ADHD drug treatment and risk of negative events and outcomes

I literally did the thing you’re not supposed to do.

my psych kept giving me everything by Adderall. So I went to one of those online doctors and got Adderall through her.

Then I just told my psychiatrist that I have Adderall prescription and she took it over.

For the record, she’s actually really reasonable and I like her but very conservative about the stimulants. Which when I finally got them were a revelation. Medication that actually works.

Yeah, it's ridiculous. I've been taking medication for ADHD since the 3rd grade. Why in the good goddamn should I have to go in EVERY month for a refill for a medication I've been taking for over 20 years.

I've heard it argued that ADHD diagnoses should come with a social worker.

Every time I realize it's Friday and I'm gonna run out of medication because I forgot to call in the refill I think about that. Three day weekends are the worst.

One workaround I've heard is that you order every 30 days even if you forgot to take your pills one or two times. Any surplus pills go into an old bottle you hide in the back of a drawer. You only ever withdraw when you've fucked up your re-order.

The analogy I've given is having an asthma clinic at the top of Mt. Everest. If I could freaking get there, I probably wouldn't need it.

A friend referred me to a telehealth clinic where I could get in quickly instead of waiting for 6 months. They're dialed in to their patient care, too: I get a string of email and text reminders that I have an upcoming appointment. And contrary to some of the horror stories, my doc spent a couple of hours with me on the first appointment before coming up with a treatment plan. It wasn't a 5 minute visit where they through pills at me, but an actual genuine doctor's appointment with someone doing due diligence and customizing a care plan specific to me, with alternatives to try if my insurance didn't cover the first line of meds.

I feel so lucky that I got connected with the right people, after a series of PCP visits and a psychiatrist referral who diagnosed me as having anxiety. Oh, you think? Yeah, I'm feeling pretty anxious that my boss is annoyed at me for having all the signs and symptoms of ADHD and how it affects my work.

Life is easier now, I tell ya.

This doesn't even account for the perma-drama due to the artificial shortage generated by the DEA. Getting your prescription filled, if you manage to wrangle one, often requires hours of calling around which pharmacy can fill said prescription.

And you get to do that every months. And you can't get a prescription earlier, you have to wait a full month. So, essentially: Right when you're forced off your medication that helps your executive function, you need to exercise large amounts of executive function.

It's massively stupid.

> handle rejection poorly

Off-topic but recently I found out about Sensitive Rejection Dysphoria, its not officially recognized as a thing but it is in active study now, and very related to ADHD, and tbh I wish I knew about it sooner

Funnily enough, my journey here in Spain was almost the opposite.

I didn’t know until my thirties that certain issues with executive dysfunction could be caused by adhd, as it is not a widely known disorder particularly for adults.

After I contacted a professional however, and once the relevant testing and assessment was finished, my doctor strongly recommended trying medication as part of the therapy. The whole thing took about $200 for the assessments and medication is cheap. Absolute life changer btw.

Highly relevant reading, from a psychiatrist who prescribes ADHD meds: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

TL;DR they believe the most responsible thing to do is to give everyone Adderall if they're seeking Adderall, with minimal gatekeeping, because the risk of not giving Adderall to someone who needs it far outweighs the concerns of giving Adderall to someone who doesn't need it.

Yeah, the journey to stimulants for me was long and painful, with a lot of procrastination on my part. And now even having them prescribed it is a pain dealing with the bureaucratic / expensive nightmare of USA health insurance.

This is actually less of an issue for technically inclined folks, since we can get our initial fix from the darknet using cryptocurrency, and then getting more consistent at planning and sticking to routine becomes cognitively easier. This also has the advantage of the fact that researching darknet is actually quite fun and stimulating, sort of like a difficult video game with lots of little tricks and secrets.

That's how I started my treatment, at least.

There are non-stimulant ADHD meds as well. Most of us don't get a chance to try all of them.

In fact, I was surprised to learn that Adderall is highly illegal in many countries, including Japan and South Korea(), both of which have a higher standard of healthcare, and a much longer life expectancy, than the US does. In other words, they're not anti-health.

() In theory, you can bring Adderall into South Korea with your American prescription. In practice, not really.

I agree, except I've been much happier with Wellbutrin. After getting through the initial insomnia a few years ago and switching to normal release, not extended, I have good focus and don't have tremors or back pain like I did with stimulants.

This is exactly me.

Exactly.

I got gate-kept with a massive ten page plus questionaire to fill out. Got half way through the laborious free form text responses. Came back the next day and none of my work was saved.

Gave up. Haven't ever gotten back. Because...

> People with ADHD are horrible at following through and handle rejection poorly

The form my GP gave me (after telling me I probably wasn't) sat in my car for six months, untouched. Went private. No regrets.

Yeah, requiring a check in every month to keep getting a prescription always struck me as an ironic requirement when treating people with ADHD.

> Welbutrin (which works poorly, if at all)

This depends on the person. ADHD medication by itself doesn't work nearly as well for me as ADHD medication+Wellbutrin.

funnily, i had zero issue getting vyvanse after a nearly 20 year medication gap, and being hugely successful by most metrics. i went to a psych, did an eval, and got medication. i know there are issues, but it’s interesting how different people’s outcomes are

And most people who claim to have ADHD don’t have ADHD. But apparently thinking you have ADHD makes you feel better about doing things you don’t enjoy.

Hmm. That hasn’t been my experience. Getting adderall or Ritalin was as easy as saying, “I’m having trouble concentrating.”

The system isn't built for people who need it to be a little easier

s/providers/insurers/

> because doctors fear losing their license like so many did during the pain pill debacle.

Which is understandable after the monumental pain and damage oxy caused to families everywhere.

The study found substantial risk reductions with ADHD medication: 38% for suicidal behaviors, 30% for substance misuse, 28% for criminality, and 20% for transport accidents - with even stronger effects for recurrent events.

This is a common belief people have, especially those with mild ADHD or those who wish to be dismissive of the disorder.

Unfortunately, in reality while there are some very limited advantages, as a whole ADHD is a whole-brain dysfunction where your neurons are literally incapable of maintaining their level of operation as long as in a healthy person, with ALL of your executive functions - all self-regulation, planning, delaying gratification, emotion management, etc - being impaired across the board, not just tuned differently.

Hyperfocus is commonly brought up, but neurotypical people experience it as well. Less often, but also without the compulsive loss of control, while being able to maintain a higher level of effort and work without it at all times.

People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things, they're just incapable of focusing it when necessary, not to mention they drift off and get distracted instead of staying watchful far, far more.

That's before getting into the fact that ADHD correlates negatively with pretty much every single life outcome, not just those depending on society - things like neurodegenerative disease, cardiovascular and metabolic problems, sleep disturbance, etc.

I understand the desire to frame things you're experiencing in a positive manner, but... in this case, it doesn't really work, and I somewhat resent it personally, as it makes people less likely to take ADHD as seriously as it needs to be.

"The problem(s) mostly relies with the modern way of life and what is expected from the society at large."

I assumed not just ADHD but a number of other psychological conditions are more about reconciling some individuals to this particular society. It seems baked into a lot of their diagnostic criteria, like how well one "functions" at school or work. Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.

ADHD is obviously a spectrum, (possibly on top of a binary), and more and more cases on the light end are getting diagnosed, which is, I have no reason to doubt, very helpful. I don’t know if the light end is a disability or a disease.

The heavy end of the spectrum, the lying on the floor suffering crippling bladder pain but unable to muster the willpower to walk to the bathroom and piss even though that would immediately fix the problem end of the spectrum, is a disease and a disability. I cannot picture an ancestral environment where this is adaptive.

Completely agree. People with ADHD are simply incompatible with many facets of mormal life.

Take school for example. If someone doesn't fit into the mass education model, they say they have attention deficit. That same person might then go home and hyperfocus on computer programming for 12 hours straight like a machine. It makes no sense.

The mass education model where hundreds of people sit on a chair listening to lectures for hours on end just isn't right for people with ADHD. Medications are just there to help cope with an imperfect reality which refuses to change for our sake.

If it's not a disability, then why can't I work on projects that I am excited to work on?

Sure, my ADHD experience is probably the impetus for most of those projects in the first place, but that doesn't help me get anything done, whether I want to or not.

It sounds like what really happened is that you found an appropriate amount/cadence of medication for your body. That's much more difficult than many realize, which is why each stimulant is sold with 5 different delivery methods: immediate release, capsule with drug dust coated in timed digestion substance, capsule with hole to pump via capillary action, skin patch, and the bonus prodrug lisdexamphetamine that metabolizes into amphetamine at the rate of digestion.

Too often the conversation swings between "meds are bad" and "meds fix everything," when the truth is way more nuanced

Isn't one of the criteria for something to be a disability that it makes it harder to function in the world you are in?

So it has to do with the mismatch between yourself (including the accommodations in place for you), the world and whatever is considered a reasonable life for a person in that world.

You might enjoy reading “The ADHD advantage” by Anders Hansen. He describes the evolutionary explanation as well.

Respectfully, my experience is very different than yours -- and I'm somewhere in between you and people who have it really bad.

ADHD can absolutely be a handicap. It might be that it's exacerbated by modern life's demands, but I frankly can't be bothered to care -- I live with these symptoms that I wish would go away, and I can't switch to some world that would work well with them.

And it's not rejecting myself or trying to be someone I'm not. I spent quite a while before diagnosis doing that. Getting treatment for and acknowledging the issues of ADHD is being more aware of who I am and what I need than pretending that things will work out. They don't, and they didn't.

And I know my experience isn't unique.

I think this is a nice attitude. I would say I do think it's possible to hyperfocus too much, I feel like I might have done that.

Where in Canada?

I had the complete opposite experience last winter in Ontario. I asked my doctor about ADHD, he had me fill two forms, set up an appointment with a psychologist, who after a couple weeks of appointments was ready to prescribe Atomoxetine (at my request since I wanted stimulants only as a last resort).

I paid for nothing in this entire exchange, and the meds are usually covered by an extended drug plan if you have one.

Try Frida. Online clinic that can get you from diagnosis to prescription in a few weeks.

This wasn't the experience of our family here in Ontario. Nobody but the family doctor involved.

There are nice clinics - I got my diagnosis in 2 working days and we started trialing stims on 3rd working day. It costed me 500CAD. The clinic is adhdvancouver.ca

Not saying it can't be the methylphenidate, but I would suspect it likely has more to do with your career than you might be giving it credit for. I don't know what your background is but, since you're on HN, I can make an educated guess and say you work in tech, which can both be a highly rewarding career but also one that can really drain the soul. The worst part about the soul-sucking is that our jobs are superficially very comfortable, so it's easy to talk yourself into just appreciating what one has and ignore your feelings.

I recommend giving up caffeine if you haven't done so. That alone had a much greater impact on my daily functioning than taking breaks from my medication. It took my body a week to recalibrate, but my mentality and my energy has been way more even throughout my days. The nice thing too is I can sometimes have caffeine when I feel like I can benefit from it and it actually has a positive effect rather than just keeping you barely at baseline for a few hours.

Wanna add my 2c here, I feel you strongly. I had a similar path, getting medicated in my 30s and feeling like it destroyed barriers I had been struggling with my entire life. But it has resulted in some negatives as well, like you mentioned.

My hypothesis is that people like myself, and maybe you, have adapted ourselves to being productive with our pre-medication brains. You can only do it at certain times, for short bursts, and in particular ways. It's not really in your "control" how it happens, so you come to terms with doing work when you can. Then, when you become medicated, you don't need to do that anymore. It's exhilarating. You can just work like everyone else does. The problem is that other people have lived their entire lives learning how to balance that kind of drive and we haven't, so we go overboard and grind ourselves down.

Additionally being on the meds all the time can fuck up your sleep. Sleep debt is no joke and the meds get less effective when you're tired ime. I've had memory issues as well and I chalk it up to the sleep debt almost entirely. The obvious answer is to take breaks, but it turns out you need to be able to effectively execute on the weekend too. There aren't that many viable time slots to take a vacation from responsibilities. It's such a faustian bargain and I deeply dislike that we're saddled with this bizarre maladaptation for modern life.

> On the other hand, if it led to my current situation it's probably one of the worst choices I could have ever made. I hate having massive holes in my memory like this, and being burned out this way is extremely difficult to bear

Considering the timing, have you considered the possibility of long COVID? I ask because the symptoms you describe are not typically associated with ADHD stimulants, but definitely are typical of post-viral syndromes [1].

[1] https://www.pnas.org/doi/10.1073/pnas.2426874122

When I first got diagnosed and medicated I pretty quickly burned myself out, too. When you spend your whole life basically unable to work in the way you want to, it can be intoxicating to finally be productive.

It's genuinely hard to describe how good it feels. But it's important to slow down and objectively evaluate how much work and time you are putting in, because burn-out is always a risk.

---

Edit to add - memory holes are also a pretty common effect of high stress levels. If you really got into work and doubled or tripled down on your effort once you got medicated it could easily be causing some of the effects you are experiencing.

It's possible that without the medication, you wouldn't have gotten burned out like this. But it's also possible that you'd have missed out on all of the benefits of being medicated and still gotten burned out anyway.

I don't know how old you are, or how long you've been on Concerta. But to provide a different experience to anyone reading this:

I too got (re)diagnosed in my 30s and prescribed Concerta. Rediagnosed because my mom then told me I'd been diagnosed as a child and she just never told me. Finding the right dose took some trial and error, and to be honest "the right dose" is something that will probably vary throughout my life based on how good my non-medication ADHD management is going. But for me it's been life-changing without burning me out, and it's been almost 7 years.

I also think even without the medication the diagnosis is worth it. It clarifies your life somewhat, if there are things you have struggled with that it explains.

I feel this. It's so very hard to manage one's medicated-ADHD productivity in a way that feels useful but doesn't burn like a white-hot flame.

My boss has been supportive and really helped me see the ways in which I was causing myself burnout, encouraging me (as a senior tech IC) to write things down, do more knowledge and skill transfer, and delegate more. That helped me a lot.

What I used to think of as "autonomy," which I valued so highly, following the shiny problems that made my brain happy, was more lone wolf behavior than I like to admit, and not serving me very well career-wise, as it was hard to document or sell what I was doing.

I also had to privately learn how to pace myself, setting realistic, appropriate and prioritized daily goals (nevermind the arm's-long TODO list). Checking myself against those, aiming for better goal-setting each day. Being able to close the laptop when it's done. I never really had a sense of "done" before, I had a lifetime of feeling always-behind. There's this peace, though, that comes with realizing that you _can_ prioritize effectively, do the things, then rest. That peace can become its own reward, which is bananas to me, because my unmedicated brain would never have felt that.

Speaking of which, I might never have had the head-space to work on things like this if I hadn't gotten medicated five years ago. My career has improved and stabilized. For the first time in my life I've stayed at a job for more than three years. Been promoted. Been able to see a future that doesn't just involve running from a job when things get too hard and starting again.

The side effects can be a beast, though. I wonder to myself how many more years I'll be able to manage them.

I wish you the best in finding your way back to a place that works for you.

This happened to me over a decade ago. Medication was a godsend, and then I burned out. I remember sitting down to do work and not being able to start anything so I would pull up a dumb io game.

So I went off, and for the next 5 years I still couldn't focus. It got worse actually. I did a lot of caffeine. After COVID I started to work out and then suddenly for the first time ever I could focus. As long as I don't do caffeine, workout, and sleep I am sharp. I've done great work in the past couple years but I do feel cheated that Adderall stole time from me. I wonder where I would be with my career if I hadn't burned out.

> Now I'm incredibly burned out

My SO has severe ADHS from early childhood on and gets medicated (first ritalin, now elvanse). She is always stressed because she has a guilty conscience; she does more things every day than she has time for. She has sleeping problems.

It's such a fast-paced lifestyle that it quickly takes its toll, and it's not as if it gets better with age. Its very hard to maintain a healthy lifestyle while permanently being "all-in" into something.

Had a similar experience with adderall. Worst decusion I ever made. Totally changed my personality. Made we eccentric, obsessive, hyper sexualized. Fucked my sleep schedule, gave me a weird kind of speech impediment occasionally, etc, etc, etc.

Also found out after I quit that it also probably contributed to an anuersym in my heart.

Highly recommend anyone to stay the hell away from amphetamines if at all possible.

The medication can help you do things that are beneficial and useful for you better.

It can also help you screw yourself more thoroughly, if you use it to do bad things for you.

Same, real life Flowers for Algernon.

If that helps, I get burnt out on just red bull already...

In addition to confirming and quantifying my more obvious and problematic symptoms, the reaction time tests clearly showed my very mild impulsivity. Nobody I know would call me impulsive, and in the questionnaires I’d have said I wasn’t impulsive, even though I had a sense I was subconsciously resisting that tendency. The tests were too quick for my usual masking reflex, and while I was still ultimately diagnosed with the inattentive variant, the tests revealed a textbook symptom I wasn’t even aware of. Quite illuminating.

Just looking now at his channel now. I’m happy to see a critique of Gabor Mate’s ADHD theory in his playlists.

I’ll watch that for sure as I’ve always felt very uneasy, and a little indignant, listening to Mate talk about ADHD; but I’ve never been able to put my finger on why exactly!

He has excellent lectures on the science and history (hundreds of years which was surprising to me that it had been studied formally for so long yet is still a weird and new “American disease” in Australia—-even considering how backwards and slow we are down here).

That kind of clarity can be life-altering

Your hypothesis is contracted by mountains of high quality scientific evidence. ADHD is a well-defined condition and there is an accepted way of diagnosing someone with it that effectively divides those with the condition from those without it. Stimulant medications may help many people to feel and be more productive, but that does not imply that people who meet the criteria for ADHD do not represent an identifiable group.

I highly encourage you to browse the Consensus Statement on ADHD, referenced below. It’s a compilation of 202 facts about ADHD, accepted by a global consensus of experts on ADHD.

Faraone, S. V., Banaschewski, T., Coghill, D., Zheng, Y., Biederman, J., Bellgrove, M. A., Newcorn, J. H., Gignac, M., Al Saud, N. M., Manor, I., Rohde, L. A., Yang, L., Cortese, S., Almagor, D., Stein, M. A., Albatti, T. H., Aljoudi, H. F., Alqahtani, M. M. J., Asherson, P., … Wang, Y. (2021). The World Federation of ADHD International Consensus Statement: 208 evidence‑based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818. https://doi.org/10.1016/j.neubiorev.2021.01.022

>My hypothesis about this for a long time has been stimulants help everyone be more productive (with some tradeoffs)

Of course they do. They're stimulants, that's what they do. Some people just need them to be closer to normal, or whatever's considered normal in post-Industrial society. Modafinil promotes wakefulness in everyone, not just narcolpetics. Anxiolytics calm down everyone, not just the anxious, and psilocybin makes everyone feel euphoric, not just the depressed. It would be weird if stimulants only had an effect of ADHD patients.

> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.

I don't think we really understand it yet, but it's not something most people have. As the article mentions, people ADHD have a higher rate of transportation accidents, lower life expectancy, higher crime rates, higher addiction rates, etc. The differences show up in brain scans, performance tests, genetic biomarkers, heritability/twin studies, etc. Whether you think of it as a disability, or brain type, or whatever - ADHD is something real.

> Probably something like this was lost when people stopped smoking, obviously beneficial for health - but a huge amount of the public was taking stimulants regularly via nicotine until relatively recently.

Yes, and this is possibly why 35-55% of adults with ADHD smoke today, compared to 19% of the population. Studies have shown that nicotine is helpful for everyone but particularly helpful for those with ADHD. Nicotine-derived formulations are still being explored.

That’s a good point on the nicotine.

I found out that i have ADHD through a process of dealing with a hearing issue - I have something called auditory processing disorder (APD), which means while I have excellent hearing, my brain has difficulty processing speech in high noise environments, especially with multiple people or frequencies that correlate to women. ADHD and autism spectrum disorders are highly correlated with it.

A friend who is an audiologist was out with me at an event and basically spotted the adaptations that I had adopted subconsciously over my life (I’m in my 40s). I then got tested and confirmed. It’s likely a result of many consecutive ear infections I had as a kid.

When reading up on APD, the literature describes stories of various people… and it was like looking back on a story of my life. The ADHD correlation is thought to be related because of the way the brain develops (or doesn’t) in the presence or absence of stimuli.

I say this because it would be easy to dismiss my scenario. By most measurements I’m successful and doing great. But had I known or maybe been treated in the past, certain difficult aspects of my life would have likely been managed better or avoided. Brains are complex, and it’s important not to dismiss that problems that people have.

> ADHD is kind of a weakly differentiated diagnosis that could apply to most people

I don't think this hypothesis would survive a look through the literature on google scholar. ADHD is associated with huge increases in risks of suicide, substance abuse, homelessness, accidents, crime, autoimmune disease, etc etc etc. It's not just "damn I find it hard to focus sometimes".

I don't know if the evidence is more than anecdotal, but I've read that ADHD smokers who are taking adderal have to increase the dose of their treatment to remain functional when they quit smoking.

I've been taking nicotine patches for half a year now, with great success (and it is available OTC unlike other stimulants). Nicotine in itself isn't toxic at these doses (7, 14, 21mg), it's a cool life hack :-).

> and ADHD is kind of a weakly differentiated diagnosis that could apply to most people.

It's not, the problem is that it sounds like it because ~everyone faces some (way) lesser version of the struggles ADHD people face literally every day, many of whom probably do have some subclinical degree of executive dysfunction.

My personal thumb rule is that somebody is capable of finishing school, autonomously managing their living conditions, finding and keeping a job, and having at least a modicum of social life at the same time, they're high-functioning enough that they almost definitely don't have ADHD, or only some ultra-light version of it.

> a huge amount of the public was taking stimulants regularly

Anecdotally, 100mg of caffeine combined with 200mg of L-theanine makes me maybe 25% as productive as I am on 5mg of Adderall, which is actually enough for me to function most days.

I grew up with this belief (not your belief; it's a common one) and it hindered me from realizing I needed help.

I regularly have people doubt my diagnosis to this day. If we talk about it more, a lot of them _continue_ to doubt me even after I explain masking.

Again, it's not just your belief -- I grew up hearing radio jockeys calling ADHD "bad parenting disease" -- but this belief is harmful. It ostracizes people and discourages help for a disability that causes measurable harm.

I've also heard something similar. That maybe the reason so many are diagnosed today[0] is they were self-medicating via smoking.

[0]: Which requires it to be affecting your life -- NOT that you actually do or don't have it and are dealing with it okay. Diagnostic criteria is that it must be hindering you in a job/school/relationships/etc.

Stimulants will stimulate anyone with a nervous system. It's just that ADHD patients will respond disproportionately well to the treatment, thereby justifying the risks.

> that could apply to most people

what does that mean? most people have more than 99% identical genes yet we are not clones.

most people don't have a perfect BMI of 23.5 (or whatever is the middle), yet there are clear pathologies on the BMI spectrum, no?

most people could better manage their lives and emotions but most people don't have that severe problems.

the usual diagnostic criteria simply does not apply for most people. the cutoff is pretty high. (problems in multiple spheres of life present before the age of ~14 -- though there's brain damage induced ADHD too)

but of course most people would benefit from some of the ADHD management strategies (which is better time management, planning, organizing things and consistently putting them into their assigned place, cognitive reframing of pervasive bad thoughts, getting a coach, etc.), but at the same time most people would not benefit from being on the usual ADHD meds (maybe they would benefit from some much smaller doses)

The science doesn’t support your hypothesis btw.

It's a performance enhancing drug for a lot of people. So many of my colleagues are on it.

That's interesting. I'm in the US and my doctor prescribed Adderall for me. While I'd obviously never argue that a drug can't be abused, for me personally, I can't imagine abusing Adderall more than, say, ibuprofen. It's not that it's unpleasant to take it, but that it has zero pleasant qualities, either, except that now I can pay attention to things that don't fascinate me. It doesn't feel good. It doesn't (seem to) change my mood. Maybe I feel a little more awake after I take it, but that's also the same time of day when I have my morning coffee, and I can't tell you which has more of an alertness effect on me.

It's a stimulant. I have no doubt that someone's found a way to abuse it. But for me, I can't for the life of me imagine why anyone would want to. Other drugs like coffee or beer are much more pleasant. If I realize I forgot to take my daily Adderall, oops! Guess I might not get as much work done today as I'd planned, but not to the point where I'd go back home to get it, and I certainly wouldn't feel a craving or desire to.

Urg, short acting Ritalin is the absolute worst. There are so much better stimulant meds out there.

> is a red flag when some patients will ask specifically for Adderall, as the potential for misuse is much higher. And for him, it was a last resort.

This is so stupid. It's so much better of a medication, the potential for addiction and abuse at therapeutic doses is minimal to none, and yet healthcare systems around the globe are continuing to avoid prescribing it. Ugh.

Your experience honestly highlights just how wildly inconsistent ADHD care is, even within the same country

And to add one more semi-interesting bit to this, I initially received my ADHD diagnosis after participating in a clinical trial I heard about on the radio living in FL in the early aughts. They were thorough in screening but I never did find out what group I was in or whether I was given the medicine or placebo. They were supposed to disclose that to us so many years after the study concluded but when I wrote in to find out, I was told the records were not kept and the clinic that had done the test was no longer operating. So who knows what I took for all those months. Some new experimental medication that never made it to market? Or a sugar pill?

Only personal anecdata, but I’ve observed that I’m far less accident prone since I was diagnosed and have had consistent treatment. I noticed it without prompt, and it never occurred to me before that there would be any correlation.

I’ve also noticed I’m much less accident prone since I’ve been sober, which came a couple years later. I couldn’t say for certain which event correlates with a more pronounced improvement, but both have been quite pronounced.

That said, yes, I can still relate to bruised shins! I’m less accident prone, but still pretty far from immune.

Why?

I don't really disagree with you but I wonder how the thwarted sense of "my body in the world" is so connected to ADHD while not being connected at all to executive functioning (which in my perception is what amphetamines help with).

It only didn’t help with the first incident of accidental injuries (makes sense, almost everyone has one early on regardless) but it was still also associated with reduced recurrence

Currently unable to remember why I have a bruise on my ribs. I know I walked into something. Methylphenidate HCL doesn't help with that.

honestly I only find that happens when the medication is wearing off. I'm much more spatially aware when its working and that leads to fewer accidental injuries, I see a huge difference in my driving, parking, etc.

I listened to that episode when it first came out, and was quite surprised that first of all it wasn't just another "how adhd is actually a superpower" nonsense click farm thing, which seem to be pervasive, but secondly how clear it was that if Trevor didn't find the success he did, he'd very clearly match the normal criteria for needing stimulants because he'd probably be hampered in every day life due to having it.

Additionally, I had the opposite impression that you did, and as an early 30s man it nearly made me tear up thinking about how much the real struggles described by both of them resonated with me.

Strong agree, especially with how it has interacted with social media since 2019/2020, but it is a bit impolitic to say.

That reminds me of an article I read which claimed that being diagnosed with ADHD will prevent you from being a commercial pilot. Pilots will avoid getting diagnosed and medicated because it will kill their career, even though medication may make them safer.

(I suspect ADHD pilots would handle takeoff and landing very well, as well as emergencies, but oh god the checklists and schedules and that whole middle part of the flight…)

Before getting onto Vyvanse, I couldn’t drive more than 30 minutes without wanting to stop for a coffee and then needing a red bull to keep going… now I can drive at least a few hours continuous without breaks.

The World Anti-Doping Agency, who defines what a performance enhancing drug is and if it's banned in sports, grants Therapeutic Use Exemptions for methylphenidate and its siblings. This is despite some countries using other medicines as first-line treatment for ADHD that aren't banned by WADA.

The justification is that treatment for people with ADHD markedly reduces accidents and suicidality, and that banning the drug outright would do more harm than would come from liars getting the drug and harming sports.

I've been diagnosed and medicated since elementary school. In the time since, I've been involved in two car accidents. Both times I had forgotten to take my meds, which is a rarity for me.

And yet it was easier for me to get a driving license being unmedicated than it would be medicated. In either case I'd need to pay a bullshit fee for a psychologist to glance at me and rubber stamp a form, and take an extra exam which is completely trivial to pass. In the case of being medicated I'd need to additionally get my GP to sign off on it as ADHD meds have the infamous "yellow sticker" telling you to not operate heavy machinery. If I ever did get in an accident on medication the insurance companies would make a meal out of it anyway, despite it being signed off.

The whole process is a complete and total scam that's not making anything or anyone any safer.

Haven't read the study yet, though I've been associated with research at the same department. Usually the study design is using matched controls which negates the effect of the parameters you mention. Sweden basically has free healthcare so there is not much difference in access to care, and controlling for the potential residual factors makes studies results quite stable.

From the West here, but anyway.

> But the cultural stigma? Folks just call it laziness or blame "village people" (supernatural enemies).

Funny, my daughter just stops my explanations after circa one minute, abruptly, saying that her brain just does not listen anymore and there is no reason for me to continue. Which is blunt, but kind. I understand and stop talking, that's that. We can do that since we know our limits, I would assume that Africa in general is more attuned to accepting people as they are? For my daughter it makes a world of difference that she can communicate her ADHD symptoms. The medication are there to make ADHD people behave like "normal" people, but acceptance in the other direction could quite helpful as well.

With some luck and effort you can have some effect with diet. It would be nice to see a graph between the rise of white flour and the amount of ADHD in the world. I would love to step off medication, but it's not doable without switching to sufficient combination training and good diet, I have neither now :) As they point out in the article it can be great to find out your vitamin levels to address shortage.

> These types of complex carbohydrates are less likely to spike your blood sugar levels and help keep you feeling fuller for longer, which may help improve your focus and attention.

> By avoiding simple carbohydrates, like sugar and white flour, you may reduce specific ADHD symptoms. [0]

I just finished fixing my bike (Suntour Perfect) and have started taking it on smaller trips, hopefully that will be _my_ way to a more stable day to day. [1]

[0] https://add.org/adhd-diet/

[1] https://i.ebayimg.com/images/g/NxQAAeSwpg1odZbS/s-l1600.jpg (about the same bike)

I've also noticed that fasting has a positive effect in this way. It wouldn't be too surprising for the gut to play a role in ADHD experience since it is involved in regulation of various neurotransmitters.

I suppose well-managed drug abuse would not negatively affect their careers either, but I think it's a good thing you can't become a pilot or similar with certain conditions.

With continuous use or a one-time dose? What was the dosage?

It's not necessarily that black and white, it can be both. When my girlfriend asks me to do the dishes quickly and I've still not done them after an hour because something objcetively less important was more interesting to me - then there's a problem as it's a fair request. The unconscious unhelpful thoughts and behaviours you develop because of ADHD work against you - because at the end of the day you also have to take care of yourself (cut your nails, floss your teeth, wash your clothes), not only the household. The connections you have with colleagues, friends, family and yourself are something you have to manage consciously - either with sports, meditation and journaling or medication - or both! It's easy to say, society is maladaptive. you could say, let all these adhd people just do creative work or teaching - but then they still have to organize and care for themselves. Alternatively give all those diagnosed a free pass to not meet demands and expectations of society and give them a basic income. I'd rather help myself or let myself be helped to meet the minimum demands and expectations of work and significant others - the alternative is: he can't be a responsible human being, cannot be asked to do a simple job, as he's always with his head in the clouds. Of course ADHD is also a superpower, but a handicap as well (to me).

> The question I pose to the “it’s a disease, medicate it” crowd is; is the person maladapted or is the culture maladaptive?

Overwhelmingly the former in my case. I'll have projects that I desperately want to work on for weeks or months, but just can't bring myself to actually get started on without the extra push from Vyvanse.

It would be nice if society could be just a bit more accommodating for people with ADHD, but that would do nothing to fix this problem for me.

When I was on Kaiser, it was an absolute nightmare trying to get any traction. They had me do a computer test and, I guess because the results of it (which aren't disclosed to you) did not indicate ADHD, they would not consider the wealth of documentation I had ready to take a look at my old school records. I asked for a second opinion and the next psychiatrist they assigned to me was aloof and refused to consider anything, either. They did give prescribe me bupoprion which did absolutely nothing for me (though I have heard it works for others).

I'm now on a PPO plan and have been using Vyvanse for over a year now. It's lead to a dramatic improvement in my quality of life. I grieved for the time and opportunities I had lost due to not having been diagnosed and treated in childhood.

HMOs have a lot of upsides, but Kaiser's behavioral healthcare is awful (at least in the DC Metro area) and there's not much recourse unless you want to/can afford to pay out of pocket.

There's so much cynicism about ADHD even existing, even among healthcare professionals. Any time on HN any mention of ADHD seems to invite a lot of cynicism as well. That, compounded with that one of the most effective treatments for it is something that pretty much everyone can see a positive effect from (stimulant medication), makes it really difficult to navigate.

I hope that you can find a better option because it seems like Kaiser is just very antagonistic towards ADHD.

I didn't get a diagnosis at Kaiser SF, but I was able to get meds through them. Maybe this will be of use to you.

I was diagnosed by a non-Kaiser psychiatrist I found on my own. After trying different prescriptions, we eventually settled on Concerta. I stayed on that (and continued seeing the same psychiatrist, whose service I paid for out of pocket) for about 4 years.

Then my psychiatrist had some family stuff come up and had to move out of California. Since she was no longer going to be licensed here, she couldn't keep prescribing my meds to me. But she was able to write a letter describing my situation and laying out how she'd arrived at the prescription I was on, with particular emphasis on the fact that she hadn't seen any evidence of misuse on my part. I gave that letter to my Kaiser primary care doctor, who agreed to take over the prescription. After that I was able to get my meds from Kaiser each month without any issues.

I imagine this kind of setup depends on your primary care doctor; I may have just gotten lucky with mine.

Too many psychiatrists do very little continuing education in their practice. I have heard more than a few try to asset that ADHD can only be diagnosed for children.

As if a neurodevelopmental disorder just magically vanishes when you hit age of majority.

It's pretty wild that despite it being a disorder that has been documented for hundreds of years, people still make the argument that people are just lying.

This is exactly my experience. I got diagnosed as some variant of bipolar 9 years ago and put on a mood stabilizer, but the symptoms never really fit. I’m in general high functioning and got great grades up through postsecondary, didn’t start really having a problem until I started experiencing burnout after having kids during the pandemic. Got evaluated for ADHD, psychiatrist focused on childhood symptoms. Refused to prescribe anything for ADHD because ADHD meds can cause manic episode in bipolar patients, they put me on Wellbutrin instead. Wellbutrin (which affects different people very differently) caused me to have a crisis and spent a week in inpatient care at a non-Kaiser facility.

It was the best thing that has happened to me in years. Inpatient psychiatrist disagreed with the bipolar diagnosis and said that inpatient care was a safe space so we could try Adderall and a different antidepressant (Lexapro). On Adderall I feel calmer, less anxious, and if I’m tired it actually puts me to sleep, which is all in line with ADHD patients. I can focus at work again and have my life back.

I don’t feel like I’ve “lost” anything on Adderall, I would describe my experience with ADHD as having a buggy thread scheduler that would overallocate CPU time to background threads. On Adderall I feel like I have control again. I can still daydream, but all 5 trains of thought are not trying to enter the station at the same time.

I’ve had 3 different Kaiser psychiatrists and all have been sub-par, refusing to re-visit prior diagnoses, being aggressive and overly rigid in their own opinions, and sometimes just being plain incompetent. My recommendation is to seek mental health care from somewhere outside Kaiser that accepts Kaiser insurance. Kaiser’s mental health division is oversubscribed and probably underpaid. Overall our experience with Kaiser has been that no matter which division you’re dealing with, you have to be pushy and advocate for yourself or they’ll just slap the easy label on you and throw medications at the problem that may or may not actually address the root cause.

I’m very open about my experience because mental health issues are highly stigmatized in this country and there are a lot of people who don’t get the care they need. Accepting that I needed inpatient care was one of the most difficult things I’ve ever done, but coming out the other side it was nothing but a positive experience and I feel like I have my life back.

I made an account just to post this as I’ve gone through something similar. Get a formal psychiatric evaluation done out of network by a neurologist who specializes in ADHD. The exam will take a few hours and they will send you a full report and diagnosis. This paperwork will help you a LOT. I’ve used it multiple times when I’ve had difficulties getting care and was well worth the time and money.

Try to talk your doctor into gaunfacine. It was an attempted BP medication that had stronger action on the prefrontal cortex, reducing rejection dysphoria (which exacerbates executive function issues). At the very least it might make it easier to confront your doctor about not prescribing stimulants. It's also compatible with Wellbutrin.

Downside is you have to absolutely avoid grapefruit unless you want to find out what bradycardia feels like.

I had pretty much the exact same experience even with a childhood diagnosis and extensive records indicating I only responded well to stimulant-based medication.

The whole process became so burdensome I just gave up and now I self medicate with Nicotine pouches.

Not proud of it and probably not the best alternative but it helps me focus and keeps me out of the stress of the constant back and forth that healthcare providers put you through.

> Curious if anyone has gone through the process of an adult adhd diagnosis at Kaiser SF.

Yep. It appears to be different by region. When I left the bay area and moved to a different kaiser region, they didn't accept any of the medical history from the bay and I had to start over again. Yes, I did have the prescribing pshyc from the bay area send the detailed clinical notes to kaiser but because I didn't take _their preferred_ computer diagnostic tests, I had to start over. Nevermind that the psych I was seeing in the bay area has been treating ADHD since Reagan was in office, the computer test was worth more than the medical professional's experience and opinion!

That makes me want to scream on your behalf.

"I believe in my heart of hearts you suck at your job as a psychiatrist."

try a nicotine patch

I'm confused and concerned. Are you suggesting that adults - doctors - should be... helping... children... get laid...?

That matches my intuition, but has there actually been any proper research on this? I failed to find any now.

I find the effect very short lifed personally.

Thanks