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Comment by zahlman | Hacker News Reader

> 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".)

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> 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.

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.

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.

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.

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