Notes on Managing ADHD | Hacker News Reader

Notes on Managing ADHD

borretti.me

633 pointsamrrs330 comments

This is one of the best linked articles about ADHD i've seen on HN. Especially because it gets quickly to the most important point which often times is still neglected:

> The first-line treatment for ADHD is stimulants. Everything else in this post works best as a complement to, rather than as an alternative to, stimulant medication. In fact most of the strategies described here, I was only able to execute after starting stimulants. For me, chemistry is the critical node in the tech tree: the todo list, the pomodoro timers, etc., all of that was unlocked by the medication.

This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.

I have to add my 5 cents to that because I've experienced something I've not seen anyone else experience and I think it might be worth to share it with others that might struggle with the same.

I had various neurological issues for the past 10 years, some of them common like visual migraine auras, GAD, panic attacks, and some of the less known and frankly hard to describe - visual snow, poor night vision, problems with adapting to light/dark places, constant fatigue, over stimulation (pins and needles over the whole body when overheating, as an example). On top of that, ADHD and I was really afraid of any and all kinds of medication, especially mind altering ones.

At one moment, I was in a really bad shape and place mentally and I decided to get professional help and start medicating, as I felt nothing else can help me anymore. And believe me, I did try all kinds of therapies, exercising (how do you do it with constant fatigue?), mindfulness and meditation (closing eyes when stressed was horrible experience for me!), nothing helped.

Look, you can tell me it's placebo or whatever, but I started on SNRIs and later on stimulants for ADHD. It took me _2 weeks_, to cure 80% of my neurological issues. It was almost like someone flipped a light switch in my nervous system. I still can't fully believe it or even try to understand, but my theory is that I've been genetically destined to have these problems, and "just trying hard enough" was not enough and would've never been enough.

SNRIs cured my neurological issues, and stimulants like Ritalin gave me willpower to start making positive changes and for the first time - start making habits. I believe, at least in my case, it would've been impossible without medication, or it would take me half my life to get to a place where I would've felt comfortable with myself and my problems. I believe my life is too short to fight with all of these issues alone, and I'm really glad I did start that.

tl;dr: medication gave me my life back, not just from ADHD but from variety of other issues, that ADHD just exacerbated. Please do try medication, it's not a one way door and we humans don't have infinite willpower to deal with all the issues on their own.

Absolutely. If you're having problems, please consult a doctor! Medicine can't fix everything, but there's a whole lot that a good doctor can help with.

If you had diabetes, you wouldn't feel hesitant to take insulin. It's not a moral failure. It doesn't mean you're weak or bad or a disappointment. It just means you have a medical issue that can be treated. Well, same here.

In a similar vein to "try medication", I'd like to add "don't write all medication off after one doesn't work". The first seven medications I tried had basically negligible effects, and then the eighth one I tried (also an SNRI) had absolutely life changing effects within hours. I had the same moment where it seemed like a switch flipped and I couldn't believe the difference one medication could make.

A big realization I had was that doctors don't necessarily start by prescribing the medication that's most likely to help, they prescribe the one that's got the highest expected benefit to negative side effect ratio.

Thank you for sharing your experiences - can I ask specifically about your visual snow syndrome? Is it improved now? Totally cured?

I always thought any kind of SSRI or alike will make it much worse, as many people on reddit indicate they caused it for them.

I seem to be in opposite camp where SNRI actually lift like majority of visual snow syndrome, but that was not the only syndrome I had. I believe I had something more like HPPD.

Believe me, I was scared as hell as I thought these meds will make it worse, and I am really glad now that I did try them and they did work for me. I still have a really small amount of snowing, but I can ignore it entirely and carry on with my life.

Thank you, that's good to hear and quite surprising to me - I have a friend with VSS, and so far they've just been told that there is no known treatment for it. This will be something to look into I think.

Just chiming in to mark the importance of the seeing an actual physician part. To get diagnosed, prescribed medicine and have treatment follow-ups.

Problem is I'll keep putting that appointment off...

Heh, the psychiatrist who diagnosed me laughed a little when I showed up rushed and late to my first appointment.

The good news is that after you’ve been diagnosed, getting near the bottom of the bottle of pills is a great reminder to call the pharmacy for a refill. Plus… shortly after noticing that you’re almost out happens to coincide with the medication taking effect, so you’ll be in the perfect place to make that call!

Assuming you're lucky in a couple of different ways, as regulations around stimulants in many countries really screws people with the executive functioning issues caused by ADHD.

Running out? Your physician needs to write a new prescription, since they can't write one with multiple refills. Maybe your physician will write multiple with "don't fill before" dates on them, but overzealous regulators make many uncomfortable writing more than your next 28-30 days of medication.

Called your physician and got them to send your new script in? Hope your pharmacist isn't an ass, because some will straight up refuse to fill until the exact day you run out. Oh, and hope they have it in stock - because limits regulators and/or distributors put on ordering make the lives of retail pharmacies just buying these medications a special kind of hell.

I've been extremely lucky, my physician wisely writes me 28 day scripts so I can consistently time my requests for a new prescription be written, so every fourth Monday I send him a message and no later than Wednesday I get a text saying it's been sent to my pharmacy. The pharmacy I get my medication filled at doesn't treat me like I'm scum that's going to be selling my medication, so I can easily pick up my next 28-day supply a few days before I would run out if it works better for my schedule. But more than once I've had to play the game of figuring out which store actually has my medication in stock, and have the script pulled and resent to a different location....

I'm not sure if it's country-wide, or province-wide, or if I just have a good combo of doctor + neighbourhood pharmacy but in Canada here I generally get 6 months of refills on a prescription. They're still somewhat strict on when you're allowed to get refills, it's usually within 7 days of running out. My doctor does require an in-person visit before doing the next 6-month prescription, mostly because they want to monitor whether or not it's having any blood pressure effects, but my pharmacy is really good about pointing out that the prescription I filled has 0 refills left and that I need to book an appointment for that.

Yes, though it might take more than one to find someone who's actually qualified and up to date on evidence-based treatment of ADHD. There are some really ignorant physicians out there who are still peddling misinformation that's been debunked for over 20 years.

I wish I could go back in time and drill this into my own head. I evolved a large set of coping mechanisms that let me get by alright without medicines. I was putting food on the table and a roof over our heads. Still, it took a phenomenal amount of mental effort just to get started with critical things. I'd have all my tax receipts scanned in and organize and just needed to make an appointment to send it all to my accountant, but I'd sit on that until the last minute. I knew it needed to be done. There was no reason not to do it. I wanted to do it. I was ready to do it. And yet, I couldn't freaking do it.

It was the equivalent of running a marathon carrying an 80 pound backback. Yeah, with enough work you can do it, but you're not going to be setting any records.

Stimulant meds have been lifechanging for me. I'm not magically doing more than I was before. Those coping mechanisms took me pretty far. It's that I'm doing it all without delaying them until they became emergencies, which is what it use to take before I could even get started. My life is so much easier and less stressful now.

I took that backpack off and how I can run the same race as everyone else. And you know what? When you've been practicing your whole life with an extra weight on your back, and you take it off, sometimes it's surprising how fast you can go.

In before "of course it's easy, you're on meth!" Yeah, that sounds reasonable if you know nothing about ADHD. I've talked about this here before, but Aderrall has no noticeable stimulant effect for me at all. I feel a good cup of coffee much more than my daily meds, which is to say, not a lot. It doesn't give me extra energy or alertness or anything else. It just tells my brain, hey, did you know you're allowed to get started on things before they become emergencies?

Late diagnosis here (38 when diagnosed, now 42)… I agree with everything you said. I had an amazing set of systems and coping mechanisms in place to get through life without realizing I was playing the game on hard mode. In retrospect, the signs were all there my whole life but I just hadn’t had the realization.

Now that I’m medicated (methylphenidate), I still lean on those systems but they serve me very very well. I remember details much better than I did, but don’t always remember them long-term. The note taking system and habit that I developed years ago is now… supercharged because I am so much better about keeping good notes.

On the coffee/meds thing, I agree. I don’t get a buzz from the medication the way I do from coffee, but before my diagnosis I was drinking a ridiculous amount of coffee every day just to stay focused, with the associated buzz and jitters. I still have a cup or two of coffee in the morning, but drinking anywhere near as much as I used to is pretty much unbearable.

Wow I could have wrote this exactly excepy for a 1 year difference in diagnosis.

It's hard to reconcile with how difficult it was previously. Life on hard mode is a term ived used too. I try to think that it was all to make me stronger for the second half of my life, but I still regularly wonder what could have been.

One of my favourite lines: “I could solve differential equations all day long, but I couldn’t remember to pay my phone bill”

To quote Ron White, "I'm smart, but you can't prove it on paper."

Heh, my undergrad transcript is so funny to look at in hindsight. Great grades in the hard courses, terrible grades in the easy courses. Did well on the final exams for all of them, couldn't be arsed to do the homework for the boring ones.

Please stop telling the world about my school experience!

One time I realized I hadn't gone to my intro chemistry class yet that semester and had a test that day. I went, bluffed my way through based on what I remembered from high school chemistry, figured out mid-test how to calculate rate-limiting reactions, and aced it. My then-girlfriend, now-wife was so incredibly annoyed with me about every bit of that. "What do you mean, you hadn't gone to class, ever? And that you still aced the test?!"

And I also failed a comparatively easy general ed class because I just couldn't convince my brain to care, even though I know I needed it and certainly didn't want to take it a second time.

Heh, yeah… I still occasionally have nightmares about something like that happening. Just completely forgetting about being registered in a class and walking in half-way through the year.

Had a midterm for a class I did actually like that went sort of how you described. I prepared for it a bit and was sitting around with some friends killing time before the 2pm exam. It’s about 1:40pm, I figure it’s time to head over. Go to the course website to find which room the exam is in and discover that the exam started at 1pm. Run over there, get there at 1:50pm, and finish the exam before the 2:30pm end time. Hand it in, the professor knew I’d been really late and had a weird look on his face as I give it to him. He looks it over, smiles, and says “I was going to offer some extra time for you because of the mix-up but… looking at your answers here… I don’t think you need it! See you on Thursday!”

I believe every word of this because I could absolutely see it happening to me.

ADHD cheers, friend. I'm proud of us for making it this far.

Perfect GPA in computer science despite playing games as much as possible during every class

Almost failed a history class because I couldn't do essays more than a day before they were due

I can do anything if it's urgent or interesting, but that's it

Story of my life, right there. I hear ya.

Also with you (both) on this one in pretty much every way too. I'd justify hard mode that I loved challenges (and I did, just not always in the right areas).

I try not to look/think back too much - I had (sort of still have) a very successful career but the costs associated with getting there were and are still being paid for.

Getting treatment and therapy has really helped improve my ability to be present, though still such a battle.

Does it mean you DON'T have ADHD if you get a stimulant affect from Adderall?

No. Brain chemistry is complex and different stimulants hit different people different ways. It took like 5 medications to find one that didn’t make me feel like a tweaker.

Originally diagnosed as a teen, was put on Adderall XR and it made me feel like an empty shell every day I took it - stopped taking it after a few months, figured the diagnosis was wrong. Last year after realizing many of my struggles in my adult life indicated I did, in fact, have ADHD, I went to my primary care provider and...well, duh, I do have ADHD. Started taking lisdexamfetamine (Vyvanse) and, while it doesn't magically make many years of learned habits vanish, I can actually function like a normal adult, or, as another poster in this thread said, I can get shit done without it being an emergency (or something I'm inextricably interested in that would immediately cause me to go into hyperfocus mode.)

Hell, caffeine barely does anything for me if I'm not taking my meds - I could pound energy drinks and go to bed 30 minutes later. Meanwhile, unless I have built up a tolerance, nicotine would give me a legitimate rush, and I unknowingly self-medicated that way for years (though it was substantially less effective).

The human brain is funny, it doesn't matter if you're ND or not, different stimulants affect people in wildly varying ways.

Similar experience here. I usually take the weekend off from the medication. Sometimes it serves as a reminder of what it was like before.

> I took that backpack off and how I can run the same race as everyone else. And you know what? When you've been practicing your whole life with an extra weight on your back, and you take it off, sometimes it's surprising how fast you can go.

The way I've always described this to people is that before, in order to get started on anything I first had to bang my way head first through a solid brick wall. It was painful and unpleasant and an absolutely absurd amount of effort. It didn't matter if the thing I was trying to do was "a load of laundry" or "build a shed"... same brick wall. That's pretty crippling in day-to-day life.

And then once I get through it I wasn't in the clear. The first interruption, the first unexpected thing that came up... was another brick wall I had to bash my head through.

The medication doesn't take away the walls, but what it has done is turn them all into drywall. I still have to bang my head through a lot of walls, but after decades of going head first through brick walls everything just seems _comically easy_.

I really wish someone had identified this sooner so I could have gotten treatment earlier. I'm grateful my life has gone as well as it has. I don't have nearly as many things to look back on with regret as other people that were diagnosed late in life. It does suck to realize that everything really didn't need to be so difficult. And some habits and coping mechanisms that allowed me to function aren't exactly healthy for me or those around me, and those are hard to unlearn.

Wait... Do I have ADD? I've never thought so, because I have three close friends who do (diagnosed and medicated), and they've never described it like this. And, like, they're always starting things they don't finish. I have massive trouble starting things, just like you describe, and have built (effective, I'll point out) systems like sibling commenters describe. This whole thread has bent my brain a bit.

I had that kind of a revelation right before I started the ball rolling. My kid has ADHD, and I didn’t “get” it for a while. When they described things like you mention, I assumed that was the way it was for everyone. I was completely shocked to find that no, it’s not, or at least not to that degree.

Well, huh.

(Similar story with asthma. I was training for a marathon relay. My doc asked how that was going, and I said it was fine, except you know how after a mile or so, you get cotton mouth and tunnel vision? No. No, they did not know. And that’s how I ended up with a pre-run inhaler, and immediately shaved a minute off my mile pace. Holy crap. Not everyone feels like they’re dying mid-run? Why did no one tell me?)

I found out I had ADHD because I was catching up with a friend who had been diagnosed since I last saw them. They'd been seeing a psychologist, taking medication, and generally addressing it. They were describing their experiences, strategies they had developed prior and now recognized, and others they were working on with the psychologist for addressing challenges, etc.

I spent the entire conversation essentially going "Wait, what?! That's not normal?" and "Wait, what?! That's a coping strategy, not what everyone has to do to get through their life?".

Called my GP, told them my concern, they referred me to a psychiatrist. Psychiatrist asked me a bunch of questions and was like "Yep, you have ADHD. You have, naturally for someone your age, developed a lot of coping strategies, but those are also consistent with ADHD." and sent me back to the GP to start medication.

So, do you have ADHD? I don't know!

I'd suggest doing some reading about ADHD symptoms, about other people's experiences, and if a lot of it feels really relatable... maybe talk to a medical professional about it. If you do have it, even if you're coping successfully, there's no reason life needs to be as hard as it is.

Thank you - I've been putting off getting an assessment and seeking medication for a while, and I've just booked an appointment with a psychiatrist after reading your comment.

Getting diagnosed and medicated should absolutely be the first port of call and one should do it without delay. However I should add that they never made much concrete difference to my "clinical outcomes". Now I'm sure I was holding them wrong (or holding the wrong model of iPhone), and I should get around to getting prescribed again, but if your main problem is anxious procrastination I honestly think you should temper your expectations about what drugs (or certainly methylphenidate or amphetamine) will do for you.

Do you mean this because the stimulants can also cause anxiety?

No, not that (though I'm sure they can cause anxiety under certain circumstances, consult your physician etc.) It's just that IME they do basically nothing one way or the other about anxious procrastination, so if that's the thing that's killing you ...

Excess caffeine poured on anxious procrastination makes me a disaster of a person.

Similar experience here with Adderall.

I go unmedicated now because it's a pain in the ass to get the prescription refilled (not the best, but whatever). But my experience was that the anxious procrastination mostly still happened when on the crank (I was a lot less absent-minded though which was something).

They can for some people on some days or parts of days (my anxiety peaks when stimulants are wearing off). But like the other poster said, its more that they do nothing to solve it. I found a beta blocker in addition to stimulants was good at unlocking my productivity. YMMV.

Additionally, the boost in dopamines rewards anything you happen to be doing, so it can lock you into your avoidant behavior that day once you start doing it.

This article addresses your last point well: https://thelastpsychiatrist.com/2007/08/how_to_take_ritalin_...

This is an awesome piece. I also like the style - maybe I just miss the way things were in 2007 online.

Medication alone won't do it. Talk therapy, so that you have someone to talk about your anxieties with, and get at the underlying emotional issues driving that, are requisite. Stimulant medication alone won't stop you from reading Reddit for 6 hours instead of doing what you're avoiding doing. You'll just get a really intense Reddit session out of it. Don't draw the wrong conclusion here, which would be to not take it if you are so affected because it won't work. They do, but that it's something to be aware of. There's no quick fix, it's gonna take work.

One of the things that I have found is very important for me: when you take your medication, make sure you’re doing something you want to be doing for a while. Like you say… if the medication starts working while I’m browsing Reddit, I’m probably going to keep doing that for a while.

Since Concerta is extended-release, this usually means that I have to start work early most days. If I take the medication too late in the day it’ll disturb my ability to get to sleep, and since the medication has mostly worn off by that time it’ll generally mean… browsing Reddit in bed until way later than I should be up.

I'm afraid I have to say that in my experience talking therapy is even less effective than drugs, which at least do something. But again, I'm not discouraging anyone from pursuing these pathways: do it if you can, and as soon as possible, partly because the problem's unlikely to get better over time. But don't get your hopes up, if you're primarily an anxious procrastinator.

(I should add that IME "body doubling"/"task shadowing" is somewhat effective, though not very consistently. It's also probably the hardest intervention to get, though maybe things like Focusmate https://www.focusmate.com/ might help with that nowadays.)

FWIW ritalin reduced my anxiety a fair bit. It changed my brain from one with multiple concurrent streams of thought, often negative and never truly going away, to focusing on the task at hand.

As a direct outcome it means I don't have bad thoughts and feelings sitting in the back of my mind when trying to do something else 24/7 so I'm generally more balanced. Indirectly, it was helped by actually getting stuff done and feeling less shit in general and not putting myself down as much for failing.

True to a point: Noting that has an effect has no side effect.

Some of us have to deal with the decision of a loved one taking meds and increasing their probability of a sudden cardiac death ( by qt Interval prolongation ) or staying unmediated.

Strategies to deal with ADS without meds are valuable I situations like this.

> Some of us have to deal with the decision of a loved one taking meds and increasing their probability of a sudden cardiac death...

Why is this such a concern to you? At some point, everything has _some_ risk, and this feels like you're putting a lot of guilt on someone else for making a medical decision they deserve to make on their own.

The parent is explicitly endorsing stimulants. Those work well to some extend for treating ADHS, but in general evidence is rather weak for then improving academic achievement, while evidence is rather strong for behaviour changes that makes it easier for teachers to deal with kids, see e.g. https://pubmed.ncbi.nlm.nih.gov/38871418/.

Pharmacology is not my main area of expertise but I used to do a lot of work in cardiology, and anything that increases the QT interval in the ecg increases the risk of Torsades de Pointes.

Rule of thumb is 5–7% more TdP risk per 10 ms QTc.

Quite a few adhs meds do this moderately, not enough to make an ecg mandratory.

I still believe that making medications the default for adhs is not warranted given the side effects, especially since in many cases it’s not clear if it treats the condition or just makes the lives of education professionals easier.

I’m reading this as a person diagnosed in their thirties and it feels a bit detached from reality frankly.

I, and millions other people, could tell you that it does immensely benefit with issues like executive dysfunction. Medication quite literally made the problem I had been battling for decades disappear instantly.

Associating adhd just with childhood is in itself an obsolete view that causes issues for people.

Preach it, although now it's crystal clear to me that I've dealt with ADHD since around middle school age and was fully in its throes by high school. Part of me wonders what my life would be like if I'd started treatment then and it was as effective as it's been for me as an adult.

Yeah same here - honestly I’m not yet even at the place where I’ve managed catch up with the issues caused by premeds time.

Lack of trust in delivery speed at work, friendships damaged by unintended slights and so on.

Even building habits that I could never have kept before is a grind. The fact that I now can build habits only places me at a neurotypical starting line, now habits still need to be built.

So many drugs that unequivocally improve people's health have minor negative side effects. I think this person needs to find a way to connect with their loved ones and understand how the medication they are taking is love changing. I know it is for me.

One thing I haven’t ever seen mentioned in these threads is how do people who can’t handle stimulants get by?

There are non-stimulant medications for ADHD but I think their effectiveness is more variable, they work well for some people and not at all for others. Strattera, guanfacine, and wellbutrin come to mind.

Outside of medication there's therapy, cognitive training, coaching, etc.

There is at least one non-stimulant ADHD medication which may help them: https://en.wikipedia.org/wiki/Atomoxetine

Coffee and chocolate (plus potentially tobacco) are technically stimulants, 100% legal, and people seem to handle them just fine. Just take them strategically as opposed to recreationally (i.e. only as support for building up healthy habits; go cold-turkey otherwise!) and you should do just fine. The effect is way stronger than most people might think, provided that habituation hasn't built up and the existing tolerance has been dissipated.

I wouldn't necessarily recommend nicotine. It works and alleviates ADHD symptoms at first which is great but that also makes it really addictive. I can't comprehend the level of discipline I would need to use nicotine without becoming addicted and I'm not prone to addiction generally.

The interesting thing wrt. this is that nicotine replacement products are widely available without a prescription. Would people really get seriously addicted to e.g. wearing a transdermal patch?

For N=1 (me), yes. I’ve been a smoker since I was about 12 years old and have tried to quit multiple times (short-term successfully a few times). I’ve had a few experiences with transdermal nicotine.

When I was in the hospital and couldn’t get out of bed, the nurses provided me with some. They seemed to be partially working, but I was still having pretty intense cravings all the time. After doing a bit of napkin math I realized that the patches were only providing about 1/3 of the daily nicotine I’d been consuming before my appendectomy.

When I tried to quit on my own, I started out with the recommended dosage from the package and had the same experience. They modulated the cravings a bit but were nowhere near effective enough to actually allow me to go through the day without chronic acute cravings. I bumped up my daily dose from the patches and did successfully stop smoking, but trying to reduce the dose too much led to the same brutal cravings. I ended up abandoning patches as a way to quit because of the daily hassle of trying to slowly wean myself off of the patches; a full patch decrement was too much at once, so I was cutting them into halves and quarters to try to make progress without ruining my concentration and focus.

I'm surprised they gave you nicotine patches - was this an American hospital? I always thought they want you to suffer withdrawal as a punishment for the moral failure of being a smoker. Also, there are probably some risks with throwing nicotine into the mix of whatever drugs they might be giving you.

I used the patch to quit, and I used to enjoy slapping those patches on in the morning almost as much as I enjoyed a morning cigarette.

Canadian hospital. It was an appendectomy, the only other medication I was on was morphine. The nurse actually offered the patches to me on her own after noticing a pack of smokes in the pocket of the sweater I was wearing when I went to the ER.

> ...without ruining my concentration and focus.

I suspect that this just isn't in the cards given that kind of situation. You're ultimately just better off suffering through that withdrawal (especially since you've said you were in a frickin' hospital to begin with. It's not like you're losing that much effectiveness and productivity) and trying to find a new normal after the worst symptoms are over. It might take some time but our best guess is that kind of habituation is not permanent, so you should see quite a bit of improvement over time if you just stick to it.

> thread about ADHD

> so you should see quite a bit of improvement over time if you just stick to it.

I used to vape and I had the worst time quitting nicotine. I tapered down to around 25% of my usual daily intake over the period of about 3 months before I decided to quit for good. Even then, for about 3 weeks I felt incredibly tired all the time, yet I couldn't sleep, and I felt borderline mentally retarded... it was really bad. It took me about 3 months to feel more or less normal again, and cravings completely went away when I was properly diagnosed with ADHD and started medication about a year later.

Humans can get addicted to anything that triggers a reward. Even things that seem gross or weird, like picking your scabs. The line between addiction and compulsion is kind of blurry.

The addiction some people have to caffeine is just as crazy. So, I guess it depends on a bunch of physiological and psychological factors.

I don't think it is a question of discipline when it comes to addiction - if you are taking it on a regular basis at a high enough dose to become addicted, you will become addicted, and you will have withdrawal symptoms when you stop taking it.

It might be possible to manage the addiction and maybe keep it from escalating with discipline, but the addiction will always be there.

Humans are excellent at denying addiction and rationalizing addictive behavior. And you don't even realize you are doing it - I've seen it in myself with cigarettes, which I fortunately quit years ago.

Lol I will provide a small anecdote as a warning from my own life. I was at a point (pre-diagnosis) where I felt my caffeine intake had reached an addiction-like level and had decided to wean myself down to a more sustainable level. I’d read about adenosine receptors and the different substances that can act as stimulants/inhibit adenosine. I was starting to get a bit of a caffeine headache + drowsiness and the good idea fairy told me “hey why don’t you have some chocolate instead? Theobromine is an adenosine-receptor antagonist so it might help without consuming any caffeine”

This led to what was probably the worst headache of my life. I don’t know enough pharmacology to understand how exactly that worked, but it was terrible. Having a cup of coffee reversed the effect pretty quickly, luckily.

> plus potentially tobacco

You know… I feel like my symptoms were not so bad when I used to have cigars

I take guanfacine. It’s an older blood pressure medication that happens to treat adhd. I also have high blood pressure so I get an added bonus. Stimulants are great for laser focus. Guanfacine helps with focus but its biggest help, for me, is executive function and curbs some of my emotional effects of adhd. I notice I’m not as sensitive to feedback or criticism.

Take less. I don't mean to be snarky, but if it makes you anxious, it's too much. If 5 mg of Adderall feels like too much, I think the issue is just that you feel different. Give it a few weeks. Psychotropic medication isn't an instant fix without side effects. You'll get used to it.

That's me. I had to stop because of the anxiety. I just have to get back to life as I always used to and measure the distractions via behavioural changes

And yet here I am, commenting on HN...

The country I live in prohibits stimulants and moving is not an option for the time being. What are my options besides atomoxetine?

Caffeine perhaps? Yerba mate? Also CBT therapy on its own is pretty good.

Yes, caffeine works but I’m very cautious not to build up tolerance, i.e. I’m afraid that if I start drinking tea/coffee regularly, it’ll loose the jolt it gives me now and I’ll just become addicted.

Nicotine. But not the smokeable kind. And low dosage. But not if you’re likely to get addicted. The absurdity is that your country definitely makes it legal for historical reasons rather than useful less addicting stimulants.

nicotine is ridiculously addictive. everyone is likely to get addicted to it

I agree that it’s ridiculously addictive. There’s a big correlation to delivery type and how your brain can associate it to drive that compulsion. It’s very fast acting, esp when smoked.

https://www.pbs.org/newshour/amp/science/column-recent-resea...

Nicotine is amazing... for a week. Then you will be chasing the dragon forever. Tolerance builds up crazy fast and doesn't meaningfully lower even when you cease smoking for years.

Plus pretty bad for your health and crazy addictive. Absolutely not a good recommendation.

> Tolerance builds up crazy fast and doesn't meaningfully lower even when you cease smoking for years.

I specified not smoking it though?

> Plus pretty bad for your health and crazy addictive. Absolutely not a good recommendation

You’re saying that it’s “bad for health” as something separate from its addiction potential?

How is it bad for your health exactly?

Also, ‘Crazy addictive’ is related to delivery method.

Also, there may be critical differences to people who have never smoked before.

It wasn't till I quit nicotine that I began to struggle with undiagnosed adhd. I wish there was a way to make nicotine safe and non-addictive. I think it was far more effective to spike my nicotine level and tackle a task than adderall twice a day has been. Vaping was huge for controlled nicotine consumption.

You are being down-voted by people making big claims ("pretty bad for your health and crazy addictive", "nicotine is ridiculously addictive") without any proofs. In fact, I challenge anyone making such claims to reference a scientific study proving either of major addictive potential or significant health concerns of _nicotine patches_ since OP specifically mentioned "not the smokeable kind" of nicotine.

I mean, tobacco smoke is terrible for anyone's health but even nicotine on its own is not exactly good for you. It's definitely a stimulant and can give you the kinds of side effects you might expect from any stimulant, including a raised BP and heart rate.

> It's definitely a stimulant and can give you the kinds of side effects you might expect from any stimulant, including a raised BP and heart rate.

Sure, but people wouldn't downvote a comment suggesting having couple of cups of coffee per day to improve ADHD symptoms as hard, for example. And for me caffeine withdrawals symptoms have always been more difficult to overcome compared to nicotine.

For average tech worker HN user living a sedentary life-style, having stressful job in polluted city periodic usage of nicotine patches won't make it to their top list of health concerns IMO.

So much of the research and the general understanding is just conflated with cigarettes as the delivery type. They present a bunch of problems: the smoke and other chemicals makes it damaging in a lot of ways. People sometimes swap the terms “nicotine” and “cigarettes”. Cigarettes (and presumably vaping) have one of the highest and fastest nicotine deliveries — this is critical in creating the physical/chemical (dopamine) response that your brain and body use in addiction formation.

We can have two companies release the same code, but the ui/UX of the users interaction with it can make all the difference.

Wait, you’re just repeating general empty statements. Why isn’t nicotine on its own good for you? A raised heart rate and BP for a period isn’t a bad thing. It’s an expected response from any stimulant.

I mean, sex and exercise also cause the same responses.

a) try to find a way to fill declaration of prescribed medications for customs and for police. (let the google/llm and local adhd communities help you) Find verified cases of how that have worked for others in your particular country. Sometimes workarounds exists, but it would take some paperwork

b) plan a trip to the Turkey, find a specialist there, get the prescription, do all the paperwork/preparations before going back

c) fill all the papers and get the approval at customs even if they didn't know about that before - prepare all the necessary links to official documents, as maybe you would have to explain them how to do their job

p.s. I know that feeling. Atomoxetine is full of side effects without direct effects.

Khat?

Khat will wreck your teeth if you chew the leaves. And it's about on par with caffeine as far as stimulants go, so personally I'd stick with coffee or tea instead of khat.

Bupropion would be one. Helps with quitting smoking, which around 50% of ADDers do, too.

I posted elsewhere in the thread about my late diagnosis. When I was much younger than when I was diagnosed, I was on Bupropion for smoking cessation and it had a pretty significant positive effect for me with respect to my ADHD symptoms (which I didn’t recognize as ADHD at the time). Definitely worth exploring; it doesn’t work for everyone but it can be quite effective if it does work for you.

I would second your suggestion to investigate bupropion. More than a decade ago I was suffering from severe depression. Psychiatrists with meds were an easy-to-access front line treatment, but I was very concerned about SSRI side effects, particularly erectile side effects. It didn't take much persuading to have the psychiatrist prescribe bupropion instead of an SSRI. I too felt it helped with my then undiagnosed ADHD a lot.

As a note, bupropion did make me feel a little funny. It wasn't bad, weird, or intolerable, but yes I did have a faint perceptual awareness that I was in a medicated state.

For the first couple of weeks the first time I took it, Bupropion:

- made me feel pretty energetic. Not buzzed, but maybe counteracted low-grade depression. I was on it because I wanted to quit smoking, because I was hoping quitting smoking would make me feel better/happier

- slightly affected my vision/perception. Colours seemed more vibrant. Everything just felt perceptually… brighter.

- made me really horny, but not in a compulsive way. It wasn’t distracting and didn’t cause any problems, but I definitely had more drive. When it was go time, it was Go Time :)

What's up with the bullet points? This almost reads like a ChatGPT/AI comment, which is especially weird for a personal recollection. Are people writing like frickin robots now?

Lol that’s how I’ve written for 25 years. I’m flattered that LLMs are copying me.

Don’t be an ass. People used lists before LLMs.

They’re just lucky I didn’t have a big run-on sentence, like I used to before taking a serious look at how ADHD affected my writing and thought processes, including significant use of parentheticals (because every thought comes with a couple of extra thoughts, for free!)

If I had more time, I would have written a shorter letter.

The more time I have, the more of those extra thoughts I can decide aren't really important.

> every thought comes with a couple of extra thoughts, for free!

Bonus points if you branch deep enough to lose the original thought.

I have to say, buproprion had severe, life-threatening side effects for me. I'm not in a typically high-risk group for psychotic symptoms, but it caused me to become quite agitated and delusional.

It feels strange to type that now, and I know these side effects are quite rare, but I can't help but warn people when I see it mentioned. It was genuinely the most terrifying experience of my life.

It happened about 6 weeks into treatment, quite acutely. I wasn't even aware it was happening.

Fringe product, not geared for ADHD specifically. But look at Gorilla Mind Rush/Smooth depending on your stimulant tolerance. In your position you don't have many efficacious options, but this works for me as diagnosed ADHD probably 60% as good as the low dose stimulant medication I take.

Guanfacine is underrated.

Bupropion, Guanfacine, Clonidine, Modafinil. Check out John Kruse on YouTube for explanation of these and others.

Thanks, but Bupropion and Modafinil are also banned over here. I’ll look into the other two.

I really wish my body could tolerate stimulants.

I tried the major ones (Adderall, Ritalin, Vyvanse, Concerta, etc.). They all made dealing with ADHD significantly easier, but even at the lowest doses they turned me into an extremely anxious and irritable person. I had never experienced anything close to a panic attack or nervous breakdown in my 30+ years of being alive until I started taking stimulant medication.

I decided that living with untreated ADHD was the better alternative, so now I'm back to copious amounts of coffee to deal.

Same here, the lowest dose concerta keeps me wide awake for 24 hours. The non stimulants give me side effects not touching those with a 10 foot pole. Did you try 2.5mg ritalin? i think thats the lowest dose.

If you can’t sleep, for sure avoid extended release meds like Concerta. Stick with immediate release with no afternoon doses. Take it the second you get out of bed. You want to time things so it wears off after your work day and you begin to get tired.

I can take pretty high doses of Ritalin and sleep as long as it’s not the extended release. The lowest dose extended release medications didn’t touch my symptoms and reduced my average sleep to about 4 hours per night.

My wife gets good results with atomoxetine, which isn’t a stimulant.

Just a heads up, Ive taken stimulants on and off as a treatment for ADHD for many years but my body/emotional health always felt compromised as a result. I've recently started on a non-stimulant ADHD medication called Atomoxetine and so far it has not had the emotional blunting, irritable effect of stimulants at all, and I haven't noticed any negative effects so far. It seems to help me get over the hump of being able to start things and stay with them which has always been my biggest downfall. We will see if I stick with it, but just wanted to mention that there are alternatives. There is also another medication called Guanfacine that I may try if this current medication does not work out - I don't think I can go back to stimulants.

Interesting! I'll be sure to ask my doctor about those options

I hope what I write will not scare you away from trying these, I just want to add to make sure to know about all potential side effects. My daughter tried Atomoxetine and reacted very badly to it. I recognized it as a potential side effect from the documentation that came with the meds. The doctors did not even know it could happen. Everyone is different though! She uses Elvanse now (I don’t know how that’s called outside Europe) and it works for her.

Again, chances are it will work for you without side effects so work with your doctor. Just be well informed.

Elvanse, which is lisdexamphetamine, is sold under the Vyvanse brand in the US. It is a prodrug for one of the isomers found in adderall. This just means that you take elvanse, which is initially sort of ‘inactive’ and your body eventually converts it into what can essentially be thought of as adderall, or more accurately, d-amphetamine. Adderall specifically also contains l-amphetamine which is absent from this drug, the l-amphetamine isomer is responsible for more of the unwanted nervous system / cardiac effects.

On Vyvanse, I felt like a machine for like two weeks. Couldn't sleep and had to be productive.

After that it normalized.

I started taking it 1h before I get out of bed every morning, so I could sleep well at night.

How does that work? You just sleep 1 hour less?

If I'm already well rested, yes.

If not, I'm taking the pill and go to sleep again quickly.

The pill will take ~1h to "wake me up".

Hey, just popping in as a psychiatrist:

Speak to your psychiatrist about atomoxetine, viloxazine, guanfacine, clonidine, bupropion, desipramine, or protriptyline. Probably in that order.

My wife had some serious problems with the stimulant meds, and atomoxetine did the trick for her.

You might be how surprised how low a dose you need for an effect. 5-10ug of Ritalin noticeably reduces the "noise floor" for me.

How do you take 5-10ug? Dissolve 10mg in a litre of something. Get a 1ml dosing syringe. It has 0.1ml markings.

You could start there and increase it until you find what works. Also, if you take very little you can have a break on weekends and not suffer too much while remaining sensitive to lower dosages.

Things that work for people with too many side effects:

Try a much, much lower dosage (e.g. 7mg/day instead of 30mg) and spread it out over hours (even if it's already a slow release medication!). Do exhausting exercise in the morning. Eat very small amounts of slow releasing carbs over the day to keep your glucose levels right as these medications lower blood glucose and that gets you grumpy, and also they reduce appetite. If you absolutely need caffeine, drink green tea with 3x water, and take L-Theanine to curb the anxiety.

Zero alcohol, cannabis, and nicotine because they will mess up your dopamine system.

And find a better doctor.

(And read this other comment on schedule https://news.ycombinator.com/item?id=45091187)

As someone who is struggling with ADHD and tried Ritalin at one point. The Ritalin did not really change anything for me, I was calmer, but it didn't help me get a better grip on my life so to say. Do you think there is a chance this would be different for other stimulants? Just looking for some experiences people had I guess.

I think it's worth trying. I started with Focalin but found Adderall works better for me. It's a little different for everyone.

A study I glanced over a while ago said something like 40% of people respond to dex or ritalin, around 80% to either (I'm in this group but dex had more annoying side effects), and the last 20% to neither (but there is other stuff out there). So it's definitely worth trying both branches of the common meds first. You should also talk about dosages because there is titration period where they need to monitor and adjust to see how your specific body responds.

Here's a fun fact. In the US, if you would like to fly a plane, and you have undiagnosed and thus untreated ADHD, no problemo.

But if you do end up taking stimulant medication for ADHD, that's not allowed. So unfortunately sometimes (rather often with the FAA) it's better not to ask questions you don't want the answer to.

The amount of undiagnosed ADHD (and secretly treated anxiety and depression, for that matter) in the aviation industry is off the charts. I have a lot of respect for most of the FAA, which is professional, reasonable, and evidence-based. But the FAA aeromedical division is a joke. They're bullies with a stone-age mentality about treatments and medications that have been accepted for decades.

I might agree in principle, but aviation pilots are glorified bus/truck drivers. It's the farthest thing from a job that might cater to a typical "ADHD" skills profile. What you really want in that role is people who can be dependable without relying on intoxicating substances that might have weird side effects.

This is the same fallacy that always comes up. People are already flying this way!

What is the difference between someone with ADHD who passed their pilot lessons but doesn't have a diagnosis and is not taking medication vs someone with ADHD who is getting help?

Why is this an aeromedical issue and not a certification issue? What is the training and testing for if not to confirm that someone has the capability to successfully fly a plane?

There is a large adult population with undiagnosed and untreated ADHD. A generation ago that population was even higher. A bunch of them are pilots.

So then the question is, if in a professional pilot and I think I might have ADHD, do I follow up on that hunch? Of course not, because a diagnosis would cost me my career.

There’s good research to show that stimulants reduce the rate of car crashes in people with ADHD. I have no doubt that if we encouraged pilots to seek ADHD treatment, it would improve safety.

IMO the diagnoses that should exclude someone from flying are those that could cause them to become suddenly incapacitated. For everything else, we can just test whether someone can safely fly an airplane, which we already regularly do for pilots.

I'm speaking from experience as someone who has worked as a professional pilot.

This was a big theme / topic on the latest season of Nathan Fielder’s “The Rehearsal” this year: https://ew.com/nathan-fielder-flies-full-boeing-737-plane-do...

Hell, taking medication or not, if you have had a diagnosis in the past (and didn't lie on your medical history), merely having current symptoms is grounds for your FAA medical certificate being deferred.

The fact that somebody can be completely undiagnosed, untreated, and potentially self-medicated, will get their medical certificate issued while those seeking treatment and function at the same level as their peers get deferred is madness. I completely understand concern being warranted, given a majority of airline accidents can, unfortunately, be attributed to pilot error, but it shows a maddening lack of understanding of the condition by the agency. Especially when their justification for telling AME's to defer individuals actively taking ADHD medication has nothing to do with the condition itself, but some bullshit that it actively increases cognitive deficits? Give me a break, I'd rather they just be honest, "we don't trust people who need stimulants to properly follow routine checklist procedures that are the bread and butter of a commercial pilot's job."

> but some bullshit that it actively increases cognitive deficits?

It doesn't look like obvious "bullshit". A number of ADHD medications are well-known intoxicating substances; it's not unfathomable that they might induce some kind of cognitive or behavioral impairment (not necessarily the same kind one might get diagnosed for, either).

It's similarly not unfathomable that they might possibly remotely provide a benefit to the people that derive a reported benefit from them.

Sure, but do you really want people flying a plane when their performance might depend on how they happen to react to that kind of medication? It's just one more thing that can go wrong in so many ways. And it's not like flying airline routes is a job that would even appeal to the typical ADHD-diagnosed person - like GP said, its "bread and butter" is sticking to boring checklists. There might be some silly glamorous aspect to it but that's not a good reason why one should want to be a pilot in the first place.

The military used to give pilots straight up meth. They still do give their pilots performance enhancing drugs. How many pilots fly drunk? Why are the checklists not done and confirmed digitally instead of relying on fallible human pilots, regardless of i how much Adderall they're on?

If this were really about safety, there is so much other actionable low hanging fruit to make things safer. Looking at the TSA and ask the security theater there. It's not surprising.

As it stands, many medical conditions that require maintenance medication that may cause side-effects you wouldn't want when you're airbore don't disqualify you from being a pilot. The entire point of the FAA medical examination isn't to make sure you are a perfect specimen of human health and have no issues whatsoever, that would disqualify a hell of a lot of pilots from flying.

> And it's not like flying airline routes is a job that would even appeal to the typical ADHD-diagnosed person - like you said, its "bread and butter" is sticking to boring checklists.

My ADHD diagnosis is not a reflection of my personality, it's a chemical imbalance of my brain that prevents things non-ADHD individuals would consider rewarding from feeling that way to me. I fucking love spending hours flying an A320 around in Flight Simulator, and I literally go through most of the same checklist items that commercial pilots do in a game, just to fly some virtual cargo around in return for imaginary internet money on FSAirlines.

Do I want to be a commercial pilot? No, I've got a pretty good job as a SWE/SRE that requires substantially less bullshit, and the vision in my left eye can't be corrected enough to pass a FAA ME for a commercial pilots license anyway. But I will be absolutely damned if I let somebody say it wouldn't appeal to me anyway just because I have ADHD - like I don't have enough bullshit checklist work to go through in any other job.

Not doubting the truth of your claim, just trying to understand you mean... How would the FAA know a pilot has ADHD if the condition is undiagnosed?

You know, enough symptoms will start to match.

Then you just don't get it officially diagnosed - then it doesn't exist! (officially)

> This means: You do have to see a physician and psychologist to get diagnosed and to get a therapy plan. Just reading articles or books about managing ADHD won't do the trick.

The cruel paradox of ADHD treatment. I only got meds in the first place because my husband was able to follow through with getting me the appointments. It's been life changing. I needed a ton of support before and now we've reached parity with chores and finances. I never could have gotten that first step without someone helping me though.

I can’t agree more. I spent a lifetime trying to master every productivity hack, reading books, doing hundreds of hours of therapy (this is not a joke - hundreds of hours), and organizing my desk and using tools and … everything.

And then I did a psychoeducational assessment and found out I have ADHD - and not just a little hint of ADHD, but really quite profoundly terrible ADHD. I learned about how much my brain had short changed me in my personal life too; because real ADHD affects you in many areas of life. It’s not just about “getting things done.”

Medication is a must have to make any progress. If you’re like me, you already tried everything else. Maybe you’re also really intelligent and even managed to get a great job and somehow maintain it. But you can’t ever follow a plan for long and never go to bed on time and always seem to be burning the candle at both ends?

Yeah, this is where you need some help from meds. And good god do they help. That being said, your brain is a responsive self-correcting system. So my advice to anyone taking this journey post-diagnosis is to not give up if things stop working. You may need to pivot, change dose, switch to something else, or add a non-stimulant option.

But, don’t ignore meds. ADHD is neurochemical in nature and it’s a joke to expect anyone will manage it without drugs.

I disagree with this article on fairly foundational grounds.

This does nothing long-term for ADHD, and in fact creates a dependency on drugs which in many cases are not necessary because ADHD and other Spectrum Disorders fall into catchalls. It treats symptoms not the cause.

Sure you can manage so long as you get your SOMA, but the moment its gone you are back to square one, and the risk is not zero.

The best thing for managing this is meditation, and a disciplined lifestyle regiment.

Meditation being the intentional practice of stilling ones thoughts, which anyone can do with a little practice.

In my opinion, not a lot of people actually have ADD/ADHD, but the rhetoric gaslights towards this label because the diagnostic criteria are catchalls and ambiguous. Additionally, it has no cure, and treatments may have side-effects and other risk factors.

Fun fact, you can actually induce ADHD temporarily with a bit of hypnosis, its just a heightened state of awareness.

Most literature on ADHD, and other spectrum disorders doesn't pass muster, and they are just looking to sell you on an incurable ailment where you have to keep coming back for more.

> The best thing for managing this is meditation, and a disciplined lifestyle regiment.

What would be your reaction to the numerous comments on this page where people are saying that they tried and failed to "discipline" themselves for years or decades, only to discover medication later and find that it instantly turned everything around for them?

I'd say they weren't addressing the core issues, or they think discipline is something that it isn't, and then kept trying ineffectively.

Here's what discipline is and isn't.

Discipline is an extremely simple concept to develop but few actually know how to do it in any reasonable way because of so much misinformation out there, and malign influence seeking to take advantage and increase suggestability, and by extension addiction.

Discipline just like meditation is really a fundamentally simple practice.

Just like with meditation, where you don't use willpower, but instead simply focus your thoughts back towards a single point, and then relax that focus slowly, which stills your thoughts.

Discipline is simply the repeated practice of limiting when and where you choose to change your initial decision or choice, for all of the choices you make.

You take your time considering before making a choice, and once made you only change it when there is some new information that becomes available after the fact, whether that is a new consequence you didn't consider, or completely new information you received later.

Its a simple rule. You don't give yourself the choice except under those circumstances. When you are tempted, you remind yourself you don't have the choice. When you cave and fail, you don't beat yourself up because that destructively interferes with your psychology which only works towards outcomes framed in the positive. If you make a mistake you examine what led to it right away, and mitigate those circumstances moving forward. You imagine what you will do next time, with a successful outcome a few times that day.

With this repeated ritual comes an understand that willpower is always finite, and you pick and choose what you will spend that on each day. You recognize when its running low, and defer important decisions pigeonholing them for a later time. With repeated practice in everything this become a unconscious ritual with good outcomes.

You do what you say you will do, and you don't compromise yourself, and people recognize that level of discipline. It becomes easier with each successful choice, and its so damn simple.

These two things together make a world of difference in coping with everything. It places the locus of control for your life within your grasp.

> only to discover medication later and find it instantly turned around everything.

First, medication in most cases in psychology doesn't instantly ever turn around everything. You still have the problems that led to your mental state, they are often subtle which have built up over time. You are just better able to cope with them where you weren't coping before, and following the initial euphoria of relief you still have those problems.

I know quite a number of people that have been diagnosed and use medication to cope with professional burnout. Eventually you pay the piper.

Sure you can take a drug, and maybe you feel better, but also maybe you feel like everything is 100x worse and to relieve the pain and suffering you end yourself; (a known sideeffect) or you have a chemical reaction that ends up in sudden death (a known sideeffect). Few actually consider this, minimizing it.

There is no panacea. Soma is just treating the symptoms. What you do, and things you choose to live by are far more important, especially in contrast to the fact that many medications make one more suggestible. For good or ill.

go kick rocks

This is a profoundly ignorant take on the subject matter. Notwithstanding neurological changes that happen to everyone over the time span of decades, ADHD isn't something that people can just willpower their way out of. It's a spectrum of disorders with a strong genetic component. None of what you wrote above bears any resemblance to fact, and these sentiments can cause actual real-world harm to people.

As a thought experiment, insert "type 1 diabetes" in place of ADHD and apply your statement to it. You get "insulin does nothing long-term for diabetes, and in fact creates a dependency on drugs. The best thing for managing this is a disciplined lifestyle." See how ridiculous that sounds now?

> ADHD isn't something that people can just willpower their way out of.

I think conflating structured meditation practice with "just willpower your way out of it" is a pretty severe misconception of its own. That's not at all how it's supposed to work. (In fact, if you struggle with focusing your attention in a meditation setting, you're taught not to apply willpower at all; just "notice" that your thoughts have drifted away and comfortably bring them back without judgment. You wouldn't expect this to help, but apparently it does.)

You are the one that is ignorant of the reality.

> As a thought experiment, insert "type 1 diabetes"

This is an apples to oranges fallacy flawed example, how about we do something that isn't apples to oranges, like heavy metal poisoning. How about we insert chronic low-level mercury poisoning in place of ADHD.

Here is a shocker, the symptoms are the same, and there are many other such environmental based issues that lead to these symptoms. The diagnosis is still ADHD/ADD which is made regularly because its a catchall, and so its the same label but its not the same thing.

So that ADHD diagnosis is ADHD, and its automatically neurological changes, or is it really Heavy Metal Poisoning, which then isn't being treated?

Are my sentiments causing real world harm to people when that diagnosis has been misdiagnosed? Really? This happens on the regular because of exposures that occur but aren't recognized or achieve testing thresholds.

The diagnostic label for spectrum disorders has been for decades incorrectly applied to people, in effect treating symptoms as a catchall.

How ridiculous do you sound in my particular example? Your causing harm to people because they thought they had ADHD because of the symptoms but actually were being poisoned because of a misdiagnosis that isn't questioned (which happens in centralized systems). Who is actually the one causing harm here. The one supporting that system and its consequences, or the one questioning the underlying truth of the matter (which has real anecdotal experiences backing this across a group of afflicted people).

Blood testing doesn't work well at detection of chronic low exposure without causing acute poisoning through a chelator, something that isn't done that regularly. Most doctors won't even order the test even after requests to do so.

Seriously, this kind of armchair theatrics and polemic is why the world is in such a horrible state today, but by all means continue shouting down people that actually know a thing about what they are talking about.

Ignorance was the most charitable interpretation that I could infer from your original statements. It seems clear that it was sincerely believed and well-intentioned; it's equally clear that your operating knowledge of ADHD research, diagnosis and clinical treatment has some significant gaps.

We're not going to bridge this disagreement over a HN comment thread. I would respectfully urge you not to spread that sort of misinformation online. Leave any advice regarding ADHD to be provided by qualified medical professionals, as your own advice could result in people not obtaining life-altering treatment due to FUD.

What's eminently clear to any discerning individual at this point is your opinion isn't credible.

For there to be a disagreement in real terms there needs to first be a fair common definition of what is actually being disagreed upon, you haven't bothered participating enough to form that distinctly, so everything that follows isn't really a conversation; just ambiguous dissembling, imposition of cost, and manipulation of sentiment on your part to all other participants detriment. In other words, harmful noise that violates the social contracts.

There is a nuanced difference between advice in issues that occur in a medical setting, and medical advice. The former was asked and given in my responses and was the context we were talking about. The two are different contexts but sometimes similar in subject matter, and you suddenly switching to the medical context for the purpose of silencing what was said when we're talking about the former quite purposefully conflates the two to confuse readers in structured ways, which is quite reprehensible if done with malice as some of your actions and behavioral characteristics may suggest.

You claim that the information I provided, which included that of misdiagnosis, and the related facts (i.e. misdiagnosis exists, and the diagnostic challenges involved, with concrete references to heavy metal poisoning), is in fact misinformation; without any kind of support or reference despite there being easily found academic literature touching on this same subject (https://www.sciencedirect.com/science/article/pii/S0946672X1...).

Doctors get it wrong sometimes, and only the individual is left as their own advocate which is routinely not fully informed because of noise and channel capacity such as your activities here.

My own advice amounts to use your brain following rational scientific principles, with specific support, and that may result in people not obtaining "life-altering treatment".

The thing is that is a good thing for them to do when that "life-altering treatment", a contradictory ambiguous statement you used, directly resolves to a state where you as an individual are dead in the ground, or harmed as a result. Same exact statement, entirely different context and opposite contradictory and expected meaning. Such is the problem with doublespeak.

Ambiguities are indirect references, and one must always consider the intent of the person speaking and the direct resolution of such statements, and whether the person has shown they are earnest in their providing value with unconditional positive regard in a structured form that doesn't rely on credibility, or the alternative; malign influence which bases their activities in deception/coercion.

Rational practices don't rely upon the credibility of the person speaking. The reasoning is independently testable. You neglect much of this.

I would respectfully urge you stop your malign use of psychological priming, and other deceptive behaviors including the distorted reflected appraisal you've engineered into your responses.

If you were a rational person participating in earnest, you wouldn't be doing any of those things.

>The best thing for managing this is meditation, and a disciplined lifestyle regiment.

Wrong.

First you reveal your wellness nonsense with "creates a dependency on drugs"

Drugs that cure/alleviate your symptoms are good things. We like curing diseases.

> It treats symptoms

Good. This is a good thing. Treating symptoms is a good thing and we like good things.

>The best thing for managing this is meditation, and a disciplined lifestyle regiment.

Bollocks. The best thing are the easy, dependable, reliable medications.

>rhetoric gaslights towards this label because the diagnostic criteria are catchalls and ambiguous.

The gaslighting is pushing shitty wellness cures, and ultimately the shame of their failure when there are tested dependable drugs available.

>Most literature on ADHD, and other spectrum disorders doesn't pass muster, and they are just looking to sell you on an incurable ailment where you have to keep coming back for more.

I literally had to fight to get access to my ADHD meds, and I my only regret is not ramming a bulldozer in the side of a pharmacy a decade earlier.

Your view is quite distorted, biased, and blind.

> Good. This is a good thing. Treating symptoms is a good thing and we like good things.

You frame this in fallacy, false dichotomy circularly. For a refutation, is treating poisoning with something that masks the symptoms of poisoning without resolving the cause a good thing?

The poisoning is still there its having a detrimental effect leading to harmful outcomes, and you don't know its happening because you masked the symptoms thinking its something else.

A concrete example? Chronic low-level exposure to heavy metal poisoning was quite common 20 years ago. It came largely from silver fillings which were in-fact 50% b/w, mercury amalagam. It was claimed stable and thus fit for us in dental fillings, but later found in the presence of acidic beverages to leach into your systems, and this is not the only exposure. Mercury has also been used in the efficient production and manufacture of Soda beverages, you have to dive quite deep in industry literature to find these facts such as they remove those chemicals after production, and label them as contaminants. No chemistry is ever perfect at removing things. They have been found present in many cases, and not all processes use this but the cost effective ones do. Similar environmental issues are neglected, such as lead paint and other products, arsenic from the water; you get the drift.

Ironically, these can easily fall into the same diagnostic criteria as ADHD/ADD and blood tests aren't sensitive enough because those substances binds so easily to remove it from the bloodstream rapidly (into tissue) to protect you. It bio-accumulates. You literally have to cause induced acute poisoning through medication (chelator) before taking the blood to get an appropriate test result.

> The gaslighting is pushing shitty wellness cures.

Ad Hominem, and lacking in facts.

> I literally had to fight to get access to my ADHD meds...

Ancedotal.

I've met quite a lot of people who initially thought they had ADD/ADHD because that is what the doctors decided. Once you have a label, there is no need to look at anything else that suggests otherwise, a common bias of your average doctor.

These people found that they actually had low-level poisoning, and half the battle was finding a doctor willing to order the chelation tests to prove it. Upon completion of rigorous chelation therapy and removal of exposure sources, and related lifestyle changes they were medication free without the symptoms. They, in effect, cured their ADHD/ADD, and some of them had been to hundreds of psychologists/psychiatrists, all being told they had ADD/ADHD.

Blind trust in centralized systems has an indoctrinated bias that some aren't able to overcome. Nothing is perfect, and some things are the worst possible solution of any solution.

The label in these cases was a classic authority based fallacy. The patients eventually did figure it taking their health into their own hands because the system had failed them, basically saying its all in their head. (Gaslighting).

It was a journey for many of them because they were repeatedly given false or misleading information from the vast majority of so-called experts. Desperation doesn't make things true.

Mind you not all experts are like this, there are some very decent and intelligent experts out there that know exactly what they should and act accordingly; but in the grand scheme they are almost impossible to find or differentiate.

What makes you blind is you assume the diagnostic label is automatically the disease, and that simply is not true in aggregate, or the correct way to approach these things.

>You frame this in fallacy, false dichotomy circularly. For a refutation, is treating poisoning with something that masks the symptoms of poisoning without resolving the cause a good thing?

"Masks" is the problem here. If poisoning causes symptoms, like vomiting, you want to treat the symptom. Depends on various factors. Just like every woo purveyor you have a simple black/white mindset.

>Ad Hominem, and lacking in facts.

You didnt make arguments, you just spouted a toxic opinion. You dont get shielded behind proper argumentation. The issue is you as a human are toxic. You specifically.

>Ancedotal.

Not really, not for Adult sufferers. Its a very common story.

>these people found that they actually had low-level poisoning

Lmao. "Low level Poisoning" you are cooked. Also right after complaining about anecdotal evidence. You literally stand for nothing.

>Blind trust in centralized systems

No ones advocating for blind trust. Just informed trust. Instead of the blind trust in kooks you are peddling.

>What makes you blind is you assume the diagnostic label is automatically the disease

What makes you blind is that you assume that anything anti authority is automatically true.

> You didn't make arguments.

There was nothing to argue, your statement was unsupported, and the only thing you included was caustic criticism and broad over-generalization both fallacy implying what I was saying was shitty wellness cures and that has no basis and your post was designed to impose personal cost.

Why would I respond to that beyond my given response, when anything more is just giving psychopaths, narcissists, and other like-minded and rightfully ill people just what they seek?

I give very minimal effort to mindless bots; and that includes whether they are of the mechanical or base human variety level 0s incapable of introspection/objective reasoning, always trying to bring everyone else down to their crude and base level.

If you can't understand what you did and how it relates to fallacy, its not my job to educate you.

You clearly don't understand basic critical thinking skills, and are quite toxic for no good reason saying much more about yourself than anything you have to say about others. Arguably, no different than any other conditioned animal, and I don't take any pleasure in saying that.

You are mistaken, I'm not blind, I have a deeper understanding than you, quite apparently. I am also not easily manipulated and quite discerning.

I understand how things fail in detail, and I don't assume that contention you make about authority.

Those are your words, and false words at that.

Everyone has the potential to be better, few among the many actually choose to act on the potential and do so.

This is recognized earliest in Matthew 7:6, and in the behavior you exhibited. Compare and contrast.

> The best thing for managing this is meditation

The research support for this claim doesn't seem to be very strong.

[citation needed]

Thanks for this.

The only times I've felt my brain was executing how I should was while doing coke. the only times my anxiety is at rest is when smoking high CBD weed.

I'll go to the doctor, see if I can get the right pills.

I strongly disagree.

First line is a reasonable very rigid schedule where you sleep 8hs, exercise/walk in the morning, and contain your distractions to a specific time in the day. A strict healthy diet. Plan when to interact with people and when to go to nature. Do a lot of visualization of what you want the day to be like (be reasonable). Time-blocking is very good (see Cal Newport)

IMO, only when you mastered the basic of a routine like that you should try prescription drugs. And even when you do, figure out how to need the least possible dosage. For example, eating a high-protein breakfast 1 hour before taking the medication and zero/low carb until evening. Then taking vitamin C foods with dinner to clear it out and prevent crashing or insomnia. Try well-timed over-the-counter supplements to improve how the medication works (magnesium, tyrosine, etc). IF YOU DON'T DO IT THIS WAY YOU WILL GET LESS DESIRABLE EFFECTS AND MORE SIDE EFFECTS. And you will risk spiraling into more and more mg and addiction. Remember: if you have ADHD you are very, very prone to addiction!

Ask your psychiatrist for a slow-release medication (Lisdexamfetamine or XR). And time how you react to it so it matches your ideal schedule. Have detox and reset days where you don't take the medication and don't study/work. (e.g. weekends or at least Sunday)

Cool, how do you propose people who _notoriously_ have trouble adhering to schedules, start and _stick to_ a "very rigid schedule"?

If only there was something, like, some kind of pill that could help with it...

Turn your ADHD obsession into doing the perfect schedule. Turn off your phone and computer. Add reminders of your schedule everywhere. Hang it on your walls. Post-it notes on things you have to avoid. BE BORED for hours without social media, music, podcasts. Use strategic fasting and breakfast to stick to bedtime (same trick used to adjust for jetlag). Get out of your house and walk in silence for an hour. Write with pen and paper everything that keeps you mind over-excited. Add drawings to engage your whole mind.

You have to train your brain. If you always walk with a crutch you will never walk properly. IMO, you should only try drugs once you can sort of stick to the schedule and you are still not reasonably productive.

If you start with drugs you'll become dependent and will need more and more. There is no magic pill.

Your point about the drugs, that's not true unless you're chasing a high

It's not always possible for someone to just tell themselves to start obsessing over a perfect schedule and just do things perfectly

the whole problem is the inability to do those things.

Yes, you can do it to a degree, but a kind of "follow the instructions" rarely works for me in any way.

You saying you should only "try drugs" if this schedule doesn't work just makes no sense to me.

You can't treat ADHD with just a schedule

My point is drugs-first is a bad idea with huge risks. I've seen multiple cases like this. It's all good at first and then it goes bad, sometimes really bad. Of course, it's my opinion and I'm just a random guy on the internet.

I think it depends on the person

But one thing I do think is that too many people expect the drugs to be a magic bullet that removes ADHD

from my own experience and from what I've heard, that is absolutely not the case.

It's a tool, and it helps somewhat but it depends on a lot of variables and sometimes it barely helps at all.

Your comment show a lack of understanding of the condition. With ADHD, we suffer from difficulties with executive functions, like adhering to a planning, being able to chose to work on something... I have obsession: I can't decide on what. I can work at length on complex subjects, again, probably not the one you expect.

It's not a choice.

Medication is not a silver bullet, but it allows, as explained in the parent article to do those things.

> Your comment show a lack of understanding of the condition.

Perhaps, since I'm not a specialist. I did use to think like you but I changed my mind through personal experience and helping relatives and friends with the same condition.

I wish you well.

> I have obsession: I can't decide on what.

This is something that some good old-fashioned introspection (and meditation definitely involves introspection) might be able to fix for you. Learning to harness and redirect the inner energy of your "bad" tendencies is a well-established aspect of many kinds of therapy.

The first line of therapy is not stimulants though, this is a massive falsehood that gets spread by those seeking ADHD treatment.

The first way to tackle ADHD is to manage your behaviour and manage the way you deal with ADHD. If you can't handle the pattern of behaviour, then stimulants don't make you magically able to concentrate. If you're in a pattern of seeking out distractions, then stimulants can potentially can increase that behaviour

What stimulants do help is for you to be able to get over the hump of wanting to get back to what you should be doing. It reduces the difference between boring task and other tasks and you need to be able to address your behaviour so that you can take advantage of the boost that meds give you

Unfortunately I've seen way too many people intentionally mess up their titration so that they're overdosed, bouncing off the walls and claiming that they're cured because they can clean the house for 10 hours straight. That's totally missing the points

Getting a real diagnosis is a big obstacle. Waiting lists are ridiculous, and the medical landscape is confusing.

In recent years, I've become increasingly convinced that I've got ADHD. Before, I used to think I've got Asperger's or something. Before that, motivational problems (that was an actual diagnosis when I was a teen). By now, I'm ready to give chemicals a try, but I can't get them without the diagnosis. (Well, except caffeine, but I'm actually trying to reduce that.)

Also, I'm trying to channel that hyperfocus. It rarely works, but sometimes it does.

Bullshit. It’s just easier. I’m doing fine without any medication tyvm, no need for speed in my ADHD brain.

I'm happy it works for you. For many others unmedicated life doesn't work, especially if we need to work to live.

I'd be off my meds too if I was independently wealthy and didn't need to hold a stable job. I could start SO MANY projects and never finish them :D

My apologies if it read like I don’t think medication is ever an answer. I merely disagree with it being the first tool one should grab.

I just wish my stimulants didn't make me such a shut in.

> You do have to see a physician and psychologist to get diagnosed and to get a therapy plan.

Although be aware that this might be a career limiting (or career ending) move. From the FAA, "Taking ADHD medication or symptoms of ADHD are incompatible with aviation safety." This is one of many areas where the upside of diagnosis and treatment needs to be balanced against being locked out of various careers and hobbies.

Here's a TODO hack that really helps me:

If you finish a task that wasn't on your TODO list, don't fret. Just add it but don't check it off. Then when you come back to the list later, you check it off. This reminds you that you did it and gives you the gratification of completing it. Otherwise, the finished task will slide into oblivion and poke at your self-worth along the way.

I will forget to check it off...

I will forget to add it.

I will forget to do it.

I will forget.

I will?

"I"

The article mentions sleep, which is very important to us all. But something not mentioned is that the symptoms of Sleep Apnea can look a lot like ADHD, and if you have sleep apnea and ADHD then you get a double whammy. Sleep apnea can start at any age, which could be one reason why your attention suddenly got worse. If you're waking up unrested, or have any of the other signs of sleep apnea, get it checked out. In my case my doctor resisted testing "because I wasn't obese," (more or less, perhaps I'm being unkind), so you may have to work at it. But an in-lab sleep study will give you a clear diagnosis. I have seen reports of people who were able to stop ADHD medication once their apnea was treated.

I was treated for sleep apnea 3 times trying to get ADHD treatment.

I eventually found a dental/nasal engineer guy and his testing was more thorough than the sleep studies I undertook. I paid for his device (300 bucks or so) but in the process he gave me a lot of techniques and understanding. He diagnosed me as borderline, despite 2 sleep studies telling me it was severe and chronic. Largely through blood oxygen levels and mouth position.

as someone who has been down this road, this doesn't sound scientific... but I'd love to be proved wrong. sleep studies (PSGs) are rather detailed, and that price doesn't align with medical-grade oral appliances

I dont know what you pay for either scenario. But where I am, sleep studies are heavily government subsidised, and cost me less than the oral appliance, which did not attract any subsidy.

The issue there is that theres an extreme incentive to push you back to another sleep study. The people who run the sleep studies also sell/rent government subsidised CPAP machines. And the sales pitch is very forceful.

On my large treadmill of doctors doing anything they could possibly do to not send me to a psych for an ADHD assessment, I was offered the option of the oral appliance. I found that gentlemans practice, knowledge and understanding of the issue to be quite thorough.

His approach was more engineering than science for sure. I don't doubt the sleep studies results, in that I was getting extremely poor sleep. I doubt the interpretation of the results towards a diagnosis of extreme OSA.

What really got me my best sleep was ADHD stimulants. Its like I have a normal humans circadian rhythm now. But spending 6 months on the oral device, learning about jaw positioning, sleep positioning and other things, probably did me better than a CPAP machine would have.

Probably some important context, is that the doctor who referred me to 2 sleep studies and a whole bunch of other shit, had diagnosed me with subclinical thyroid problems. And on the basis of that diagnosis was unwilling to ever refer me to a psych because he believed his diagnosis explained all of my symptoms that OSA did not. I do have subclinical, treated, genetic hypothyroidism. My current doctor is inclusive of that diagnosis, and doesnt use it to exclude others.

YMMV.

sleep studies don't really have significant rates of false positives. it's not unreasonable to want to treat OSA due to it causing executive dysfunction as a side effect.

yeah, the DME market is weird which is why I just bought my equipment outright. but the point of repeating a study is to ensure you're being treated. if the government is paying for it, they aren't going to do an extremely expensive test for fun.

based on your description it sounds like you may have both ADHD and OSA, so I'm glad you're doing better

oral appliances aren't really a first line treatment and can cause issues with one's bite and TMJ. in the US, sleep board certified dentists can make a custom appliance that reduces these risks. $300 sounds like a budget for a toy by comparison...

more engineering than science? isn't engineering a science?

doctors aren't perfect but the alternatives are rarely better. if this person isn't a medical professional, they can't "diagnose" anyone

>but the point of repeating a study is to ensure you're being treated. if the government is paying for it, they aren't going to do an extremely expensive test for fun.

Welcome to Australias Medicare lmao. Visit > referral for test > Visit for test result is how GPs make money. They get a cut from the government at every step regardless of how much is billed to me directly. We arent far away from needing a royal commission to investigate how many of these yoyo visits are required.

>based on your description it sounds like you may have both ADHD and OSA, so I'm glad you're doing better

The OSA is real. The OSA is definitely mild and not extreme. It is also heavily influenced by sleep position and my jaw.

>custom appliance that reduces these risks.

The device was customised to my Bite profile. He had better options, but the 300 dollars was what I had. He had options up to 2k. He was also certified, as I had a referral to see him.

>more engineering than science? isn't engineering a science?

Engineering is applied science.

Not even my only medical issue fixed by visiting that professions engineer either tbh. I had a crown fail, and a dental engineer refitted it for 15 dollars, told me the cement he used would last 20 years and isnt made any more. 20 years later my toddler popped it out.

Tell us more, where can I find this person?

Most diagnoses of ADHD start with a sleep study.

Of course a sleep study for a child in a loud hospital will probably fail due to the constant PA messages.

My ADHD meds (mostly) cured my sleep apnea. The remainder has to do with allergies.

>>> An example: you have to fill out some government form. You’re averse to it because you worry about making a mistake. And just the thought of opening the form fills you with dread. So, take the boxes in the form, and make a spreadsheet for them. If fonts/colours/emojis/etc. if that makes it feel more personal, or like something you designed and created. Then fill out the form in the spreadsheet. And then copy the values to the form and submit.

Oh wow this spoke to me - do it a lot …

This maps pretty closely to the theories of Dr. Russell Barkley!

However. The article encourages a diagnostic approach—it asks the reader to introspect and identify the root cause of their inaction. But by omitting both PDA and RSD from its list of potential causes, it creates a "diagnostic trap" that can lead to misdiagnosis and self-blame. The omission is particularly damaging because PDA and RSD are two of the most powerful (and often invisible) drivers of severe, persistent avoidance.

I am obviously not a psychologist, I got kind of worried reading this that maybe I had misdiagnosed myself and that going the route of official diagnosis would lead to a lot of wasted effort. But reading into these two things you describe (Pathological Demand Avoidance (PDA) and Rejection Sensitive Dysphoria (RSD)), I am glad to note that I don't think I've ever had anything of the sort.

But I agree it's good to spread awareness of these kinds of things.

These are the two articles that got me to get diagnosed:

https://gekk.info/articles/adhd.html

https://miniver.blogspot.com/2021/08/the-subjective-experien...

I have the sinking feeling of having both, they both explain me very well.

It's not just ADHD people who are like this, ASD people can be too.

While I do think the distinction between ADHD and ASD is still useful in some ways, mostly around having signposts regarding where to start for treatment… a number of people in my life, myself included, are basically “mix-and-match from both lists of symptoms”. Some very clearly are majority from one list or the other, but most are both to varying degrees.

yes you can have both, but they are both distinct. ASD is not really treatable with stimulants.

That’s exactly what I mean. The distinction is useful for determining treatment approaches but overall it might be more useful to generally look at them together holistically.

In my own case, I was diagnosed with ADHD. Autism didn’t enter the discussion even a little bit. I’m medicated with stimulants and it works well for me for executive dysfunction part of my overall symptoms. It’s only very recently, while helping someone close to me go through a combo diagnosis, that I’m realizing that there are probably some other traits I have that would be better addressed with Autism counselling.

The kids are calling it AuDHD

PDA is more associated with autism isn’t it? Though some people have both.

It's heartening to read the comments in these threads and see that this might actually be the problem I have dealt with for 29 years and that there might be a solution for it.

Now the hard part is getting myself to fill out the paperwork required to get the NHS to pay someone to look at it.

You might want to just have a chat with your dr, as you'll likely try something like concerta if you are diagnosed - but you can skip the long process of diagnostic and just try the medication if you fill out a few questionnaires. At that point it's pretty self evident if the medication helps the issue or not and bam, you might have solved your problem without going through the hurdles.

Tried to speak to my GP and my local surgery told me to either register for the NHS waiting list (probably 100 years long at this point) or use the right to choose process to get the NHS to pay for me to see a private clinic (takes 2-8 weeks to see someone instead of years).

They didn't even suggest that I could/should speak to my GP first. And I can't actually get an appointment with my GP other than the way I specifically tried to. At least not my local GP.

That sucks, I'd love to be of more help, but I'm in Canada.

If you're able to, I'd go for the private option. Really, the medication helps tremendously and having access to it makes every other step easier to take - I really wouldn't have thought that's how it would make me feel.

Good luck going forward!

I had to pay for diagnostics myself too since here in Germany, adulthood ADHD diagnostics are unfortunately not paid by the health insurance. Cost me around 600 €. The hardest thing really was fighting myself to actually get an appointment

Doesn't apply to UK. In the UK the NHS will pay for a private company so there is no reason to go private yourself. But they absolutely won't dispense medication without a diagnosis. And the waiting list is at least a few months, closer to a year in my area.

My GP applied on my behalf. The queue in my area is more like 8 months though. You have to fill out a bunch of forms but importantly that's after you are in the waiting list.

I appreciate the author's notes on managing ADHD. I was glad to find I didn't learn much new, because I'm already applying many of these practices.

I've tried several to-do apps, but centralized systems didn't work for me. I now use multiple to-do lists across different media: some on paper, some on my phone, others in markdown files within project folders... sending email to myself. It may seem messy, but it works for me. One system doesn't fit everyone. And any customization and tweaks are encouraged.

Books that helped me:

Atomic Habits by James Clear emphasizes small, consistent changes. Over time, they build into significant improvement. It’s better to improve your system gradually than attempt a major overhaul.

The Now Habit by Neil Fiore offers tools to overcome procrastination and start tasks. It helped me understand my resistance and find ways to move forward.

Getting Things Done by David Allen focuses on reviews and planning. I struggle to make time for them regularly, but even occasional reviews help.

Marcus Aurelius' Meditations, especially annotated versions, provide a Stoic perspective. His reflections on virtue and responsibility inspire me. He seemed to dislike being emperor, preferring philosophy, but accepted his role out of duty. That example helps me do necessary tasks, even when I don't feel like it.

ADHD has a biological cause and drugs are the first-line treatment for good reasons.

I was diagnosed with ADHD as a child and spent several years in special classes as well as receiving a lot of private therapy/tutoring. I'm not a self-diagnosed adult (as is common). I've managed my situation in various way for a long time (50 years) and refused medication the entire time. Phone alarms really helped me when I started using them.

There may be good reasons for drugs but there are also bad reasons - especially, they're a quick "fix" allowing a care provider to do this and wash their hands of the situation.

Further, of course ADHD has a biological cause - human beings are biological beings so every human behavior has a biological cause when you come down to it. But the implication that proscriptions drugs designed based on a deep and verified understanding of the mechanisms of ADHD is completely false - ADHD drug prescription, like all behavior-altering drug prescription, is based on just "bucket chemistry", maybe-educated guess work. Which isn't implying drugs don't work for some people. But I think it's important to be clear the various drugs aren't ADHD cures in the way that antibiotics are cures for infection. But again, I support the right of people want ADHD drugs to have them. But I think drug use shouldn't be automatic.

Stimulants are still first line therapy for treating ADHD but I think mindfulness meditation is wholly underrated. People with ADHD have too much activity and overly-robust neural nets in the default-mode network in comparison to healthy controls. There is a network above this network, the salience network [0] that is responsible for the switching between the default-mode and executive control networks.

ADHD may present with many brain-network anomalies, but I believe the classic case is one where there is more default-mode activity, less executive control activity, and ineffective switching occurring from the salience network. Mindfulness meditation is honed at training the salience and attention networks towards playing closer attention, which offsets the deficits observed in ADHD.

That's my lay interpretation; but actually, I believe that people who suffer from ADHD probably have even more to gain, relatively, than those who don't from taking up the habit of mindfulness meditation. It's not an easy fix--I've read that it takes about twice as long for those with ADHD to benefit from the practice. But it seems like it's worth it; after all, your mind is really the only tool that you have.

Those interested in this topic should read about ADHD and it's relation to the salience and executive networks; and how mindfulness sharpens the function in these areas.

[0]: https://en.wikipedia.org/wiki/Salience_network

I’m not clear. Are you someone who has ADHD or is this recommendation based on experiences with someone with ADHD?

I have ADHD and meditation, for me, is very difficult. Painful even.

Meditation practitioners have been writing for thousands of years about the problem of "quieting the monkey mind" which reads just like your typical description of ADHD, only in the specific setting of a meditation retreat (which is typically an intentionally challenging, spartan, uncomfortable environment - hence one where pretty much everyone is enticed to get fidgety and hyper). It's difficult for everyone at first!

Next time Please state that upfront: you don’t know anyone with ADHD that this has been effective for and you dont have ADHD yourself.

“Have you tried” comments from people without firsthand experience is basically asking others to be your guinea pig. I didn’t say “hard” I said “pain” as in a physical reaction. If you don’t have the same pathology I don’t think you can truly empathize or understand what you’re asking me to do (even if you think you do).

I’m glad you found meditation and that it’s helpful for you. I’m asking that you modify your evangelism in the future to give people maximum context on where your suggestions are coming from (and associated limitations).

There is a lot of data that meditation is beneficial for people with ADHD and potentially even more so since they “need it more”. Yes it is extremely challenging which is why in my parent I stated that according to what I have read, it takes someone with ADHD potentially twice as long to see the benefits of practice in comparison to healthy controls. I have ADHD and have learned to meditate; my mind was out of control, and I feel as though I have control of it now, without stimulant medication. I encourage you to look into the data if this is something you find interesting.

Thanks! Have you found any types of meditation work better or are easier? Suggestion where to start if it hasn’t stuck in the past?

I've only tried mindfulness meditation, but as others have chimed in in the thread, other types may be easier depending on your circumstance. As I started, even being able to focus for 5-10s uninterrupted by thought was a huge win. It may be slow, but eventually you will be able to extend these periods and get to a point where it's actually 'working'.

Also, I don't think using stimulants or other adhd meds (like atomoxetine), if they're part of your routine is necessarily cheating. I like to think of them as 'training wheels', which will help you focus internally and less on your thoughts. It will still be difficult (like it is even for those who don't have ADHD), but it may help your brain start shaping those neural important pathways a bit sooner and more easily than it'd otherwise come unmedicated.

There’s a nut bar on Reddit who talks about the dangers of “quietism” and I have to grudgingly agree with some of his points. I did quiet my monkey mind, but then discovered that without my constant, rapid fire internal monologue, I had difficulty engaging in other self improvement activities. I would later discover I was working predominantly from Fast thinking (Thinking Fast and Slow) which has trouble moralizing on your actions.

Mindfulness is not the same thing, but I’m not sure it’s a solution for us either.

I have unmedicated ADHD (Psychiatrist diagnosed) and I really struggled with mindfulness meditation (Even tried a Vipassana retreat). However Transcendental Meditation (TM) worked really well. I find my mind is more organized after a year of practising.

I had a bad back before trying meditation so it was doubly bad.

I have a trick for you but quieting your mind won’t necessarily make your life better. I would instead encourage you to look at “walking meditation”. Forest bathing, cycling, walking. Tai chi is remarkably good. A lot of people with emotional issues are detached from their bodies, and part of healing is accepting that “you” is both your mind and your body.

Alright, caveat served: count your breaths. Count to ten, then start over. This gives your brain something to do, connecting the math and verbal centers but without triggering deeper thoughts. You will catch your mind has wandered when you realize you just counted 13. Just stop and start over, don’t get into judging yourself. It happens to everyone. Just go back to 1. You can analyze the sitting afterward, not in the middle.

But seriously, tai chi is fucking amazing.

Strong agree

Breathe in: ONE. Breathe out: TWO. Next: THREE... reset at 10.

If you find yourself breathing in on an even number, or out on an odd number, you've gotten lost. No problem, just reset to 1. Got to ten? You win! Also, reset to 1.

Very useful and simple technique for calm and focus.

I also think ADHD is a combo of many different, more specific problems that we blob into ADHD since we are not precise enough to diagnose it beyond the 3 types we have now, and these sets of problems are responsive to stimulants.

For some people with ADHD, this will work very well, others will not. Some with ADHD are already naturals at mindfulness because they have really bad time blindness. They are always, a bit too in the moment and low anxiety.

> ...naturals at mindfulness because they have really bad time blindness...

FWIW, this is not what "mindfulness" means. Mindfulness is a combination of concentration (i.e. intentionally focused attention) and insight (i.e. a deep intuitive knowledge and familiarity with the three characteristics, viz. anicca, dukkha, anatta). People who have reached the deepest stage of enlightenment (known as arahants) are believed to be able to switch their default mode network on or off pretty much arbitrarily (there is interest in verifying this claim experimentally, and it doesn't seem to have been outright refuted so far); they seem to have reached a deeply ingrained understanding of what it does and doesn't do for them, and the control ultimately flows from that.

Read closer, "naturals" means they have talent at the skill, unlike the contrasted people who have a harder time about it in parent comments. If you are a natural, it doesn't mean you go pursue that skill either. You also get hyperfocus with ADHD.

I'm sort of inclined to agree with your premise that ADHD may describe how a patient presents without describing the underlying faulty physiology; but, at the same time—it's all about attention.

It doesn't matter how you get there—mechanisms that can improve executive control and control over the mind's salience network will greatly end up benefiting those who suffer with ADHD. Those who practice mindfulness meditation—ADHD sufferers or not—show strengthened neural circuitry in both executive control and salience networks. Head trauma, environmental factors, genetics or what have you; working to strengthen these networks is a good thing.

Oh man, this article is timely!

"Decision Paralysis Procrastination". I've been going round in circles for 3 days trying to decide where to go travelling. I can go pretty much anywhere I want to and there are lot of places I want to go. I've even found some /really/ good deals but couldn't pull the trigger.

> One thing to consider is that thinking in your head is inherently circular, because you have a limited working memory, and you will inevitably start going in circles

That REALLY resonates. It's crazy how much I will put off writing things down. Like my mind keeps telling itself "that's too simple to actually help"

On deciding I think you’ll find that most of use are sort of bipolar in this regard. But moreso introverts, particularly ASD and HSP ones.

Some decisions you want to sit with so they need to be made early, and then god help you if they change last minute. Doom for ASD, lots of emotional energy spent twice or three times for the rest.

Others you’re more afraid of deciding wrong than not having prep time. Things like writing papers in an adrenaline fueled marathon versus just writing a fucking outline on day 3.

> I can notice if something has not been worked on for a while, and act on it. Otherwise: out of sight, out of mind.

A visual indicator for task age works wonders for me. I use parentheses to show the age of a task. As the parentheses accumulate it's very obvious what I'm behind on. e.g. ")))))))))) respond to important email".

Works especially well for recurring tasks: the parentheses disappear when the task is marked complete.

I try to keep my lists as small and up-to-date as possible and this serves as a staleness indicator as well.

I use Todoist and have a script to manage the parentheses. https://github.com/leroux/todoscript

Credit to intend.do. I shamelessly stole the concept from NotDone Propagator. https://intend.do/features#notdones

Interesting - how is this used? Run every day or its a long-lived server?

I have set up my projects in a way that whenever I work ok it, all the context I need is available from one single starting point. My goal is that zero friction is needed for to resume work on any project, no matter how long it was paused. My habit to keep the context for each project fresh is a at-least weekly, timestamped, append-only Captain‘s Log, which - just as its namesake - is a very brief 1-2 sentence summary of what’s going on for everyone to get back into the story after the commercial break. „No updates“ is a valid update. Since its append-only, retrieving more context is just a matter of keeping on reading after having read the latest update.

How do you remember to update it?

Recurring todo list entry.

adult diag ADD (prob some ASD also). Kids were diagnosed, had one of those ahah moments. At least in my generation, the quite, bored as hell kid in the back of the room. Thankfully, I think the ASD made me determined, hardheaded, and perceptive, and my parents encouraged and supported me to set good goals. That served me well, but I look back and wonder what could have been if I could have stayed awake in high school classes.

My longest friend is hyper, smartest dude in the room but could not stay out of trouble. Right now, he is literally climbing up a mountain. Even today, I get so pissed at my adult peers who don't understand that that distracted kid is just wired different, not undisciplined. You can't change your neurology anymore than you can change your eye color.

Stims helped much more that antidepressants, but I burn thru catecholamine quickly. Vyvanse lasts maybe a few hours, by example. I've had days where I could take a stim, then fall asleep waiting for it to kick in. Its burn-out, and it sucks.

One thing that helped was NALT and Phenylalanine. Initially, 700mg of NALT was miraculous. Doesn't help so much any more, but I continue to take it. I suspect there are other things causing dopamine production bottlenecks and-or low storage of dopamine.

Gene test indicates I may not convert folate to methylfolate, which is important for the stress hormone cycle. You can supplement methylfolate but so far I've not seen improvement.

The ASD makes it very difficult for me to not call a spade a spade, especially around touchy-feely people. My ASD daughter is now in college, like me, struggling greatly with social. She's as liberal as it gets in a free society, but when the college offered group therapy she refused for the same reasons I hated all that groupology crap; you can't really speak your mind without getting ostracized.

IDK if I have ADHD but I started taking Bupropion to help me quit smoking and stayed on it because I feel better on it, and naturally have picked up a lot of this organizational stuff over the past few years like lots of reminders, notes, managing inboxes, calendars, pomodoro. I don't think I've had or have any of the main symptoms of ADHD but sometimes I see a post like this and think maybe? It's also hard because the list of symptoms of ADHD in pop culture seems to be growing out into infinity and it's difficult to separate what's actually ADHD and what's not.

Also there many are other potential factors such as desk-job, sports, sun exposure, and nutrition.

HOWEVER, there are also birth defects such as the MTHFR gene mutation which reduce Vitamin B12 utilization of your cells by as much as 70%. It has far-reaching consequences for every single cell in your body. Modern medicine is mainly symptom-based and things like chronic Vitamin B12 deficiency are hard to diagnose (unlike famous low Vitamin D levels). In many countries you can't even sequence DNA of your own child, and for a hereditary gene defect in a core chemical reaction of the human metabolism this is just staggering.

For example as someone who has the MTHFR gene defect, my organism needs the "bio-available", methylated version of Vitamin B12, because it can only use 30% of the Vitamin B12 in my bloodstream.

The effects of Vitamin B12 (methylcobalamine) supplementation after many decades of Vitamin B12 deficiency is staggering. Within 30 minutes it felt like someone lifted a very heavy baseball cap off my skull. If someone would've told me methylcobalamin is a potent anti-depressant or some illegal drug I would've believed them based on the effects.

If you scout google scholar or NCBI for recent studies on Vitamin B12 you will find recent case studies that use Vitamin B12 supplementation to treat infertility, long covid symtpoms, and autism in children. And if nature gifts you with the MTHFR gene defect(s), Vitamin B12 can be really rare in your cells.

Yet here we are, even in one of the wealthiest countries in the world you need to do gene sequencing on your own if you want to learn about basic genetic defects, because doctors won't touch anything involving "genes" if the disease is not named after yourself. According to Wikipedia roughly 20-30% of all people have this exact MTHFR defect.

Here is some more info: https://www.snpedia.com/index.php/gs192

PS: ADHD is often linked to depression, and I've been discussing with a good friend what comes first. If you have chronic disease, there is first the disease, then comes the depression. But then doctors or others see you and only focus on the depression which - funnily - increases the depression / anxiety even more.

I wish I knew at a younger age that methylated Vitamin B12 / folate supplementation is needed due to a genetic defect.

They even ban things like ancestry DNA tests??

AFAIK in some places your child needs to be 18 in order to knowingly consent to getting a genome sequencing. But of course you can assign a religion to your child before that if you want ;)

Bupropion is an interesting one because pretty much everyone with ADHD is dogged by situational depression. So it helps a bit with that as well as executive dysfunction.

I tried too high a dose once and it worked imo too well. I couldn’t procrastinate if I wanted to, and I found the lack of choice disturbing. I wonder though sometimes if I should be on that dose. But the side effects (muscle spasm) created more intense feelings of loss of body autonomy.

Has anyone talked to you about guanfacine? It reduces RSD, which makes it easier to start things.

Interesting, i might try to talk to a psychiatrist about it sometime.

> If being organized makes you feel good

> If you are very OCD

Please educate yourself, OCD is serious shit: https://en.wikipedia.org/wiki/Obsessive%E2%80%93compulsive_d...

Some people with OCD literally starve to death, because they can't leave their house. Commonly you find those affected washing their hands repeatedly until they bleed... and then some more. It is absolute not a "what makes you feel good" kinda thing, it's a dysfunctional and irrational mental world model enforced by a crippling sense of doom, anxiety and shame, which will consume life (especially if "very OCD").

Most importantly, for those with actual OCD, you absolutely aren't advised to embrace that destructive, irrational world model by leaning in on compulsions. You cannot really exploit it for good, by definition. And by definition, it isn't benign.

I wish people would stop attributing a quirky/controlling personality, a desire for order, symmetry and tidy rooms to a serious mental disorder. You wouldn't twist major depression, schizophrenia, or cluster B disorders like that. If you feel left out on the identity game, go read Lord of the Rings, or Das Kapital, try horse riding, or golf.

Quite honestly, for me this casts serious shade on the whole article. Because "ADHD" is similarly misattributed and casually "self-diagnosed". Maybe the author just got very ADHD by browsing too much Insta and later found stimulants to be stimulating. Much easier to cure that kind of ADHD through abstinence and structure. (Although coming up with elaborate routines and revolutionary hacks, which are a total breakthrough for a whole month, is a very ADHD thing...)

Do you really believe there is only one kind of OCD, specifically one you described?

I'm sorry to tell you, but both ADHD and OCD exist on a spectrum. Furthermore, ADHD like symptoms can be caused through other illness than actual dopamine deficiency.

There are many kinds of OCD! There are zero kinds of OCD that aren't a disorder. A helpful mnemonic is: you could imagine OCD stands for "obsessive compulsive disorder".

Yes, "one kind", by definition of being a disorder: https://en.wikipedia.org/wiki/Mental_disorder

"Some people", "commonly" already implies a variety in symptoms and manifestations. But by definition, they all cause clinically significant impairment, or distress.

> I wish people would stop attributing a quirky/controlling personality

> for me this casts serious shade on the whole article

I think that's healthy wariness. The article seems overall well thought out, but OCD is an extremely common blindspot today, so I don't think it spoils the rest of the advice (which is largely good and spot-on).

Even my primary care doctor, when I told him I'd been diagnosed with OCD causing many disparate kinds of anxiety and depression, said something about "well you want your accountant to have a little OCD for example." I was a little stunned!

I agree, there is some good advice in there. However, this makes the OCD remark stand out even more for me. Bit like a doctor recommending homeopathy or starts talking about flat earth stuff. Getting such a basic thing so wrong, taints everything else.

See, "the good advice" is knowledge I can recognize as such, therefore information I already have. You need a basis of trust accepting any new information. A flat-earther may get Newtonian physics right, but I won't go there to learn about it.

I don't think the OCD section adds much anyway, so I think the article would be greatly improved by removing it.

Apparently, the article has changed and now doesn't contain the OCD reference anymore. Cool!

Here is the version I was referring to: https://web.archive.org/web/20250828075812/https://borretti....

I would say that control issues are the seed of OCD. Nobody wants OCD, but Illusion of Control is no cakewalk either. Generally that will also go along with an anxious or avoidant attachment style, which is even less fun.

I don't get your point, sorry. Not sure you got mine, either.

As mentioned in a comment elsewhere, the article has changed since I wrote the call out. It doesn't contain the ignorant OCD remark anymore. I didn't bring up OCD out of nowhere.

Probably too much assumed context. I’ll expand.

A good deal of ADHD masking/coping mechanisms show up as trying to control certain parts of the environment. We need to do this thing that way and keep this thing at that location and never ever do X but instead Y.

It can look like someone who needs those things for other reasons, like mild OCD or even autism. But it’s really about preventing everything from going to shit in the worst ways that we cannot deal well with.

So while your room may look like a bomb went off and your fridge is half empty, there are certain things you are super precious about. Because a little work now saves a lot of grief later, and for those little islands of sanity you find the motivation to perform them.

For me this is mostly at work. And the things I need to be a certain way help everyone during an emergency. High cortisol levels make every brain more like an ADHD brain.

Yes, it may look like OCD superficially, but it isn't. By definition (and name) it's a disorder which mean its symptoms impair life to a clinically significant extent.

ADHD and OCD are often co-morbid (see below), can fuel each other, and otherwise share the "obsession" dynamic. However, a very important characteristic of OCD is its cyclic, repetitive nature. Being obsessed with order and symmetry isn't the point of OCD. With OCD you get "stuck" on this obsession. Keeping/restoring order/symmetry is not enough, you have to do it over and over again. With the hand washing example, it's not that people typically need to wash their hands 20 times as per head canon, but rather immediately after washing their hands, doubt creeps in, then comes the sense of doom and anxiety about the consequences of not having it done "right". ADHD can worsen this, as lack of attention to the "task" increases doubt.

You know this feeling of "something extremely horrible is about to happen"? Similar to how a panic attack feels. That's the sense of doom. It's a medical phenomenon also observed with people actually about to die, sometimes. It's an old feeling... The "this cave is not safe", "being watched by a predator" feeling. It can cascade into the most fear and anxiety the brain can experience, it's very, very imperative, and commonly what people with OCD experience when they ignore their compulsions. (Shame may also play a role and compulsions may also be completely internal "thought habits".)

OCD is for the most part an anxiety disorder, it's mostly not about the actual ticks and obsessions, which may change over time. People with OCD are aware their obsessions are non-nonsensical, statistically unlikely, irrational, etc., but the feeling of terror is too imperative!

Neurologically there is an anxiety plateau which is important for OCD CBT, as learning this feeling is not a bottomless pit and you can endure it, is the path to reshaping neuronal pathways. Not giving in to compulsions, staying with the fear is how OCD is therapeutically treated - the opposite of what the author had suggested.

For normal people, the "spectrum ramp" to this dynamic may rather be the common experience of "did I lock the door?", "did I turn off the gas?", where it's also common to check and even recheck. Though, healthy minds get out of this loop, before it becomes an impairment. Again, because of the lack of attention, bad working memory ADHD may derail this dynamic and an "OCD-ish" extent may also present as adaptation. For example, forgetting about the stove may become an (rational) anxiety trigger from experience ("I almost burned down the house and everyone I love"... again) and inattentive checking and rechecking may become a coping strategy. This can spiral into OCD, especially because shame and stress are at an increased base level due to colliding with other people's expectations and so on.

Without the anxiety, without the repetitiveness, without the impairment quality of an disorder, it's not OCD. Personally, I think it's very bad taste to use the term inflationary considering the suffering and disability this mental disorder causes.

This is all good advice but it presupposes that you have enough energy and motivation to organize yourself.

For me, most of the time, the challenge is lack of energ and motivation to do anything outright. Even on 50mg Lisdex.

Came all the way down to see if someone has a comment like this. I have tried all possible frameworks but finding the energy to execute them is the hardest part. Has gotten slightly better after I started meds but a lot depends on how my energy and emotions are at that moment

For me, first came the stimulant meds, then slowly and over time the energy, as I started being more organized and putting my day into a routine. Try Bullet Journalling, it was created (discovered?) by a guy with ADHD.

Thank you for this article. I have yet to discuss with my doctor about this. But I have noticed several issues that are severely lacking for me compared to my peers:

1. My brain drifts away very easily. Even in an important work conversation, my brain just starts thinking about a completely different project or upcoming meeting. 2. I have a hard time remembering things/events that my spouse and others can easily recall (ie: which restaurants we have been to) 3. I can't seem to form an opinion on very basic things like do you like restaurant A or restaurant B better? do you like option A or option B? I can't decide or come up with any heuristics.

At first I chalk it up to I am being too critical about myself and others are having the same issue. But that doesn't seem to be the case. Can these all be rolled up in the same conversation with my doctor?

Probably all part of possible ADHD, except point 2, which might be a sign of SDAM (Severely Deficient Autobiographical Memory). It’s recent and not well known.

> Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.

How exactly is this supposed to work?

(Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".)

In Poland, you are basically unable to get diagnosed if you are an adult. You will be treated like drug-seeker.

You did okay at school? Clearly it's not ADHD. And so on. Heard similar stories from my friends and colleagues.

Americans have that one easier, ngl.

You need to look for a psychiatrist that specialises in attention disorders. You also need to work with them on a therapy -- you don't go to them and ask them to give you amphetamines, but instead go talk to them about the issues you have in your day to day life.

Speaking as a fellow European that until recently had the same views as you.

With therapy I of course agree - I do think that people are overmedicated. It should be the last resort.

But even on that, it's unlikely that someone will concur it might be that. General vibe I got was that, as I said - it's something you grow out.

And sometimes I find myself doubting, maybe they're right and it's something wrong with us? Many times I have wondered if it is just my subconscious way of trying to avoid responsibility for myself.

> And sometimes I find myself doubting, maybe they're right and it's something wrong with us?

Yes. The thing wrong with us is that our life style is not a good fit but we persist to it despite knowing that. But why? Well we are more or less forced into it because society currently values dicking around with the JS library of the day much higher than herding a flock of sheep.

That's unfortunate. It's not exactly easy in the US, either. When I wanted to get treatment, I asked my family doc, who referred me to a psychiatrist. The psych diagnosed me with anxiety and depression. We tried treating that; it failed. Turns out ADHD causes a lot of anxiety. The anxiety was a symptom, not the cause. I found another doc who specializes in ADHD who finally started treating it, and the change was immediate.

Not true,

Source: diagnosed in Poland, see my other comment. Feel free to contact if need help.

What's your general region you live in if I may ask?

And yeah, I've read it. I'm happy it got better for you. (not saying that sarcastically, I just have trouble with tone over text) How hard was the process for you to get it diagnosed?

The default city, but the process was that I paid out of pocket for psychological diagnosis and then used that to talk with psychiatrist. It seems to be the "easiest" route to be taken seriously, rather than drug-seeker.

And other comments - you NEED to look for people who specialize in ADHD specifically, both on psychologist and psychiatrist side. I got SNRI only because the doc said "it's used as last resort for ADHD, perhaps it will help you" - no, it does shit nothing for ADHD in my case. But it did help with many other things so I'm still grateful for that.

Also, keep in mind that non-stimulants also do work, but they don't work _immediately_ and that requires actual regime to make know whether they work on you.

Gotcha, thanks. (tbh I don't know anyone on NFZ anyway, if I wanted to meet a psychologist, I'd wait close to 300 days and I'm in one of major cities.)

I literally went through the process in Poland with success. It was back in 2021 though but I don't think much has changed since then. A bigger probablem at that time was just finding pharmacies that stocked the medicine.

Could I ask what region you are from, then?

I was, without doxxing myself, somewhere in central Poland. Whether it's Łódź, Toruń, Bydgoszcz or Poznań, I leave that unsaid :D

I did everything in Warsaw. But I had to use private health care for the first consultation.

> How exactly is this supposed to work?

It's not exactly "executive function in a pill", but in people with ADHD, stimulants help with task initiation and sustained attention. That's often enough to help people create a structure for creating and maintaining habits that work for them.

That's not what I was asking. Please note both parts I italicized in my quotation, and how they interact.

Ah, now I understand what you meant. The OP assumed the "get diagnosed" part would be understood. I've made it explicit below:

> Here’s an example: you (having undiagnosed ADHD) try to set a schedule, or use a todo list, or clean your bed every day, but it doesn’t stick. So you [get diagnosed and then] get on medication, and the medication lets you form your first habit: which is using a todo list app consistently, checking it every morning.

No, you do not understand. Please read the parenthetical in my first post, in which I preemptively made it explicit.

Getting diagnosed is the first step. It can be a steeper step for some than others. But once you have a medication that works for you (which sometimes takes a few attempts) then you'll find that task avoidance becomes less frequent. Having a to-do list will help you ensure that the "must-do" tasks get completed. I rely on my phone's calendar, task list, and a journaling app named Daylio that I use to track how effective I was in completing tasks that day (you pick an emoji)

I was fortunate to find a physician that specializes in ADHD. Most of his patients are children/teens but they also see adults like myself. You can also go the route of seeing a psychologist that specializes in ADHD.

At a certain point, if someone doesn't understand what you're communicating, it's a problem with your communication and not with them. Personally I still don't understand what you're trying to say; it wouldn't hurt for you to expand on your point if you want someone to respond in a useful way.

I said it plainly:

> Even assuming a health care system that actually cares about ADHD in adults, "just get a diagnosis" seems like a much higher bar than "just clean your bed every day".

I would elaborate if I understood how there's any room for confusion. I don't.

ADHD diagnosis is extremely easy to get. There are websites that will link you with a doctor that will "diagnose" you remotely by giving you a questionnaire with extremely leading questions. Even with more reputable doctors it's easy: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

If you really want ADHD medication, you can get it today. The doctor will probably still start with atomoxetine (it's not a stimulant) at first, but then they'll transition you to stimulants after a couple of months if you ask for it.

Edit:

> How exactly is this supposed to work?

People with ADHD often have an irrational aversion to doing some tasks (e.g. paperwork or laundry) and have to actively trick themselves into doing them. TODO lists, automated voice reminders, and daily routines are some ways to do it.

Once a task is started, it's easier to keep rolling. Stimulants help to reduce this initial barrier, and they help with staying focused. They do NOT make you high in therapeutic doses.

> ADHD diagnosis is extremely easy to get.

I am in Canada. My family doctor apparently cannot do this, and has advised that a private specialist would be quite expensive (not that I'd know where to start looking anyway). I can't fathom that an online questionnaire would lead to legal access here to stimulant medications, considering that even things like SudaFed are controlled. And anyway if I am going to feel safe with a medication I don't want it prescribed on the basis of self-reporting on "extremely leading questions".

> will probably still start with atomoxetine (it's not a stimulant)

First I've heard of this one.

> How exactly is this supposed to work?

By "this" I indeed meant dealing with the "not diagnosed" hurdle.

I don't know how it works in Canada. In the US, it's not hard. For example, you can use https://www.donefirst.com/ to get started.

And once you get the initial prescription from a provider, it's much easier to keep renewing it going forward.

> I can't fathom that an online questionnaire would lead to legal access here to stimulant medications, considering that even things like SudaFed are controlled.

Nobody ever accused the US drug enforcement policy of being consistent and sane.

Canadian here. You can try booking an appointment with a provider specializing in ADHD on Maple (it's a telemedicine app). First appointment is a screening/intake appointment, if they feel you're likely to have ADHD or rather you might be a better fit for something else (e.g. anxiety), they'll schedule a follow-up appointment for that. Prices are pretty transparent on their app, but IIRC it's in the realm of a few hundred CAD for both appointments.

Here in Germany people can wait years to get an diagnosis. And I mean literal years.

And we are talking about an active process here of actively calling therapists, adding yourself to their wait lists and so on. There is no central system. If you have the money to pay privately you can get it done in months but it is a lot more involved than a simple questionnaire either way.

And even if you have an official diagnosis this does NOT get you medication. You got to find a psychiatrist first. So back to square one. Call ten, twenty, thirty, forty people, maybe get an appointment in a few months.

The US is pretty progressive when it comes to mental health all things considered. Most people in this world are not so lucky.

In the States, frankly, if you are a clearly responsible adult, it is incredibly easy to get diagnosed: just describe your symptoms like missing deadlines etc. The psychiatrist said “yeah, sounds like adult ADHD. If the medication works, clearly you have it”.

There are tests they can run on you but no one has ever required me to do them, and I’ve been rediagnosed 4x when switching psychiatrists due to moving/switching insurance.

Note: last time I did this was 2020 or so, so maybe outdated. First time was 2014ish.

Meanwhile in Sweden:

Public healthcare queues for ADHD diagnosis range from 1 to 2 years. At the end of the process, many end up with a "You clearly have ADHD, but there are others that have way more issues than you, so therefore we can not provide you with a diagnosis nor medication". They prioritize diagnosing people who struggle enough with their economy or have children that they are unable to take care of.

I went the the private route, paying out of pocket to hopefully sidetrack the long queues. Sweden is very strict on diagnosis criteria and subscribes to the WHO standard. My result is "You very clearly have symptoms of ADHD, but you fail on the 'must have been present before 12 years of age' criteria". This is a ridiculous criteria when diagnosing ADHD in adults, with either parents who have passed on, or are in a mindset of "No, you were just lazy".

My only option is "beat it through willpower alone", which is hilarious when you have a massive dopamine deficiency with an executive function disorder.

Either that, or get medication off the black market, which is likely just sourced from some poor student who has to sell theirs off to make ends meet, due to Sweden's insane stance on drugs.

I also live in Sweden, and I also went the private route. Think it took me 6-8 weeks from initial contact to get the prescription.

I’m lucky enough to never had too much difficulty with access to meds. In your situation, considering the hugely positive impact they have in my life, I’d consider it worth it to try another country’s healthcare system until I get them.

"It's affecting my work, I'm worried about getting fired" -- this'll help, even if it's stretching the truth.

It was much easier for me to get a diagnosis than to make my bed every day. I talked to my PCP, she recommended I talk to a therapist that was qualified to diagnose ADHD (among other things). Went there a couple times and took some tests and got a diagnosis. It took only a handful of appointments. Making your bed every day goes on forever.

> I often fail to finish projects simply because I forget about them. I start reading a book, but I don’t write it down anywhere (say, in Goodreads) that “I’m reading this book” is something I have committed to.

I don’t have a history of ADHD symptoms. But I’ve been happier and arguably more productive since I abandoned the idea that I must complete projects just because I committed to them at the start. Sometimes you learn, halfway through a book, that it doesn’t contain the info you thought it would; then it’s best abandoned. The same applies to many commitments, I think. We learn more about them as we undertake them. Something might stop being engaging because deep down we’ve realized that it won’t serve us as we expected.

But maybe I’m able to discern productive vs nonproductive commitments because I don’t have ADHD? I just hate to see people beating themselves up about not following through with ideas which really don’t deserve follow-through.

If it helps anybody experiencing ADHD type symptoms.

>> The symptoms of ADHD and thyroid disorder are similar.

Ask your doctor to check that first before ADHD.

Definitely make sure to check since it's easy to test and easy to treat, but remember that it could be both. What blows is that some doctors can become really dismissive of the idea that you might have something like ADHD if your chart already carries a different label (thyroid, personality disorders, depression, etc.) so watch out for that, it can be a challenge to get them to take it seriously.

The cognitive bias of humans to "explain away" is one of my great pet peeves.

My thyroid was checked multiple times and always was fine. Now (recently) I got diagnosed with ADHD.

Generally you’ll have both a blood test for thyroid dysfunction and possibly a sleep study because chronic sleep deprivation also presents with adhd like lack of focus.

For those who cannot be prescribed amphetamines, I recommend seeking out Modafinil. It works really well and a regular psychiatrist should be able to prescribe it.

I found it made me think and act sleep deprived even though I didn't feel it and also increased anxiety.

Guanfacine is also an alternative, and it's method of action also makes it anxiety reducing.

Preach, this is a great post. The author has approximated the same system I (and many others) independently found to be working well for themselves. The bad news is that it’s very hard, if not impossible, to teach masses with ADHD all these elaborate, often very personal systems. The good news is you can make an app which will automatically make it work for individual people. Which is what I’m working on right now (not out yet).

I'd be taking my meds if the pharmaceuticals didn't keep having many-month long shortages of the ones I'm taking...

I need the higher doses, so I'm practically screwed. Makes me so damn frustrated, cause I'm 4-5 months down without meds and I'm REALLY STRUGGLING. Depression, zero motivation, practically no executive function. Really needs to be accountability on these companies to ensure they can supply.

Has anyone used the Todoist app? What are the apps that you find the most helpful in supporting ADHD - I am thinking to get this app, but also have never used Obsidian before, would love to hear what others are using.

Edit: Oh also want to mention that I generally prefer privacy oriented apps - so if there is something, even paid, that will keep my notes on device without sharing them with a server I'd love to hear about it.

Obsidian is the best then, it's just text files. You can sync them anywhere or keep them local. It has plugins for todo and daily diaries etc.

Obsidian for todo lists is a bit of a square peg and round hole situation.

And for someone who likes to "work on their productivity", it's a never ending swamp of plugins and optimising data views and reports.

I just switched to Things3 and couldn't be happier. It has very little customisation and options. It just lets me write down my TODO-lists.

I use obsidian mostly just for markdown and the tasks plugin but I can see how you could get caught up trying to create the perfect setup lol.

(Edited to add: this is an app I use to help with my likely-ADHD, however it is not a note/taking app)

I'm on an iPhone and I use Streaks https://apps.apple.com/us/app/streaks/id963034692 . I really dig it. It's easy to set up, easy to add or pause tasks, and easy to correct past mistakes (I often forget to record I took my meds even though I can see I remembered by looking at my pill organizer, fixing this takes a couple taps).

You can configure it to remind you to do a task N days a week. I use this feature to track checking the mail. You can also make a daily task and configure it with a "2 day rule" that gives you a little wiggle room. I want to read a book and practice chess every day but sometimes I miss a day -- this rule lets me miss one day but not two days in a row.

It's well designed with lots of color choices and icons for each task, plus it has Apple watch support. I'm pretty sure it's all entirely offline other than backups to iCloud, which can be disabled.

Finally, it's a one time purchase. If it wasn't I wouldn't have given it a try.

Have possibly tried every single app out there. iPhone reminders for basic personal stuff. Doesn’t scale for work related stuff. At work I operate better when there is a free flowing hierarchical view on my laptop - Workflowy is what I keep coming back to

question about the first line of advice

anyone from India willing to share some pointers on how to get an evaluation

signed - someone who has been procrastinating on it for a few years now

My doctor in the states was willing to do what she called a "clinical diagnosis". After filling out a short questionnaire, my score indicated I may have ADHD. She prescribed a medication for me to try. The idea was if the medication helps, and doesn't make me feel bad, then it would indicate I have ADHD.

It helped. I do. That was it!

It makes so much sense but the UK is too risk averse to do this unfortunately. Multi month waiting lists for us

Unfortunately in India it’s nearly impossible to get a prescription for stimulant medication because of “abuse potential” even if the psychiatrist acknowledges you exhibit ADHD traits.

I am fortunate in that regard. My doctor maintains the inventory needed for his patients purely because it’s almost impossible to get the good stimulants in local pharmacies

I am from India and got diagnosed in my mid 30s. If you live in a tier-1 city it’s not that hard to get diagnosed. Go to a psychiatrist. Reddit has a lot of good recommendations based on your city

On the chemical note, I found glycine supplementation to be actually helpful in avoiding hyperfixation (not being able to stop on a task). In contrast, stimulant meds solve the issue of not being able to start on a task (not enough motivation/dopamine). Make your own N=1 experiments though.

Glycine makes me feel depressive/anxious if I take more than 1-2g per day, for more than a few days. Very calming otherwise. Common effect for many people.

I feel like this is amazingly useful and not only to people with ADHD! Or maybe I suffer from undiagnosed ADHD

Take one of the more reputable questionnaires... they never require a login or anything. If you score high enough, see if you can get proper neuropsychiatric testing done. Really think about the questions and be honest with yourself… is easy to gloss over problems we have that we learned to compensate for, or be too eager to answer yes to everything if we’re just looking for an explanation for having a hard time at work, for example.

Some primary care doctors will refer you to get proper testing, but many will either ask you a subset of the questions you took on the questionnaire and say “yeah you have it,” or ask you nothing further and say “no you don’t have it,” depending entirely on their personal feelings on the matter. Testing isn’t cheap if your insurance doesn’t cover it but if you work in a knowledge field, being informed is an investment.

Medication, if it makes sense for treatment goes beyond controlling attention to tasks at a higher level — like not getting squirrel brain distracted trying to code. It also has much lower-level cognitive effects that I can’t directly perceive, but are completely obvious looking at my raw capability. A modest dosage of methylphenidate makes complex math problems that previously made me drop classes after putting in 20 hours per week of hyper-focused study time effortless. I don’t ‘feel’ smarter on it, or dumber off it— I can’t even perceive the specific threads of thought getting derailed in my normal state that make some cognitive tasks so difficult. The proof is entirely in my ability to do things that were incredibly difficult before.

Barring any of this, regular physical activity and good sleep have huge benefits. For some, it increases the dopamine enough to make medication totally unnecessary. I see dramatically worse results if I get super busy and drop sleep and gym visits staying up late working.

But seriously, getting medicated absolutely changed my life.

could you suggest some of those reputable questionnaires

Sure— here’s a pdf one so you don’t even need to use some janky JavaScript quiz.

https://contentmanager.med.uvm.edu/docs/default-source/ahec-...

The DSM-V criteria are also available on the CDC website.

Important notes: many of these symptoms, if acute rather than chronic, can be part of depression or anxiety which is suspected to be part of the dopamine deficit. If that’s true, you likely won’t get any neuropsychological testing because they’ll probably go away when you the base conditions. ADHD is something that would have been affecting you significantly since childhood. Also, other things can affect executive functioning like Autism Spectrum Disorder and Tourette’s (which usually manifests itself with ticks that don’t involve swearing loudly, despite its reputation in pop culture... they’re often not vocal at all.)

I read at one place regarding an ADHD drug that is non-stimulant and makes people a little drowsy, which is why it is good to take before going to bed. I don't remember what the drug is called. Does someone know?

Guanfacine.

Yes. That's the one! Thank you!

Way too much information, brain wouldn't let me read it.

As a life long member of the decision paralysis club, this was incredibly refreshing to read. Have been getting better, but reading this has brought it back to the forefront of good habits.

I guess I have some reading to do tomorrow! Which is also a great reminder that I should update my own posts with all my current techniques of managing with ADHD.

if you are on Android, you may use Google Tasks or Samsung Reminder as a simple and good enough Todo app.

Google Tasks has the advantage of allowing you to manage your Todo list through its web interface, while Samsung Reminder is a mobile app only.

> Using OCD to Defeat ADHD

Does this also work in the opposite direction?

https://www.saner.ai is a handy AI Personal Assistant made specifically for ADHDers

This looks good, gonna test this out

Lost me at “salt water”.

For reasons of personal history, stimulant medications like Adderall are a hard no for me. I am curious, though, about non-stimulant options like atomoxetine, if anyone has views.

Stimulants are a front line defense because they pretty reliably treat the symptoms in just about everyone. There are many other medications that _can_ help with symptoms, but their effectiveness is largely dependent on your body chemistry. It can take trialing several drugs to find one that works best with you.

Methylphenidate was a no-go for me too, was emotionally unstable and burnt out at the end of the day. However, this is my second month on atomoxetine and so far, I have only words of praise. There are one or two months to go for full effectiveness but I am satisfied so far. Focus is better, my mind is much more quieter, I've been able to kick some dopamine seeking behaviors and am working on new habits. I really feel positive and ready for change in life -- speaking this as an anxiety ridden person for more than ten years. The only negative is that it slightly increases heart rate, but I think this is supposed to go away too. I'd note that I am on some supplements as well and beforehand I did a simplistic dna check to see my methylation/detox profile (wanted to see why methylphenidate was a no-go).

Having a ton of apps is not the solution to managing ADHD.

"One app is better than two: the more disjoint things you have to pay attention to, the worse it is."

Wait... Silicon Valley is the cure fir all that ails!

I searched the article for "meat" and "carnivore". Zero mentions. First paragraph admits that this is a biochemistry issue and then immediately jumps to the conclusion that MEDICATION is needed.

Insane.

Eat a proper human diet, and your ADHD symptoms will mostly go away.

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