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Comment by leoc | Hacker News Reader

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.

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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.

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