Comment by thebigspacefuck | Hacker News Reader

Comment by thebigspacefuck | Hacker News Reader

thebigspacefuck

I got on meds for ADHD and they objectively didn’t help that much. I also felt like my pulse and emotions were greatly elevated in confrontational situations to an uncomfortable extent (though caffiene was involved). The other aspect was that it was almost $300/month for a prescription. In social situations they did help a bit. Any impact on productivity was minor.

I’d also say right after the meds kicked in I would do something like get on hacker news and write a long post about how everyone should get their ADHD checked and how life changing meds are. That always felt like the meds talking to me.

Not that anyone shouldn’t try it. I’m glad I did, even though I decided it wasn’t for me, because otherwise I would be wondering how much better I would be on meds. Now I know for me it’s not much better.

Is it possible that you don't have ADHD? I am not an expert, but it is my understanding that the medications affect those with and without ADHD totally differently.

In reponse to the original post, I don't think psychiatrists are really the ones who should be diagnosing ADHD. It is again my understanding that neuropsychologists should be the ones administering the tests and diagnosis, where psychiatrists will then manage the medications.

For myself, I was convinced that I had ADHD but went through neuropsychological testing. It turns out that the primary diagnosis is that I just have severe anxiety, which shares a lot of the symptoms but with completely different cause mechanisms.

Not all medicine, and especially not adhd meds, have the same effect on everyone.

Yes, of course, but in this specific case, it is my understanding the effects are opposite, as in calming versus agitating.

That’s really a misunderstanding, commonly repeated even by professionals but not really scientifically valid.

There are a lot of different causes / paradigms / regimes for ADHD that all get lumped into “ADHD”. Various therapies have hugely different effects on different types of ADHD.

And some ADHD drugs tend to have the same effects on non-ADHD people as they do on ADHD people.

Here is an (also outdated) breakdown of 7 types of ADHD that are differentiable using brain scans: https://neuropedia.com/7-types-of-adhd/ Each show different parts of the brain affected. The "ring of fire" type of ADHD is notable for responding very poorly to stimulants.

I see. Thank you for the correction.

It’s possible, but I’ve been diagnosed multiple times by multiple psychiatrists who said there was no doubt in their mind. This also included a questionnaire to my parents that showed I had it as a child. It’s also been mentioned to me by coworkers or even commented on by strangers.

I do have a free floating anxiety and that was something the meds helped with.

There are a lot of different types of ADHD medication that work differently for different people. If stimulant medication overall is a no-go for you, but you still have the hallmark symptoms of ADHD, I would suggest asking your psychiatrist about a medication called Strattera.

I recently got an ADHD diagnosis as an adult, and similar to you it was a "no doubt, you 110% check every box in every aspect of your life" from both my therapist and psychiatrist.

My therapist obviously can't prescribe, but I have a fantastic relationship with them, and they did convey that they think I'd probably be a better fit for non-stimulant ADHD meds based on some of my other behaviors. My doc, however, started me on Adderall ER because I guess that's the standard medication to start ADHD patients on.

But I got some crappy side effects, kind of how you're describing: elevated heart rate, some nausea (especially if I didn't eat enough). My therapist was worried about some of the emotional intensity stuff, especially with stress and caffeine, but I felt like I was managing that okay.

In any case, my doc wanted to start putting me on _additional_ meds to counteract the side effects. Therapist was still prodding for non-stimulant (but I'm a bit skeptical of SNRIs in general, maybe a bad bias...)

But I really pushed to just....reduce the Adderall dosage. Doc knocked it down twice, I ended up at _half_ the initial dose, and now it's just _awesome_. Most of those side effects have gone away, I'm still getting the benefits I want out of it, and unlike a lot of other meds, I can choose on a daily basis whether or not I feel like I'm going to need it.

Obviously, I'm not your doctor, and I'm sure you did your due diligence far beyond what I'm offering here. But I did want to share my experience in successfully shaping medical decisions with multiple expert and personal inputs. Ultimately, I landed on a medication path that's been EXTREMELY beneficial for my happiness and productivity, and it was one that wasn't initially suggested by either professional.

Almost exactly my experience, I went to the lowest possible dose and have never felt better.

One thing that isn't talked enough is the importance of regular exercise for managing adhd. Humans are not to designed to sit on our butts all day.

This is huge and as someone with bipolar/adhd the medicine doesn’t work without regular exercise. It makes me more depressed if I don’t (I believe this is the adhd meds)

Shared my Adderall experience in response to OP, but didn't mention exercise.

HUGE +1, since I started working out more even just a few weeks ago, my overall happiness, focus, sleep, etc. have all improved massively.

But I think it's worth noting two things:

1. Almost anyone, regardless of medication or diagnosis, can probably benefit from regular exercise. These benefits are well-documented in the general population.

2. The initial benefit of my medication _without_ exercise was enough of a catalyst to help me finally get off my butt, join a gym, and make the decision to invest in personal training as a forcing function to more regular and high-intensity workouts. Until I started taking meds, I had this illusion that I'd come up with a workout plan, commit to it regularly, combine a wide variety of aerobic/anaerobic/freeweight exercises, and all for free with home equipment, YouTube, and some books. All of that was (and still is) absolutely _possible_, but without medication, I procrastinated it all for the better part of 2-3 YEARS. With medication, I quickly came to the conclusion that the time, stress, and inaction of that plan was not worth the money I could spend on making progress. And now I'm regularly working out.

It's also great for depression; it's just a lot harder to get depressed people to exercise than ADHD people[1], so compliance is worse.

1: Though it's by no means easy to get ADHD people to exercise; most cardio is boring and there's also: "I'm behind on all of my work and personal projects, and you want me to set aside time for recreation?"

Taking caffeine with Adderall gives me horrendous anxiety and heart palpitations so I don't drink coffee anymore. When I take adderall + magnesium I'm almost as calm as I am unmedicated.

For anyone else taking them both that may not have made the connection yet.

Some people don't experience anxiety from caffeine whereas others do.

This effect has been linked to polymorphisms on the A2a receptor gene (https://pubmed.ncbi.nlm.nih.gov/12825092/).

Interesting, thanks!

Edit: are low quality replies like this appreciated on HN or no?

> "...comments like "lol" or "That's the dumbest thing I ever heard" teach us nothing.

> Empty comments can be ok if they're positive. There's nothing wrong with submitting a comment saying just "Thanks." What we especially discourage are comments that are empty and negative—comments that are mere name-calling."

https://news.ycombinator.com/newswelcome.html

I thought caffeine + adderall was sending my heartrate through the roof, as I usually feel extremely alert on that combination. I was blown away when I finally got a watch with a HR monitor on it and found that it was barely moving it, from mid 60s resting to low 70s on stimulants. I figured it would be closer to 100 because it makes me feel like my eyes are vibrating lol.

Hah, yeah I do worry about the cardio effects of stimulants esp now that I'm past 40. I may try the smart watch route as well.

weird. it felt like your heart was pounding out of your chest as well? what about heart palpitations (feeling like your heart skipped a beat)?

my blood pressure is high but I never tested it with specifically caffeine + Adderall, I just know it was high with Adderall.

Magnesium is a very helpful supplement for anyone taking ADHD meds. Take it at night, and make sure it's chelated magnesium for best absorption. It will help you sleep.

What does the magnesium do?

Helps with the minor amphetamine-induced.. not sure what to call them, OCD-type symptoms for me. Teeth grinding, messing with my beard, making weird throat noises, etc. It also helps a lot with sleep.

Caffeine with Ritalin (or Focalin) causes insomnia for me, and I'm definitely not alone in that; it's the first thing I tell anyone who talks to be about going on ADHD meds and I don't know why my Psychiatrist didn't say anything, particularly since a lot of ADHD people are self-medicating with caffeine.

Adderall and I were just not meant to ever go together. The first dosage had no effect other than a slightly elevated resting heartrate, and when the dose was increased, I was awake for 40 hours straight with mild psychosis.

OTOH, some people respond great to Addreall, and I've heard great things about Vyvanse (a prodrug for Adderall) for an all-day treatment for ADHD in those who do.

Given the $300 price point it sounds like you may have been on vyvanse? I found vyvanse to be way too intense of a medication for me personally. I shifted to extended release Adderall which has been much better at managing ADHD symptoms without turning me into a robot running on overdrive.

ADHD meds enable focus, but I find that I still struggle with picking the right tasks to focus on. I think picking the right tasks is a weaker skill for me, probably because I didn’t start to develop that skill until I was well into adulthood (and medicated for ADHD).

I also tried it for about 6 months this year (Ritalin and Vyvanse, ultimately settling on the latter) after getting a diagnosis. I had tried these drugs back in college and early in my career to what seemed like great success, but this was a sideways experience... boring/monotonous stuff was easier, but it actually didn't conclusively help in situations where deep concentration was required. The effects also rapidly tapered off doing it on a daily basis and it didn't feel great for my health on the whole, so it eventually turned into something only done when needed, but ultimately it just seemed to be less and less effective.

Also tried Straterra and had a bad reaction to that, so decided to just go without and manage. As a mid-40s adult I feel like I have all sorts of ways to cope that I didn't make consistent use of when younger, esp. using GTD tooling and taking copious notes to keep things on track.

Interestingly enough my 'normal' concentration off these drugs seems to be improved... as if they were training wheels.

Barkley considers meds necessary but not sufficient. The second part is "to design prosthetic environments around the individual to compensate for their EF [Executive Function] deficits." [0] For those not following the ADHD conversation, Executive Function refers to a set of: Nonverbal working memory, Internalization of Speech (verbal working memory), Self-regulation of affect/motivation/arousal, Reconstitution (planning and generativity). [1]

0. This is how you treat ADHD based off science, Dr Russell Barkley part of 2012 Burnett Lecture: https://www.youtube.com/watch?v=_tpB-B8BXk0

1. https://chadd.org/about-adhd/executive-function-skills/

Barkeley is such an important person in the ADHD community and I wish more people knew about him and listened to him.

this 100 times. Meds help tremendously in being able to design and using coping mechanisms and good habits. For me in particular, meds are keeping at bay my secondary depression and anxiety. Before I was spending so much energy on managing my mood that I had no energy left for managing my tasks.

I have family members with ADHD and it's been a journey of years to find the right meds and the right dosage and the right timing. It's also possible to be diagnosed with ADHD but have something else (like bipolar) and vice-versa. We have the "luxury" of decent health insurance, so have been able to make this journey and still afford food and rent.

The wrong meds can have no effect; be much worse than not taking at all; have benefits early in the day and then negatives later on; side-effects; etc.

They can also be expensive. I know several people for whom medication is coffee in the day, weed at night. Actually cheaper.

Interesting!

My doc also told me that everyone is different, and not all medicine works for everyone and most medicine doesn't work at all for some people.

That's why I didn't put emphasis on medicine alone, but I do think it's important to seek for professional help in general. It was important for me, but now I understand it's not a silver bullet.

Thanks a lot for sharing, as it put some new perspective for me and others in this thread.

Did you work with your Psychiatrist to try different meds? There's a lot of different types, including some that are not stimulants.

I had 3 different types that didn't work for me until I settled on an extended release dose of an aderall derivative.

I tried Vyvanse, Focalin, and Clonidine. Vyvanse seemed to work the best. I was offered the chance to try Methamphetamine but didn’t due to social stigma.

There are multiple types of medication for ADHD and as part of working with a psychiatrist they should be trying different options for you. It took me 3 different tries before finding one that worked for me.

> I got on meds for ADHD and they objectively didn’t help that much.

There are different meds for ADHD. One not working isn't indicative of all meds not working. Neither are they all $300/month.

how long did you try the meds? in my first weeks I was definitely more confrontational and aggressive, but after two months I went back to baseline, or even less, while getting significant benefits on almost every other aspect of my life.

I always wondered why the aggression - for me it was mainly directed to situations where I needed to advocate for myself (and would "slip" before medications) while being less aggressive overall

Ask you doctor to try a different medication. Not all work the same. My wife had to try a couple before ending up on Ritalin.

Your pulse and emotions may have been elevated on the medication because they're mostly amphetamines.

After the first week or so this only happens if you are allergic or abusing then

Vyvanse was life changing for me. For all psychoactive medications your mileage may vary.

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