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Comment by aidenn0 | Hacker News Reader

> Add: I wonder why they don't just give people some ritalin and ask if they feel calmed down? Except the obvious reason of course

I have been screened a few times for ADHD and each time was found to obviously have it.

Ritalin does not make me feel calmer. I have been told by those close to me that there are externally visible improvements in my behavior. At doses to reach that effect, it also impacts my sleep quality enough that I don't take it.

Adderall causes mild symptoms of psychosis and mania before it has any theraputic effect.

Dexmethylphenidate (aka Focalin) has identical theraputic effects to ritalin, but slightly reduced side-effects.

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I'm still on my journey of finding meds (and dosages) that work but I would highly recommend for anyone who has a inattentive scatterbrain to try lis/dexamphetamine.

Methylphenidates can be quite numbing (zombifying) in my group of ADHD friends but dex seems to have a more consistenly helpful effect. The unfortunate caveat for me is that I personally seem predisposed to pelvic floor/urinary issues, which you'll find anecdotal evidence of being exacerbated by amphetamines (research seems yet to catch up), but aside from that the theraputic effects, particularly in emotional regulation seem so far unmatched.

It's unfortunate we have such a tentative model of how our body and, particularly, our minds work so drug treatments often require a trial and error process.

I have exactly the same problem with pelvic floor and urinary issues when I take adderall, although with continued use and PF therapy it's gotten moderately better (and my dr and I decided that the benefits outweighed the risks and issues).

I found methylphenidate-based drugs to be useless after a few days.

Have you tried pure lis or dexamphetamine? I know dex can be prescribed without the mixture, maybe lis can too. I keep meaning to ask my doctor about it.

The other issue I find is tolerance, though even with this I'm still far more focused than when I'm not taking adderall. It really is amazing how much better it makes me feel. I find no problem with addiction whatsoever -- if I forget to take it, then I just have full blown ADHD, but I'm no worse off. I also find it's more effective if I minimize coffee, but I haven't yet cut coffee entirely. (I find caffeine is vastly more addictive than amphetamines.)

I have similar stimulant intolerance since I developed bipolar 1 in my late teens (had been diagnosed with ADHD at 7). I was off ADHD meds for several years, and have now tried a few of the nonstimulants.

Strattera was subtle, but I had clearly improved feedback at work, a cleaner apartment, and no side effects.

Qelbree caused a lot of nausea.

Intuniv caused lightheadedness and got me an unnecessary cardiac workup.

Wellbutrin doesn't have as much ADHD efficacy as Strattera (my doc won't let me take both at the same time), but it improved my seasonal depression and motivation significantly. I had some irritability for the first few days after a dose increase, but otherwise the only side effect is reduced hunger and I also stopped asking people for cigarettes or zyns when I'm drunk.

I had a doc that prescribed me amphetamine. It was glorious for work, being in one of those horrendous open table environments with only a screen in front of you to keep from staring at the person directly across.

I was able to laser focus and jam through things but the side effects were not worth it and I backed off. I've yet to find a magic pill that does that without the side effects.

PSA: depending on your specific needs, guanfacine can be close. Once you get used to it, it can be just... constant +1 to wisdom.

Thank you! It seems worthy of pursuit -- gonna bring that up with my doc.

I'm nearing my 40s. In my mid-twenties I was diagnosed and over the next couple of years tried all of the usual ADHD meds and none of them were short of terrible in regard to side effects. I guess I've just learned to live with it in a way that outweighs the side effects I get from the drugs.

I was diagnosed with Shiftwork Disorder at one point in time and was prescribed Modafinil and it was incredible for the most part and had zero side-effects, but my doctor wont prescribe it for ADHD. One down-side to Modafinil is that I could get stuck on an unproductive task and would realize in hindsight that I had just been hyper-attentative to this unimportant task for hours.

Studies show Modafinil isn't effective in ADHD adults. It may have benefit in children with ADHD.

I think many prescribers give ADHD adults a high dose too soon causing side-effects. In my experience, it's best to start with a low dose and slowly increase as necessary. The myth is ADHD responds quickly, but observing hundreds of patients it takes months, not days, for benefit of treatment to develop. There's wisdom in the phrase, "start low and go slow".

Yep. What you find often is that the drug is effective right away, at a 20-30-40% effectiveness level. But over time you learn to take advantage of the benefits more effectively, and get more used to the side effects, so it tends to increase significantly in effectiveness at the same dose over 6-8 weeks much like SSRIs, not because the effects last that long, but because you use the tools to improve the tools.

Have you gone down the rabbit hole of non stimulants?

I have had bad reactions to every stimulant I tried since I developed bipolar 1 in my late teens (had taken them as a child for ADHD).

I had a good response to strattera, but there's a variety of them out there.

I had terrible brain zaps on Strattera and didn't notice anything at all in regard to benefits. Probably because I just could not get through taking it long enough.

> it also impacts my sleep quality enough that I don't take it.

Yeah, it's basically why I don't bother with it. I know it works, but trading one set of problems that I know how deal with for a different set of problems that needs more meds isn't appealing at all.

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