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Comment by atemerev | Hacker News Reader

I have been diagnosed with ADD about 6 months ago (of course, I knew it for much longer time, but adult ADD only recently started to be recognized in Switzerland, where I live). I started taking Ritalin immediately after. Here are my observations:

— The first day on Ritalin, you feel like you have superpowers. You are cold, calm, Spock-like, having laser-like focus. Unfortunately, brain adapt to this new state quickly.

— Later, you return to your baseline, but something changed. You can now actually learn things that you read in these countless self-help books while trying to understand what's wrong with you. Meditation? It works now! (Before treatment, I couldn't sit still for 2 minutes). GTD? Sure! It doesn't come naturally, you have to work to learn hundreds of things that were obvious for non-ADD kids, but now you can.

— You'll keep your insatiable curiosity and desire for new things. Otherwise, I wouldn't agree to the treatment.

If you have any more questions, I'll happily answer them.

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Some additional acencdata:

When I started Ritalin (in my 30's, I think) I also become somewhat "Spock-like." This was a problem when talking with my girlfriend about some sensitive matters, as I was kind of detached and lacked empathy.

I also noticed that I no longer had a soundtrack running through my head. Usually I would have assorted self-invented tunes and riffs playing in my brain. That stopped and it really bothered me.

Before too long I became more adapted to the drug. The empathy and soundtrack returned. I eventually stopped taking it, though, because it didn't seem to make much of real difference as I became more acclimated. Even taking "drug vacations" didn't seem to make a difference.

I took Adderall some years latter and the positive effects lasted maybe a week. Very disappointing. Immune to speed; what a let-down.

At this point I just accept it as a fact of life that I have to work at managing attention and motivation and not get too depressed when I have a million unfinished things.

Life is too short, and I have a dance-party in my head.

If you are literally taking Ritalin, I highly, highly suggest you get your doctor to prescribe long acting variants such as Adderall or Vyvanse instead. Short-acting Ritalin has awful side effects--it lasts maybe 2 hours, you can feel it kicking in and leaving in a very harsh way, you get all the nasty dry-mouth, etc. Vyvanse lasts 12-16 hours, you don't feel it kicking in or leaving, minimal side effects, etc.

Honestly, I would rather go without meds than have to take Ritalin every day. That stuff is plain awful. The long-acting meds are where it is at.

Not literally, of course. I tried Focalin-XR and Concerta, settled with Concerta, as it really smooth.

Side effects vary significantly from person to person, but adderall and vyvanse are different drugs from ritalin, not simply long-lasting variants. The longer-lasting variants of ritalin are Concerta (brandname) or methylphenidate ER (extended release--generic): https://en.wikipedia.org/wiki/Concerta#Extended-release

When I was first treated they started me on regular ritalin, and I didn't have any negative side effects, but it wasn't very helpful simply because it only lasted about two hours. Switching to Concerta worked much better for me because it lasts steadily throughout an entire day.

As far as the mechanism of action and side effects, I have the impression from talking with psychiatrists and my own reading that Adderall tends to be a bit stronger in effect than Ritalin. Ritalin is a dopamine reuptake inhibitor, which means that dopamine remains in the synaptic cleft and continues to stimulate dopamine receptors. On the other hand, Adderall (amphetamine) is both a reuptake inhibitor and a releasing agent for dopamine, so it stimulates the release of dopamine into the synaptic cleft and blocks the reuptake of dopamine, which causes dopamine to remain in the synaptic cleft for a longer period of time as with Ritalin. The wikipedia links on the mechanism of action for each drug are helpful: https://en.wikipedia.org/wiki/Methylphenidate#Pharmacodynami... https://en.wikipedia.org/wiki/Adderall#Mechanism_of_action

Some knowledge of how synapses work may also be helpful: https://en.wikipedia.org/wiki/Synaptic_cleft#Structure Basically, neurons secrete specific chemicals to transmit specific messages to other neurons, and other neurons have specific receptors that bind to those specific chemicals. Increasing the release of messaging chemicals like dopamine will increase the strength of the "message", and preventing the chemicals from being reabsorbed back into the neuron that originally sent the signal allows them to bind repeatedly to the receptors on the neuron that receives the message, which also effectively strengthens the message. Dopamine itself plays a number of roles in cognition, which makes me suspicious that ADHD medications that operate on dopamine release and reuptake are probably a little more of a "shotgun" approach to dealing with ADHD symptoms than would be ideal, but their effectiveness in dealing with the symptoms is very well established. https://en.wikipedia.org/wiki/Dopamine#Attention_deficit_hyp...

This is a really simplistic way to describe the mechanisms, but the impression that I've had is that Adderall tends to be a stronger drug because it acts on more than one mechanism (both stimulating dopamine release and blocking its reuptake). For me the extended release methylphenidate has been extremely helpful, so I haven't been concerned about trying any other ADHD medications.

Disclaimers: YMMV, consult a psychiatrist for actual medical advice and explanations of the mechanisms of these medications, etc...

I had the exact same story until

- I started to constantly feel nauseous

- I started to feel vary anxious about everything

- I had a hard time eating or wanting to eat anything

- I started to feel overloaded by my environment

Got off of it and lost some of my super powers, but gained my sanity. Which was worth it. Converted over to understanding my strength and weaknesses, eating better and getting out.

Looks like you took higher dose than needed. Ritalin is really dosage-sensitive, you'll have to calibrate it carefully with your doctor.

I'm taking the dose determined after some experiments (27 mg/day) for the last 6 months, and I don't feel particularly insane. Anyway, like I said, it works differently for different people.

I'm glad to hear that. For myself, I became more afraid of the side effects then the ADD.

It also sounds like you probably have some degree of anxiety that was being amplified by the drug. Most of the time it's probably beneath conscious awareness or latent. I imagine that when you're always disorganized and getting in trouble for things outside of your control as a kid, it sets you up to develop an anxiety disorder.

Maybe - I'm not going to self-diagnose myself as a calm individual. But this kind of anxiety was more like stage fear then some continual anxiety. Hands tingling, stomach upset, nervous. In the 8 years since I stepped away from the drug option, I've never again felt that sort of reaction.

It can be hard to untangle what caused what. My feeling after many years is basically that emotions are emotions and drugs are drugs: if you feel anxious, that's an emotion. The drug may have been involved in setting the anxiety off, but anxiety is still an emotion and not a drug effect. Not everyone is going to become anxious from any given drug, because different people have different sensitivities to the sort of stimuli that may trigger anxiety. A true drug effect will not feel like an emotion.

It can be useful to pay attention to when a drug is triggering anxiety; just in case you go on to try other meds in the future.

I've also just been diagnosed at age 30 (constantly been labeled "lazy" / "dreaming" when I was younger - you believe it after a while - ADHD diagnosis still seems to be something novel here in Austria as well).

What you write really gives me hope, for now my neurologist put me on Wellbutrin mainly to treat my depression but he said he really wants me to try Ritalin soon.

I'm one of those people who rather meditates and works out regularly than to take any drugs - I don't like to mess with my brain - but I'm so fed up with my ADHD and the Wellbutrin alone already helps not only with overcoming my fail(ed-potential) derived neurosis but also a little with focus.

Do you feel as if Ritalin might help with getting to where the ADHD recovery group managed to get themselves even when not on Ritalin? "Plasticity of the brain" yadda yadda...

It would be better to ask your doctor. If he's willing to try, I think it worth a shot. Ritalin is not a panacea, it makes miracles for some people and brings nothing but side effects for others. For me, it was something in between.

ADHD is a recognized neurological condition, and I believe it's better to remedy it with drugs than try to live with unadjusted brain. It's not our fault.

I guess one really has to try it to know for sure, thanks.

I'm on Adderall, which is very similar to Ritalin - they're both stimulants. I have tried Ritalin in the past and it worked decently; I went with Adderall because it was cheaper.

  > I'm one of those people who rather meditates and 
  > works out regularly than to take any drugs - I 
  > don't like to mess with my brain

I wasn't diagnosed until my 30s. Like you, I didn't like the thought of messing with my brain but eventually got fed up.

Meditation, exercise, diet, getting lots of sleep... these help me more than Adderall. BUT, the Adderall does help too. So I think you are a very good candidate. It sounds like you are thinking of the big picture and not just relying on Ritalin to be a "magic pill."

Probably the best thing about trying Ritalin/Adderall is that you can always stop them if they're not helping you. Just reduce your dose slowly over the course of 3-4 days.

Good luck!!

Moderate to heavy sessions of running and swimming (minimum 40 minutes for me) really help with focusing but that doesn't last very long. Maybe an hour or so? That's still much longer than when trying to ride the caffeine waves, exercise also doesn't come with the risk of "wiping out" my focus (getting unproductively hyper-active) because of borderline coffee-abuse (not good for the stomach either...).

So regular exercise and meditation? Check. Discipline with my diet? Check. Proper sleep hygiene? Check. Still fed up? Check.

Thanks for your always-uplifting comments, they are very much appreciated.

That's interesting to hear. I don't really get a stretch of "focus time" after exercise. It's cool that you do!

Exercise feels like it helps my ADHD in indirect (but important) ways.

Exercise boosts my energy level, and reduces my stress level in general a bit. I also sleep much better at night if I get exercise during the day. The sleep, of course, helps with everything else as well.

I salute you for having discipline with your diet! That's the hardest for me!

Yes, the exercise-sleep connection is important for me as well. I mustn't exercise in the evening though because it gets me in that "thrill" mode where I'm wide awake (it feels like the only time actually when I feel awake..) morning or noon sessions work best for me. I'm self-employed so that is one of the benefits of having an unstructured work day, which apart from that I guess is dangerous for someone having ADHD like myself...

I've been on a vegetarian diet for about 10 years and it helps me with attaining more of an "inner calm" / reducing my constant inner agitation but that wasn't the reason why I picked it up originally - it's just a very welcome side effect for me. I could definitely improve on the health side especially when I get the blues, like I've been having for the last couple of months - I tend to binge excessively on sweets (which for me is worse than being on too much coffee in terms of ADHD symptoms) and processed junk food. I feel really great on low GI foods, so usually I eat lots of beans, fruits and vegetables. I also try to take my vitamin b12 supplements as well as my ground flax seeds regularly (omega 3) and have some organic eggs or cheese now and then. I've been on half-year long, strictly vegan diets twice over the years but ran into health issues (iron, vitamin b12 deficiencies -> anemic) each time probably because my discipline and knowledge were limited then.

I feel there is so much chance involved with picking up the right habits - e.g. if it weren't for Vibram's Five Fingers (I know they are not as healthy as they were advertised but I simply love the feeling of running "barefoot") and all the quantified self apps on smartphones I probably wouldn't be running today. It's all the little things that keep me motivated.

I was diagnosed with ADD in the early '70s and, after moving to Austria, it took me way, way too long to find a doctor who even acted like he was interested in understanding anything to do with ADHD.

I briefly tried Wellbutrin as an alternative to Ritalin a couple of decades ago and I did not find it helpful then. On the other hand I find Ritalin really does work for me and in ways that meditation and exercise simply do not.

I'm not saying that meditation and exercise aren't helpful. They're important parts of my life (/ coping strategy). It just that Ritalin is also part of that strategy. In fact, at this point in my life I view using Ritalin much in the same way as wearing my glasses and hearing-aids.

In fact, at this point in my life I view using Ritalin much in the same way as wearing my glasses and hearing-aids.

That feels like an apt analogy, I'm looking forward to see how Ritalin works for me.

I was on Wellbutrin as part of my treatment for depression. What's interesting is that Wellburtrin is dopamine reuptake inhibitor while Ritalin and Adderall stimulate (or mimic; I can't find a decent reference right now) the production of dopamine.

I'm one of those people who rather meditates and works out regularly than to take any drugs - I don't like to mess with my brain

Something to consider is that your brain is already messed with, so the use of drugs might be needed to un-mess it. But it's kind of a black art. You need to try things and see what works for you.

I had been on assorted antidepressants and stimulants for a number of years and it really helped to a) read up on neuropharmacology and b) have doctors who would listen to my suggestions about what drugs to try and why I wanted to try them. For example, it's handy to know if you respond better to drugs that focus more on dopamine than, say, serotonin.

(The reality is that no mind-altering drug is so cut-and-dry and completely understood, so you end up being a lab rat in your own life experiment.)

But it's kind of a black art.

Yes, it's truly interesting to read up on all the "wetware" aspects while trying to introspect on how the medication affects you accordingly.

The whole thing feels like finding hacks to make your mind work properly.

> What's interesting is that Wellburtrin is dopamine reuptake inhibitor while Ritalin and Adderall stimulate (or mimic; I can't find a decent reference right now) the production of dopamine.

Both Ritalin and Adderall are dopamine reuptake inhibitors. I believe that Adderall also stimulates the production of dopamine, in addition to the reuptake inhibition.

> Both Ritalin and Adderall are dopamine reuptake inhibitors.

Methylphendiate (Ritalin) is a dopamine reuptake inhibitor, to be certain: it binds to and blocks both dopamine and norepinephrine reputake inhibitors. It's thought to increase neuron firing rate, but that mechanism of action is unknown.

Adderal, however, is a mixture of dextroamphetamine and levoamphetamine salts. They stop reuptake of the two monoamines not by blocking the transports, but by reversing their action. Instead of taking up dopamine and norepinephrine, they pump it out. It also stimulates the release of the monoamines from the synaptic vesicles into the intracellular membrane.

Ritalin causes dopamine and norepinephrine to stick around longer, making their action last longer. It's like closing a drain half way with the faucet on medium: the water level rises more than typical, but no higher.

Adderal causes them to flood the intracellular fluid. It's like turning the faucet on while flood waters are coming up the drain pipe.

>Something to consider is that your brain is already messed with, so the use of drugs might be needed to un-mess it

Absolutely. I came to this conclusion after a few months of therapy and reading several books about ADHD (Driven to Distraction was the first of a rather deep rabbit hole). I was terrified that I'd lose that creative spark I always held unique, because that's what previous psychiatric medicine had done to me.

Bupropion (Wellbutrin) isn't just a dopamine reuptake inhibitor: it's also a norepinephrine reuptake inhibitor and a nicotinic acetylcholine receptor antagonist (which is why it's also prescribed for smoking cessation). It didn't work with me. I was calmer, less hyperactive: but I had a flat affect. I could concentrate on busywork, but I couldn't think. It also wasn't prescribed for ADHD: it was the second attempt to treat a (non-existent) bipolar disorder when I was 15. I'm pretty sure (at this point) my neurochemistry is such that my reuptake rate is fine, but my release/synthesis rate is much too low. Which is why a reuptake inhibitor seemed to only work part way.

The first tried, however was Depakote. In extreme cases it's prescribed to stabilize mood and impulse control with ADHD. It's usually prescribed to quell manic episodes and control seizures. I only dully remember my time on it. I do remember being in a constant fog, a miasma - while I couldn't really think straight beforehand, I could barely think /at all/ on that medication. I was on 900mg/day. Given my bodyweight at the time, my plasma concentrations were probably well above the typical controlled therapy concentrations of 100mg/L. It was probably closer to 200mg/L, which explains the stupor and slight tremors I had.

Given its pharmacology, I can't see how it is, in good conscience, prescribed to those with ADHD unless a manic skewed bipolar disorder is also present.

But the story of why they were absolutely convinced I was manic/bipolar is another thing entirely.

Random question, do you / did you drink much coffee before you started on your meds? If so, how did the effects of caffeine compare to ritalin in relation to your ADD symptoms?

As a child I was diagnosed and took Ritalin for a while. My parents didn't like the way it altered my behavior. However, they then tried coffee twice a day - Breakfast and Lunch (I was in 2nd or 3rd grade).

The coffee worked well. Entering highschool I couldn't stand coffee and didn't do anything to address the ADD symptoms. In college I powered through on other caffeinated beverages. I now enjoy the occasional cup of coffee (1-2 cups a week) and can definitely tell the difference in my ability to focus when I've been drinking coffee and when I haven't.

I have a similair story, as I child I never liked taking meds or how it effected me, I refused to take a blood test one day and was removed from treatment, I'm now 26, recently I tried matcha (green tea powder) and found it to be much better then coffee as it's a stimulant & relaxant (no crash, very calming and alert). I also found as I got older it got easier to manage, it also left me with the ability to hyperfocus when I'm in the zone working.

Yes, I did (around 5-6 espressos per day). After the program started, I am happy with a single espresso in the morning, or occasionally just skip the coffee at all.

Caffeine effects are somewhat different — Ritalin gives me the ability to think clearly and plan more long-term, caffeine just makes me more alert (a good thing, too).

I am far from being cured, though.

Adderall user here. Tried Ritalin in the past. Adderall and Ritalin are very similar in my experience. Compared to coffee, they're less addictive and there isn't really a "crash" when Adderall/Ritalin wear off.

To others reading this, keep in mind that it's very much anecdotal. I've taken Adderall XR for several years, and can confirm that it is far, FAR more powerful than coffee:

- I experience an extremely severe crash in the evenings (attention issues worse than my baseline, depression, anxiety, and lethargy to the point that it's difficult to start any non-trivial task) which I manage with anti-depressants and beta blockers.

- I become physically dependant on the drug after about 5 days of constant use. After discontinuing use, it takes approximately 4 - 6 weeks for the withdrawal symptoms to go away and to return to baseline.

- Excessive dosages (can be caused by not taking my medication for a few days then restarting) cause symptoms similar to mania, aggression, anxiety, social withdrawal, sweating, and racing heart.

My medication helps me live a normal life as a software developer, but I respect it for what it is - a powerful, physically addictive narcotic with potentially severe side effects. I know that it's become in vogue for professionals and students to take prescription stimulants as performance boosters, but it's important for these people to know that these medications can be very dangerous if abused, and are certainly no where near the safety and side effect profile of caffeine.

We definitely agree that Adderall is not something that should be used casually, like coffee.

And unlike coffee, with a little determination it's physically easy to ingest enough Adderall to do serious harm. (Although that's pretty much true for any medication in pill form.)

Were it not too late to edit my post I'd amend it to say that.

I definitely believe your experiences! However, from all of my reading and anecdotal reports from friends, I believe your experiences are not the norm.

  > I've taken Adderall XR for several years... I experience
  > an extremely severe crash in the evenings

I tried Adderall XR (the extended release version) and it didn't give me enough flexibility.

I didn't crash as severely in the evenings as you report, but the XR seems formulated to give about 8 hours of efficacy and that wasn't nearly enough for me. I now take 7-8mg of Adderall (non-XR) three times a day: morning, noon, and late afternoon. Sometimes more if I need intense focus... less on the weekends.

  > After discontinuing use, it takes approximately 4 - 6 weeks 
  > for the withdrawal symptoms to go away and to return to baseline.

This seems like it would be much more of a problem with Adderall XR since they're all-or-nothing capsules, correct? Are you essentially quitting "cold turkey" when you discontinue it?

With the non-XR Adderall, I have much more control over my doses and can gradually reduce my dosage day by day.

Interesting.. I briefly attended HSG for a Master's program but left shortly because I was treated during undergrad for ADHD in the USA, and not having the same treatment options in Switzerland, I couldn't begin to learn how to focus again and hope to pass the courses. One day while walking the streets of Zürich, I saw a protest with many people against ADHD medication and signs advocating banning Ritalin.

What's the bad?

Potential for side effects, like increased heart rate, poor appetite, and panic attacks.

Unfortunately, my appetite wasn't affected (I hoped). :)

I have to sleep a little more (paradoxically for a stimulant, but this is how it works). Occasionally I feel more irritated (when I do, it's better to use half-dose or skip the meds the next day). But the benefits are much more numerous.

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