So, there are addicts. That has nothing to do with therapeutic use.

> Yes, they should be cautions in my opinion.

Since they aren't prescribed to self-diagnosed ADHD patients, there should always be a doctor involved. And I can tell you the titration and monitoring is taken quite seriously, at least where I'm from.

> Using crutches can make physical rehabilitation impossible.

If you're missing a leg, that rehabilitation is going to take a long long time. As will be the case with ADHD. You might learn to cope better, but your symptoms aren’t going anywhere. ADHD isn’t something that generally gets better with age, although better coping skills may mean some people don’t experience as much of an impact on life.

And yes, stimulants are a crutch, but they do help people function better despite their disability.

This thread really describes the issues with all drug use. Drugs (licit or illicit) affect people differently.

So instead of focusing on bespoke medications we try to ban them all if a small percentage of people have addictive natures or negative side effects.

How about we agree that drugs can be beneficial and harmful, but keep them legal for the large percentage of people it actually helps.

> comparing a drug to a wheel chair is just ridiculous.

Not every disability is visible. By definition they have a significant impact on someones life, as such there isn’t use for competition.

A wheelchair is a great comparison. Both enable someone to do something they previously couldn’t. Both are temporary, and stop being useful when removed. Both have a very different effect on someone who does not need them.

> I don't want to get addicted to another thing in my life FWIW, among those I know with ADHD taking stimulant meds, addiction is not a concern but remembering to take them is.

> I don't feel "more like myself" on speed

Do you have a deficit of dopamine, serotonin and norepinephrine? If not you’re experience will be very different from someone who does. Even then, some stimulants work better for certain people, and for other only non-stimulants work. Our brains are complex, and our experiences are not universal. Speed is also a pretty catch all term, and the ratios of salts have a huge impact on the effect. It may not be very comparable to pharmaceuticals.

> I seriously doubt most positive effect would persist after a year of using and rising tolerance.

People have been taking stimulants for ADHD for decades, but I think its effect is not what you think to an ADHD brain. It’s more akin to reading glasses.

> Do you have a deficit of dopamine, serotonin and norepinephrine?

What evidence exists that points this is the cause of ADHD? Wouldn't a dopamine deficit be more akin to Parkinson's Disease?

Also, last I remember reading, I am pretty sure we are not fully aware of why stimulants help people with ADHD. I think the leading hypothesis is that dopamine plays a role somehow, but I thought that he yet to be fully observed.

This article from about ten years ago asserts that "a highly cohesive story [was] emerging regarding the etiology and treatment of ADHD": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894421/ and gives an overview of that etiology, which concerns norepinephrine and dopamine in the prefrontal cortex.

I really don't care about the drug or addiction when the alternative is not taking it and not remaining employed. For me I need medication to keep a job if I could. Have a fun and free-wheeling life without employment and without medication. I would totally do that but the reality is in this world you need a job to earn money for everyday life.

"It helps me stay in my golden cage" is what I tell my GFriend.

I don't give a shit about my job but it allowed me to buy a house, take vacations and sometimes buy an extensive toy.

I would gladly stay in my own world and daydream away, doing some woodworking and see birds in my garden but if I lose my job all that will go away.

So I take my ~3€/day pill and try to do my best. I've lost so many opportunities before getting diagnosed...

> doing some woodworking

I'd only manage that for about two days before giving up without the meds, heh

I've been taking Elvanse for 6 months. If I don't make the conscious effort I will not take it... I feel like addiction is not a worry at all.

It allowed me to stop eating my feelings (which allowed me to lose 13kg and counting), made me stop drinking, I still play games but can stop whenever.

I know I will surely have to take it my whole life (days I don't, I'm a wreck) but I see it as a diabetic needing insuline.

I was diagnosed with ADHD when I was about 27-28. I've been on medication since then, and the impact has been amazing. It makes me wish my condition was diagnosed much earlier. So much unnecessary difficulty (Especially in school) that could potentially have been avoided.

You're proposing a false dichotomy. It's quite possible that it works for some people and it doesn't work for others and only being in the persons' shoes will let you truly evaluate the benefits vs. the tradeoffs.

For example, stim meds increase my focus but also seem to reduce my creativity and injure my sleep (to the point that I have occasional short-term memory loss). So every day I individually evaluate whether it will be worth it or not, and I make sure to take at least a couple days off a week to catch up on REM sleep.

Ok, that is the assessment after one month. I would be interested to hear your opinion after a year and after a decade of using.

Without meds, the constant feeling was that life was moving a little faster than me. I had to put a lot of effort just to stay apace, and taking a day off means having a day and a half of stuff to do tomorrow.

I don't need meds to live. I need meds not to feel hollow in my soul. If I think about doing something that is meaningful, I need my meds to up and do it. Otherwise it's living the life of someone with really great plans that are unable to leave their head. It is hellish.

Now I have 35 unmedicated years to catch up to.

I know exactly how you feel, but I there is a bigger question: how well do these medications do in the medium term (counted in months)? I have read people testify how the initial boost evaporates, and when things come back to normal, they have to either continue the drug for not much benefit or face withdrawal.

Edit: to clarify, I'm not telling anyone not to try medication. Everyone's response will be different. Just beware of the initial euphoria.

No idea, but habituation is a much bigger deal than people give it credit for.

I did the titration regimen after my diagnosis with a licensed psychiatrist and ADHD specialist, so you start very low and test a dosage for a month at a time. You increase it slightly until side effects are noticeable, then you scale back. This was my timeline:

Euphoria lasts perhaps two days, and you're on the lowest dose so it's pretty mild. You're just doing something and feeling happy about yourself. Good, it's a side-effect, and needs to go ASAP. Many people start on too high a dosage, so euphoria lasts maybe weeks, and when it stops they think it stopped working. This opens the doors to abuse, especially in teenagers.

Adaptation, during which other negative side effects start to lessen, lasts about 10 days.

Then there's peak productivity with little side effects for 6 months or so.

Then you start to question if it is still doing anything. There are days that you just don't feel like doing much. Take a couple days off, and it's obvious it was working all along. Without it you're still unproductive and scatter-brained as you've always been without. Also, you've started getting good at using this new powerful tool, but still don't know what to do with it. This is where I'm at at the moment.

When you're used to having good days, good days become normal days and it is very hard to remain objective in your assessment.

Thanks, this was very useful information.

> Take a couple days off, and it's obvious it was working all along.

This is key to appreciating the value of the medication and also benefits as a way to fight tolerance. "Medicine holidays" it's often called. Every month take a weekend off, and every 6 months take a week off. Those off days will leave you terribly lethargic. But going back on will make you really appreciate it. Or not in which case take a longer break and maybe lower your dose.

AFAIK there is no real proof these holidays work, and many therapists do not even prescribe them to their patients.

I wonder if the dopamine system might need more than a few days to reset. In my experience with addiction, it takes months.

You don't need to get tolerance to zero as you might with addiction-level situations, just back to levels where it's no longer completely adapted.

I've been on adderall for 20 years and haven't ever had to increase my prescribed dose. I even usually reduce my dose in the summer after my week-long break. I bring it back up after subsequent holidays in the autumn.

The only times when I've thought it wasn't working, the med holidays brought it right back on track.

Could be placebo. Also n=1. There's very little lost in attempting (it assuming your dr is kosher with it).

Well, if it's worked for you I might as well give it a shot. Reaching now the 6 months mark, already took a a few days off here and there, I'll try a whole week off around Christmas.

What was good to know was that there doesn't seem to be any addiction potential for me at all. I hate being lazy and unmotivated without the meds, but there is no urge nor withdrawal whatsoever, which is fantastic, as someone that got addicted to half a dozen things in their life.

I was afraid I would start to enjoy the meds too much, but I am much more dependent on the cup of coffee I drink once a week (and every day during work I start craving a Coke) than amphetamine.

I thought it took at least 3 days for the medication to clear your system.

The lessened effect is due to your body getting used to having increased levels of dopamine and norepinephrine, so stops producing as much.

The fact that the medication is out doesn't make your dopaminergic system more sensitive by itself. It might take a while.

I've been on the medications for almost a decade now, so when I take a weekend off, then I am basically useless by Monday when I start them again. I swear it takes days from them to start working again every time I take a break.

So, my dopaminergic system probably has holes burned through it.

Yes, I have certainly noticed it takes a few days for the full effect to ramp up as well. And there seems to be residual effect for about 12 hours after the last dose, though in general the peak effect lasts about 4 hours for me (on lisdexamphetamine)

I take methylphenidate slow release, and have for several years now. If I take an extended holiday, the first ~week back definitely feels like there is a stronger effect, but days when I take it vs don't are very noticeable in how difficult my day is. People in my personal life can call it out when I am unmedicated, my sleep is worse, chores don't get done, I waste more time at work, I go more crazy at social events and so on.

I really hope it keeps working in the longer term because it's been life changing so far.

I'm right there with you, getting medication that worked for me made a huge difference. I can now just get up and do a thing without feeling like I have to tear down a wall to do it. It doesn't hurt my brain to have my focus interrupted, and I can get back to what I was doing right away.

The best explanation I've seen is this comic: https://teddit.net/r/ADHDmemes/comments/pmrh5d/quite_possibl...

This is me, too. I grew up in a "Kids just don't want to learn any more, they all just take meds to fix behavior problems" household.

I quit my meds when I was about 16/17 failed out of my last year of highschool, went on to become a construction foreman for huge projects managing crews of 30-40.

During a layoff in 2009 because there was no construction, I installed linux on a laptop because I borked my OS and didn't have a key. Ended up getting a job as an ISP call center tech at a small ISP/hosting company a few months later, taught myself systems and networking administration and was running the whole place a few years later including the BGP peering, system automation, monitoring, and building.

I went to work for a FANNG for a decade, Built some cool shit, have a few patents.

When the pandemic hit, I really stopped for the first time and looked at what being able to perform at a high level was costing me and my family.

1. I was drinking too much, a small buzz would slow my mind down and let me focus on a single thing, It kinda works but at what cost?

2. I always knew what I needed to do, I understood how to build what I needed to build but there would be times, whole weeks, when I'd be unable to bring myself to read the docs I needed too or do what ever I needed to do, that would make me uneasy and lead to a lot of self-loathing. Not a great person for my family to be around during those times.

3. Always feeling like I needed to work but never working, so everything was an inconvenience because I should be getting something done at work but I wasn't, then things like dinner with my family felt like it might be taking away from some work I wasn't going to do anyways.

4. The lightning would strike, I'd find a deadline or whatever and I'd work, almost unbroken for days straight, online before my kids got up, get them to school, work, pick them up and make dinner/put to bed, work through the night or late into the night.

5. I'd build the thing I needed to and then I'd crash and be tired, and then I'd have a day or two to be the father and partner and person I wanted to be, but there's always the nagging feeling that next time, I'll be too late or won't pull it off . . ..

I spent 2 years in therapy (starting before the pandemic) addressing the symptoms and working on Cognitive Behavioral Therapy techniques to address a chemical imbalance in my brain. Working on being kind to myself, working on stress management, working on time management.

Part way into the pandemic, I ended up quitting, realizing I just needed a break and I was working so much harder than any of my peers for a similar or worse output. Them mental overhead of keeping up was excessive.

Eventually, I went back and got properly medicated. It was like a switch flipped. It took me a month or so, to get into it, but I found myself feeling like I could stop and be available for my kids whenever, because I started to realize, I could just turn my focus on and off whenever I wanted and I didn't have to wait for lightning to strike.

The thing that's most beneficial is a bit unseen, I'm not carrying a burden of self-loathing, fear, anxiety on my back, all stressors that were a result of my inability to entirely control my focus and do the thing that I wanted to do when I wanted to. That invisible weight that I carried everywhere vanished.

I've seen a marked improvement in my life over the last year or so. I'm a better father, partner, employee. I like myself for the first time in decades.

This is long winded, but I wanted to put this out there because there are a lot of us in tech. having ADHD is actually a great way to get into tech, we find something we don't understand or a blocker and dig deep. I was just trying to find a way around a license key and ended up learning internet routing . . .. I have a very broad skill set because I'll dig deep on anything that walks by. I see many like myself. But if you find yourself in a cycle like this, go get help. Life doesn't have to be that hard.

Fist bump!

So I'm like this just not as 'successful' AND I haven't gone medicated as I'm on the cusp. Although, I've been putting something off for a while....;)

'The thing that's most beneficial is a bit unseen, I'm not carrying a burden of self-loathing, fear, anxiety on my back, all stressors that were a result of my inability to entirely control my focus and do the thing that I wanted to do when I wanted to. That invisible weight that I carried everywhere vanished.'

I am currently in the mindset that I don't get to choose what I do. I either do it, or I don't and that has forced me down a route to where I find myself. Which has really worked out. But only because I caught myself and that those knife edge moments went the right way.

> I am currently in the mindset that I don't get to choose what I do. I either do it, or I don't and that has forced me down a route to where I find myself. Which has really worked out. But only because I caught myself and that those knife edge moments went the right way.

The problem that I found as I got older is there's substantially less room for just going with the flow. It worked great for years. Now I have people that I'm responsible to and do it or don't do it doesn't work. I can't just leave it to chance if I sit down and read with my kids daily or cook them healthy foods. Their lives will pass by while I'm wondering around waiting for the inspiration to be a good parent.

So a heads up, that works great when no one depends on you much. It works a lot less great when you owe people things that you really care about.

I’m 46 and a fully fledged animal

And ‘parenting’ and the other things I’ve manage to choose. However, jobs I can’t stand I leave (eventually) One of the concerns over meds is that it would enable you to do those jobs you just don’t (and maybe shouldn’t) do.

lol, I don't think I take enough of anything to do things I don't want to or shouldn't do.

This has helped me to do the things that I want to do. It more helps on the task level and less the overarching job level.

It is so interesting how it manifests differently by different people.

I still don’t subscribe to ‘it’s all ADHD’ where everything gets lumped into this block of behavioral reasoning.

I think it’s at an OS level but I think we are just a little more sensitive than non neurodivergents. And that comes with some huge benefits as well as negatives.

No, part of the thing that has made this more successful than when I was a kid is I have spent quite a bit of time working on things like maintaining focus, prioritizing, time management, maintaining healthy sleep patterns. Additionally, I understand what is and isn't ADHD and what can be fixed with a stimulant. If you try to fix all your problems that way, it's not going to work.

When I was young, it was just 'here take this'. No help with understand what was happening or how to work on it. And I think that's a bad place to be.

This is extremely helpful for me to read. I was diagnosed in high school, stopped taking meds in college because my family had the same mentality and I thought I could do without.

I've been experiencing the exact same emotions/habits you mention for the past 5 years especially, now that I have a wife and child and it's been extremely stressful and I've been less than fun to be around unless I'd found a way to be super productive that day or perhaps after a couple drinks.

I took adderall for the first time in years yesterday coincidentally, and felt like a new person. I could work through the stuff that I'd been putting off for weeks. My house wasn't a disaster zone with baby toys everywhere.

So all of this just to say, thanks for your write up. I'm going to look into CBT as well and maybe get back on the meds permanently. My only concern is the come down where I was left feeling terrible, but I hear they have better stimulants than adderall these days so perhaps I'll give another one a shot.

I'm on the same path. I feel like I will ask for a IR to take around 5PM because I can't switch off after work and it's starting to affect my couple.

I can feel the medication starting to wear off around 4PM and get sucked into the time blindness and must work/play rather than spend time with my family.

Thanks for your message. Eyes opening

Yeah, the med management thing is tough and you still gotta do a lot of the work yourself.

What meds are you taking? I avoided this path for as much, but I’m looking to get my doctor prescribe me something.

> Regardless of anything else, I think the key thing to remember about ADHD is that you do not need to be a high-performing human being, at all, in life. You will forget things and get distracted and not get as much done. So what. You are still intelligent and caring and dedicated and responsible and a hard worker.

Exactly! I was diagnosed later in life by which time I had experienced a significant amount of trauma expecting myself to be normal. Learning to embrace limitations and the "workarounds" needed to function helped me tremendously. Learning to "ride the waves" so to speak and working with your brain changes things day and night.

The other part is learning to stand up for oneself. There's often a lot of undue criticism from others because you need to do things differently. Being constantly criticized because you forget what often amounts to trivial things is one of the worse "symptoms". Many people also associate "togetherness" on unrelated items with competence or ability. Of course there's basic tasks that need to be handled, but many folks view even "struggling" with such things as evidence of incompetence.

For example, adhd'ers often pay a "tax" because they occasionally forget things at the grocery store, but at work they also tend to foresee certain problems long before others do. However many managers see or here about the former and ignore the latter and are too narrow in their mental models to comprehend the differences.

It's also acceptable to ask for help for those weird things your brain refuses todo. I've asked people to "hit enter" for me just to short circuit a procrastination loop. Now I can actually do it "in my head" as a sorta role playing game. :)

> Do not put pressure on yourself to live up to what someone else can do. Only do what you can do, in your time, and be at peace.

Right on. Ironically doing this also lets your brain work better!

Unfortunately this requires understanding from those around you too. Sometimes family members with undiagnosed adhd can be some of the worse due to internalizing all the normal criticisms.

Its great seeing so many adhd'ers sharing actually helpful advice nowadays.

Riding the waves, great metaphor!

When I stopped fighting them, my life got much easier. I found a way of working that suits this better.

Your comment about foresight… enlightening. I’m often in a position where I’ve mapped out a problem far ahead of my peers, sometimes I have to let them toil with the problem for a while before I break the bad news. Quick wit has never been my strong suit, though.

Your comment really, really moved me. And I identify so hard with the press enter anecdote.

Thank you.

You’re welcome! It surprising how similar many ADHDers experiences are and yet we think we’re alone. :-)

Hi, could you give an example of the “press enter” part? I feel it would work for me but I don’t fully understand what you mean.

Sure! It can be a method to overcome procrastination.

Say you’re procrastinating on starting on a new work project. Neurotypicals might just type `npm init myproj` and “hit enter” to break it down into a smaller piece. Useful and seemingly simple..

However, ADHD’ers brain may interpret “hitting enter” as akin to putting your hand on a hot stove element. You literally just can’t do it! In that case type in `npm init myproj`, grab an (open minded) coworker to “hit enter”. Despite the odd looks, having the repo created will often override the blocker!

Though it’s the principal that counts as your brain could shift the blocker to the readme, etc, so you have to adapt as needed. The general premise is to ignore the odd looks, and get help despite the seeming inanity of the action. Involving someone else even trivially helps too, similar to the “body double” concept.

Generally you can use your ability to reason to overcome hind brain hindrances. It’s sort of like using reasoning to create a hot glove to grab hot things out of a fire, rather than “just try harder” to force yourself to have thicker calluses like everyone else. But first you have to accept you don’t have natural calluses and your brain won’t let you grab hot things because it hurts. Grab a glove, or get a friend to.

Hey, thank you for explaining it so clearly, it makes total sense. Have a wonderful day.

How did you get diagnosed? Do you feel like it was worth going through the process?

A lot of what you said resonates with me...

> Being constantly criticized because you forget what often amounts to trivial things is one of the worse "symptoms"

I spent a lot of effort removing "trivial" things from my day to day life. I have a rule of ever only doing a single "life admin" thing per day, ideally 0.

A lot of people act like I'm crazy when I talk about hating the dishwasher because it creates a future obligation of having to unload it later.

I'm actually writing a productivity book that revolves around doing less each day and avoiding tasks that create future commitments to avoid cognitive load. When I talk about it to some people, it really resonates. Other people look at me like I'm crazy and and tell me to stop being lazy.

Yes, the process was extremely valuable for me since I didn't know what was "wrong" but knew there was something. I looked up a psychiatrist experienced with diagnosis who recommended a professional IQ exam. There are very clear statistically significant differences associated with ADHD, which helped me accept "adhd" as a real thing. That part alone was worth it and the evidence was pretty undeniable.

I went back for a PhD program and got a diagnosis from the health services there, along with some CBT therapy.

I'd recommend going to a psychiatrist/ therapist with a good track record of diagnosing and treating adhd. Many doctors, even psychiatrists, are dangerously under-versed in adhd or even believe its fake.

haha and I feel the bit about cognitive loading.

I'm gonna back you up here. My life is much better without the meds. I have no issues with people who do prefer being medicated, but as the comments to this show there's a weird non-acceptance of people who do not want to be medicated.

Being on meds destroyed my creativity and emotional life, gave me devastating crashes every day and made me feel like I had to fit my entire life into the 6-12 hours a day they were active. If my career required me to go back on meds I would choose a different career, and that is just fine. Structuring your life so that it fits your unmedicated, natural self is just fine. Taking medication if it truly makes you happier is also just fine. Don't judge.

I've never been diagnosed, but around two weeks ago some random soul on Reddit spotted some symptoms that might be signs of ADHD, or at least things that ADHD meds could help.

I was provided this article: https://invisibleup.com/articles/27/

It is such an accurate description of something I've been struggling with my whole life without ever knowing it. I'm now waiting the weeks and weeks it takes to get a doctor's appointment; going to try for meds and maybe a diagnosis. I've already been formally diagnosed with autism, but ADHD never came up.

If you have even a sneaking suspicion that you might have ADHD, read the article. It is absolutely an eye-opener.

oh man, i'm in my 30s and this is exactly how my daily life is. I grew up in a culture that didn't have much of an inclination of understanding what ADHD is and stuff, so I never bothered. I really need to get myself checked.

Same here. Both in age (mid-30s) to being exactly how my daily life is to the point of a culture that had a misguided opinion on ADHD.

I shared before on HN that I'm still ongoing investigation with my therapist, after some 2-3 years of therapy and working around some anxiety issues I had we're narrowing it down to a very likely ADHD diagnosis.

The more I read and educate myself about it the more I believe I might have it. It's still hard for me to properly accept that this might be it, and not that I have an inherent failure of character by never being able to keep my focus, motivation, planning, etc. as well as what others can.

To be very honest, something inside me still don't want to believe that I very likely have ADHD, that part still shames me by telling that I'm just using this as a crutch for my failures, that it's just a convenient excuse for not being good enough at some mundane tasks.

It's exhausting, I'm glad I'm finally getting help because for the past 3-4 years I have been on a steadily downwards spiral. It's been very gradual until I got to this point where I can definitely tell I'm suffering mentally because of it...

Yeah I went through something similar, but recently started trying meds again. Not to take every day hopefully, but only in periods where I feel especially affected and want to be more productive. I feel it’s the best of both worlds, but will see how it goes and if I stick with ‘em.

I think it’s good to experiment and figure out what works for you. I’m generally opposed to relying on drugs for things like this unless it’s really necessary, which is why I stopped taking meds for a while. But I’ve been having some real challenges recently with my focus & it’s been so frustrating. Hoping I’m able to find some sort of balance with it.

Guess my point is that it’s ok to let the meds help you too, and it doesn’t need to be problematic. I think I resisted going back on medication for a while because I was thinking “I don’t need anything, I can get by just fine with no help from meds!!” And while that may be true, it can still make my life significantly less frustrating to take the help sometimes.

I agree. I hope I didn't come off as anti-med; just wanted to share that we can be OK either way. Do what works for you, try different things, but be OK with however you end up, even if it's not as productive as you'd like.

Just as an FYI: I recently started working on my CPTSD by reading stuff by Pete Walker and watching interviews with Gabor Mate. My symptoms have been significantly mitigated. My overall mental health has improved massively, too.

Full disclosure: I've been taking Escitalopram and Wellbutrin for a few years now. I've been working on my CPTSD for a few weeks.

EDIT: Of course I don't just consume the material. I actively engage with my suppressed emotions to heal.

I probably have ADHD or something similar, and have coped for nearly 30 years of my life with that. Let me just say, f*ck going through it all without help.

The moment I get an official diagnosis, I’m getting on meds. I don’t know what the side effects are, but I struggle to imagine that they are worse than barely being able to function as an adult IT professional.

Good luck my friend. A bad day on meds is at least as productive as a good day without.

Invest in your mental health. (Diagnosed 1 year ago)

ADHD can be partially treated during childhood. The problem is when it goes undiagnosed for years.

Your adult life may have looked much differently, would you not have been medicated earlier.

Thanks, I really needed to be reminded of that this morning. I've been beating myself up over the same types of thinking and it can be hard sometimes.

Similar case here. In rational circles a study (or studies) came around showing that learning outcomes between the medicated and unmedicated are roughly the same even if testing performance is better on medication. Since I improved my sleep (and lowered distractions), I've had no issues performing or focusing as needed, at least as much as the next guy.

I think the meds are a double-edged sword, and the compromise may be more appropriate for some than others. I also think even more strongly that despite real cases, ADHD medication is overprescribed in the West. If school was boring and I'm a daydreamer, do I need to be "corrected"?

Diagnosed with 25 or so, ADD however. Amphetamines made me even more guilt to function as a super human. And they would make me moody.

I stopped and changed my work environment as well as my self pressure. I can be super functional and motivated sometimes, if I give myself enough time to get there.

However, my partner is taking meds for her ADHD and for her it's honestly a life changer.

I had dropped out of college three times, spent a short stint homeless, and had nothing but tumultuous relationships before I was diagnosed with ADHD and started medication. Now I can live life like a normal human.

Please don't discourage others from taking medication to treat a very real illness.

I think this is a nice sentiment, but how did you get there? Truly, I'm desperate for the answer.

Problem is, even if you're perfectly comfortable with your own limitations, and being transparent about them, graduating up through the ranks as a software dev IC or w/e means meeting or managing the expectations that higher ups unempathetically and unilaterally apply. You have to get pretty (extremely) lucky with having a space to advance in the ways that you can. The reality is that you do need to be sufficiently successful to get by, and that bar is getting higher as everything increases in cost. If the smallest piece of real estate in my city for example demands the salary of a senior faang dev to pay for, the pressure is hard to avoid.

Remember that the pressure is being applied by yourself. Nobody is demanding that you buy a home, work at faang, climb the career ladder, etc, except you. Stop giving yourself a hard time. You wouldn't give others a hard time about their career [or lack of one], would you?

The way I got there is: My goals were not very high. I made a crapton of personal projects and taught myself an insane amount by 19/20 so that I actually knew a good deal more technically and practically than some intermediate positions. I was overconfident and good at seeming very talented. I took jobs that didn't require a ton of technical or incredibly hard interviews. And I coasted for about the first 10 years. The next 10 I overworked myself because I thought I needed to, because I didn't want to do the job anymore and figured if I just did it better than anyone else I'd feel better about it. And finally I took jobs where I was literally making the world and people better.

The whole time, I gave myself crap for not getting enough done, and much of the time felt bad for "wasting" my time. Now I realize that I have a ton of life left still and no particular goals in mind, so who cares if it's a waste as long as I can enjoy the waste? And I do (mostly) enjoy my job and my free time now. Sure I don't own a home and the things I want deem farther off than for many others. Same is true for many other people, and that's fine. Whatever happens is just life and it's OK. Just sucks that it took me so long to realize that who I am is fine and doesn't need fixing.

'Only do what you can do, in your time, and be at peace.'

This.

Everyone has their own genius. Go find it. It might be

As a noob, can you guys give me an idea of what it is to live with ADHD? My understanding is that focus is a spectrum and different people are on different spots on that spectrum. I always imagine that something becomes a condition and gets a name (like ADHD) once it becomes an issue in your life and prevents you from functioning in society. When I hear that you're a staff engineer it sorts of tells me that it's not really an issue for you? Not saying that you don't struggle with focus, but everybody is, I imagine that some people can't even hold a job because of their lack of focus though.

> something becomes a condition and gets a name (like ADHD) once it becomes an issue in your life and prevents you from functioning in society.

It gets named once it becomes an issue in life. It doesn't need to be as bad as being unable to function to get diagnosed.

It's a tough one, because the symptoms are relatable to most ("isn't that everybody?"). They're just more intense than for most, and come with unexpected "features" like executive disfunction. The intensity also varies from a person to another, and the severity depends on a person's lifestyle.

The lack of focus is a lure, an oversimplification. It's not just "I can't focus on something I don't like to do". It's more like "halfway into making a cup of coffee, the most important thing in my life became to clean the pantry". Imagine running late, but stopping dead in your tracks with only one sock on, and answering an email. You know it's mad, but you can't help it.

However if you have a job that's lenient enough, you can hide it well. I stopped treatment because I couldn't gather enough data. My job was too easy to know if it worked. It's still the case.

Another thing is that a lot of people learned to cope with it for decades before getting diagnosed. Their life is full of alarms and error-catching mechanisms, so the symptoms are well-managed. If you know your strengths and weaknesses, you pick your battles. It's not an issue unless your battles are picked for you.

I think for outreach, hammering on executive disfunction is the best way to go. It's the most alien to the neurotypical, and it most clearly paints ADHD as a disability, rather than a mere personality trait. And rather than talking about failing to focus on things you don't want to do, talk about failing to focus on things you want to do, but simply fail to produce incremental enough satisfaction to remain focused on. Like, before I got medicated, I would want to watch a movie. I would enjoy watching a movie. But you better bet I'd be getting up, checking my phone, going to the restroom out of sheer restlessness, etc, instead of doing the thing I wanted to be doing: watching the damn movie.

It's like hearing a lot of noises up close and loud but then noticing they are far away. They distract you. The clock ticking. The tap dripping. The person on the other side of the office eating crisps. Ok, turn back to your desk and focus. Got to finish this task.

"Hey John, did you fix that problem with the DB log crash?"

You look up, realize John and the boss are on the other side of the room and you are not part of the discussion.

You put your mind back to that task. Reading the product documentation, "click click, someone across from you taps their keyboard" ... wow, you noticed that 1 hour 30 minutes suddenly passed but you do not recall much of the documentation you just read.

Getting back to it.. a friend messages you a funny joke on whatsapp. 20 minutes of chit chat go by and you realize most of your team already left the office to go home.

There are also other things like fatigue. You'll be able to force yourself to keep up but it takes a toll and eventually you fatigue. Productivity then drops massively and people think you are a slacker.

Isn't it just how normal people perceive life? That's why so many people are happy not to work in the offices after all, or, when in office, wear headphones for hours.

On balance there are measurable effects that substantially impact the person over their lifetime. More likely to not finish tasks, assignments, schooling (dropout or poor grades that dont reflect capability). Poor impulse management leading to bad finances, addictions etc. The symptoms start in childhood and over time these small paper cuts accumulate. As an adult the adhd individual often has extremely low self esteem (and very often comorbid depression), even if they do not show it.

Idk, sounds like normal day to day life to me.

It feels normal. Until you talk to more people and realize you aren’t normal and you don’t actually suck and you might be able to get it together and have a reasonable life if you chain yourself to daily meds and sleep enough and exercise enough and have routines and build 20 other environmental tweaks, guardrails, and micro habits.

There’s some breakdown between wanting things and being able to do them. Wanting to do the things but letting down everyone (teachers, friends, family, self). The thing you can’t do might be chores (frustrated that the house is a mess but unable to make it not a mess), keeping up with friends or family (never keeping in touch enough), hobbies (never able to focus long enough to really make progress), work (continuing to function after the initial learning curve wears off), being able to focus long enough to read books you want to read, having conversations with people who prefer to have one conversation at a time instead of four, listening patiently and not interrupting as someone continues explaining the thing you picked up on after their fifth word and they’re on their fifth sentence now…

Everything falls apart slowly and it’s easy to get frustrated with yourself and lose hope. Meds help but being chained to them is a shitty feeling too. They’re a pain to get and require frequent check-ins as stimulants are controlled substances in the USA. The other non-medicine interventions all help in little ways that add up too.

Life falling apart and you go play in the woods ;)

This may solve the associated psychological issues for people that have them but does not help with the executive issues.

Does your company know that you have ADHD? If so how was there response?

Why did you stop taking meds? Curious what would be your reasons against it.

Mainly because I was also put on anti-depressants, anti-psychotics etc and it was making me much worse (sometimes parents are idiots). But before that the stimulants turned me into an emotionless zombie. Once the meds wore off, crying was a magical revelation, like, "oh! this is what feelings are like! this is awesome!"

I'm not GP but I also stopped taking meds (actually recently for me, and I'm 27). I'm sure GP's reason is different. My reason was that I had realized that a lot of my old ADHD symptoms were actually still happening. I was still procrastinating, still getting stressed when forced to focus on stuff I don't care about, still forgetting stuff. As an experiment, I decided to keep lowering my dose to see what happens. I kept lowering it until 0 and basically nothing has changed. I still do great at my job, can study stuff I'm interested in, can function completely normally. Makes me wonder whether the effects had simply worn off after so long, or if it was placebo from the start.

> My reason was that I had realized that a lot of my old ADHD symptoms were actually still happening. I was still procrastinating, still getting stressed when forced to focus on stuff I don't care about, still forgetting stuff.

Anecdotally, I've watched a lot of friends and colleagues go through this exact cycle: Going on meds and then just focusing more intensely on their distractions. I really think we're doing a disservice to all the people who get a prescription and get sent out the door without a more involved framework for how to use the meds as part of their ADHD treatment strategy rather than a presumed cure in a pill.

N=1, I can confirm this effect. I started to call stimulant medication "sticky". As in, when they kick in, I find it much easier to focus on doing whatever it is I am doing at that time. So, if they kick in while I'm on HN, I can kiss the next couple hours goodbye.

It's a trap that took me too long to figure out, and one I still fall into quite often (the period between taking a pill and it kicking in is long enough that I may habitually start procrastinating), but wrt. differences in my life on vs. off meds, in times when I feel similar to what GP described, I'm reassured by my wife who can smell me taking a med break even if I don't tell her, because from her POV, I change for the worse in the scope of a day or two. She sees the change even before I feel it.

> I really think we're doing a disservice to all the people who get a prescription and get sent out the door without a more involved framework for how to use the meds as part of their ADHD treatment strategy rather than a presumed cure in a pill.

As much as I believe the meds are a net benefit overall (they definitely are for me), I 100% agree with this sentiment.

This feels so validating to read. I was having problems with my attention cannon and they just handed me a bigger one.

I stopped when I caught myself in a deep dive about the different types of flour in Germany.

It also affected my mood in really unpleasant ways, both for me and people around me. And it gave me a productivity boost at work at the expense of my life past 4PM.

Nowadays I just have a coffee before work.

Everyone's different. In my case, medication almost entirely eliminates the anxiety that's been a constant background presence, slow-burn torture, for most of my life. They also stabilize my mood. If the meds were to suddenly stop having any other positive effect, and kept the negative and neutral side effects, the anxiety reduction and mood stabilization alone would make them worth their weight in gold for me.

This was my experience with adderall in college, as someone who I don’t think suffers from these conditions.

Similar for me. It is like shooting a bullet. If I was pointed at a distraction by god I did the shit out of that thing. Maybe I was supposed to be reversing an app for a project but instead I made the most beautiful CSS thing I had ever created. Or some other highly unrelated tangent O_o

> Going on meds and then just focusing more intensely on their distractions

... shit, that was today for me. Oops. (But in all fairness, I'm still recovering from a flu.)

I'm curious... Are these not things virtually everyone struggles with to some degree? There are no end to time management books and people who wish they would spend less time on their phones/playing video games/etc.

No when you have ADHD it's really really hard to get started on a new task, but you do obsess over a task once you get started on it.

You'll do everything you can to avoid it first though, until the stress of the deadline overweighs the dread to start.

I always find that portion of ADHD somewhat amusing. Getting fixated on a task and unable to context switch is a big thing, which I think is surprising for many people.

This is also something that has crossed my mind. In the early days of my diagnosis, it was a challenge to explain that I even had a problem. People would (rightfully) say "isn't that basically everyone?" and I would have to struggle to say "yeah but mine's worse. I'm diagnosed." It was a real drag at the time but nowadays I'm thinking maybe they were right.

Virtually everyone struggles with it to some degree, some of the time. ADHD people struggle with this to a high degree, all of the time, to the point it interferes with their ability to function, and causes no end of anguish.

It's like accidentally giving yourself a small burn when pulling things out of an oven, vs. having a 2nd degree burns on half of your body. Technically the same thing, but scale matters.

k [deleted]

That's not ADHD. That's normal.

As a next experiment, give Atomoxetine a shot. Works nicely for me and is not a stim. I feel it makes me more emotionally involved/interested in whatever I'm focusing on, so very easy to get into flow states, provided there are no distractions around. It doesn't warp time or change your mood/personality like the typical stim based meds. It does affect appetite, so if you are trying to lose weight, it becomes very easy.

thanks for this.

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