About getting treatment: it's extremely irritating that some people judge using Ritalin is somehow morally wrong. Yes, I get that "lifestyle changes" could help, but I don't want to change my lifestyle.
Imagine if there was a pill to reduce risk of cardiac arrest, with some increased risk of something relatively minor. Can you imagine the uproar if cardiologists denied prescribing the pill, instead forcing people to spend 30m a day running? Sure, it's "better" in some metrics to just run, but that's their choice to make. Doctors should be doctors, not moral guides.
There's another weird factor. Ritalin is an upper and it's stigmatized to take an upper - either your performance, judged by coworkers, will be equivalent or below theirs and the stimulant is seen as the only thing keeping you in your job (which can get super depressing internally) - or, if you're doing well in your position, it can breed internal and external doubt as to whether your performance would just be normal and is being boosted by the drug.
It's kinda hilarious that, when going off Ritalin, things don't slow down (or become "less upped by the upper") they stop - this article touches on it but ADHD can feel the most torturous when it impedes even your leisure - especially when coupled with depression. Ever spent a day off staring at a wall dreading the possibility that you might waste a day until you realize the sun has gone down? Yup, so much fun.
I keep it very closely that I am on any sort of medication because of the stigma. At this point in my life I refuse to allow someone else to have an opinion of what my doctor and I decide I need to be healthy.
I take a suite of medications for symptoms like this and never felt the need to advertise or hide it, and never experienced stigma although I have the mindset that leads me to not even notice negative cues (a mixed blessing).
More people need to do this. So many people are way too open about their private life and then end up frustrated when they get negative reactions about their disorder.
What I don't understand is - why is it a problem that somebody performs better on medication? Life isn't sports or a game. It's not a competition. Shouldn't people be happy that someone else can keep their life together? That's less of a burden on society.
>Ever spent a day off staring at a wall dreading the possibility that you might waste a day until you realize the sun has gone down?
That sounds silly and boring. I was daydreaming instead of looking at the wall.
Sometimes you benefit from others doing well. Sometimes you are hurt by it. It's not as simple as you make it out to be. Globalization, for example, is zero-sum for many people. Since we're now buying <wheat/metal/electronics> from <x country>, people who did that here lost their jobs. It's absolutely a competition. In capitalism you have to fight for your right to feed yourself, and if you are in the bottom x% of society, you quite literally have to live on the streets.
>Globalization, for example, is zero-sum for many people. Since we're now buying <wheat/metal/electronics> from <x country>, people who did that here lost their jobs.
Considering that those are some of the hardest and most dangerous jobs, it probably is better for you that it's done somewhere else for cheaper. This means that everything that depends on those jobs, such as the price of food, will also be cheaper for you. You can learn another job and do that. I realize that many people don't really want to do that, but it is an improvement for society.
>In capitalism you have to fight for your right to feed yourself, and if you are in the bottom x% of society, you quite literally have to live on the streets.
This is true by definition, because if you are homeless then you're by definition poorer than somebody that is not homeless. Essentially, it's not an argument, but I do understand that there are poor people under capitalism, but they are much better off than poor people 100 years ago, and they're much better off than middle class people 150-200 years ago. Society, especially the US, is so rich that almost anyone has a supercomputer in their pocket. All western countries offer lots of support for the homeless and poor.
Because the way they would have to do it is by offering people something even better in return. In a voluntary trade both sides end up better off, because both sides get something they want more than what they give away.
> Shouldn't people be happy that someone else can keep their life together?
There are entire large groups of people in this world who feel the need to drag other people down with them. Some of them are extremely good at it. Pray you never attract their attention. It's a nightmare.
This seems like wishful thinking. We all have a place in the hierarchy of our societies and your performance certainly impacts your position. Don't believe me? Decide to stop working. Eventually you loose your job, can't pay rent, and become homeless. You will find yourself falling down the hierarchy pretty fast.
Not trying to make any kind of judgment about this being good or bad. Just trying to point out reality. This is the world we live in - performance matters.
I get the idea of the hierarchy, but why does performance matter? Performance matters because we want to promote those that generate value the most. This correlates with improving the world for everyone. If your coworker invents cold fusion, then yes, she's going to be promoted over you, but the long-term effect is that you're also going to be better off because of that invention. Most improvements to the world are just smaller, but they're still there.
> Ever spent a day off staring at a wall dreading the possibility that you might waste a day until you realize the sun has gone down? Yup, so much fun.
This is literally every Saturday for me. I'm thinking about keeping my Ritalin by my bed. I don't understand why it's so difficult and it makes me really frustrated - I just can't get out of bed. I try to wake up and my mind goes "naw". I sit up to get out of bed, sit there for 40 minutes, and still can't get myself to get out of bed. Stare at my Pillow, some reddit posts, another 45 minutes are gone.
Now it's 2pm, I've wasted half the day. My depression tells me it's because I'm a lazy piece of shizzle.
Source: Diagnosed with ADD/Aspergers/Depression/Anxiety... Horaay :(
Being diagnosed with all of those things -- doesn't it seem like a pharmaceutical spiral brought on by a sick process? Ever since my sister was misdiagnosed with a handful of labels and put on a handful of drugs which subsequently ruined her life for a very long time I've been interested in looking at alternatives to the pharma status quo. I read Lost Connections by Johann Hari recently and it was remarkable. The chapter on how people with similar diagnoses radically improved by joining a gardening club (reconnecting with others) makes the book worth reading, but it goes into much much more. It's worth looking up.
Right. Those are very extreme diagnoses. Medication is often required. What this book speaks to is the problem with overprescription as applied to the average person, and offers many solutions.
Overprescription? It is so damned hard to get stimulant medications (patients don't even dare ask for fear of being labeled "drug seeking") that even people who need them badly have a hard time getting them.
So, no, it does not seem like a "a pharmaceutical spiral brought on by a sick process", whatever the blazes that means.
IMHO what you are saying and accurate diagnoses which result in positive-to-lifechanging treatment are not mutually exclusive. There's always more than one way for a thing to go wrong ;). And I'll check that book out. There's an interesting book on addiction, based on studies on rats, arguing that addiction is usually a coping mechanism for an unhealthy environment. Again, I don't think these different things are mutually exclusive.
That and being late to work. I don't think anyone would believe me if I said that I'm more upset that I'm 10 minutes late then my boss is.
I got up 10 minutes early! I thought I was running on time! Suddenly I'm supposed to be there in 5 minutes! WHY?!!? It's like time isn't freaking linear!!!!
Hey, this is exactly why I keep it by my bed with a bottle of Soylent. The first thing I do when I wake up every day is take it and chug the Soylent to make sure I've got enough nutrition for it to work well. It helps a lot, I would earnestly encourage you to try it
I struggle with a few things, and probably some things from your list, but no diagnoses yet.
One thing that always goes through my head is just feeling like society is made for a model of human that just isn't me. There's a society out there that would suit me great, but I missed the boat on that. It was probably in the distant past before things got big, noisy, and complicated.
Replace "upper" with "caffeine" and the absurdity becomes apparent.
"either your performance, judged by coworkers, will be equivalent or below theirs and the stimulant is seen as the only thing keeping you in your job (which can get super depressing internally) - or, if you're doing well in your position, it can breed internal and external doubt as to whether your performance would just be normal and is being boosted by the caffeine."
the difference between them lies only in the degree of effectiveness.
I dream that within my lifetime uppers will be as de stigmatized as weed.
> the stimulant is seen as the only thing keeping you in your job (which can get super depressing internally)
Literally experiencing this right now while getting a degree in software engineering. Got diagnosed during my first year with AD(H)D and I'm currently in my fourth, final year. Looking back at things I have no clue how I even managed to pass the harder subjects/courses. All I remember is I took my meds and studied about 12 hours a day 3 weeks straight during the hardest parts.
Before I had never studied more than 2 hours a day and I would start only about 5 - 8 days before a test.
I often wonder if I could work at a software company without my medicine because of this and it actually worries me.
>Imagine if there was a pill to reduce risk of cardiac arrest, with some increased risk of something relatively minor.
(Some?) Antihypertensive drugs can contribute to harm to the liver. They're unlikely to cause anything on their own, but if your liver is already not the healthiest it can make things worse.
>Yes, I get that "lifestyle changes" could help, but I don't want to change my lifestyle.
As far as I've read about ADHD, nothing comes close to the effect that medication has in treating the issue.
I can't speak for everyone, but regularly exercising and eating healthier foods reduced my need to take my ritalin as often. When I first started taking it, I had to take a dose every 2 hours to stay on track. Once I started eating healthier and doing ~1 minute of exercise every hour, I can comfortably go 3-4 hours between doses. I still function much better when I take my medication, but as long as I eat healthy and exercise, I don't feel useless without it.
Yes, exercise absolutely helps, but a person with ADHD is much more likely to exercise if they have been prescribed medication. Without medication they will likely just stop exercising at some point, because they "don't feel like it today" and then forget that they were supposed to exercise every day. Then 3 months later they remember for a moment, commit to exercising again, but that only lasts for another 3 weeks.
You're probably right when it comes to those of us who medication works well for, but there are some people who medication doesn't help much. In those cases I think diet and exercise tend to be the best line of defence against symptoms.
No. Just don't entertain this idea. You can go 20 years since the first time someone told you you may be ADHD or depressed with subsequent diagnoses. Then tell yourself it's all in behavior no one needs drugs. But twenty years on you'll still find yourself in the same cyclical patterns of periodic depression or chronic inability to select your attention to a task. "Lifestyle changes" could help with the right crutch. But if you need Ritalin or another drug to learn those lifestyle changes so be it.
In your (not quite perfect) comparison. It's as if the pill will reduce cardiac arrest and improve peoples aptitude to learn to run for 30 minutes daily.
There are about a dozen factors with a positive correlation with each other, but they are not links in a causal chain. One does not simply "fix" them, they all have feedback on one another.
The knowledge of how they are related helps, but does not fix.
There is definitely a lot of internalized shame/pressure when it comes to ADHD diagnosis and seeing a specialist. I have been diagnosed and prescribed since many years ago, but I still feel the distress and get anxious every time I am forced to switch a provider due to life events (nothing dramatic; usually just either to me moving states or my provider moving states, which is exactly what happened with my most recent one).
You're not alone. I was 33 on a high powered rocket to the bottom. I think ADHD can erode your sense of self, your self esteem, and as a result, every part of you. The distress gets real. And yet once you finally realize you _need_ help, you have such a low appreciation for yourself that you don't believe you _deserve_ help.
If I didn't have kids I probably wouldn't have gotten help. I did it for them. I'm glad I did now – everyone deserves help.
The medication is just as personal as other options in how effective they are.
As a diagnosed sufferer of ADHD, my experience is that Adderall works better than Ritalin, but the extended release stuff shortens my temper. If I'm still having a bad day, an energy drink can help.
On boredom: I can be bored, but lack the drive to do anything to make me less bored. When I'm having fun, it is difficult to switch to the next thing I need to do.
Well, I admit I'm biased because I started taking ADHD meds and then had a manic/psychotic episode, that involved me getting involuntarily committed to a psych ward and burning all my career bridges, and also got diagnosed with heart failure, and I attribute a huge chunk of the blame to the ADHD meds. Both my psychiatrists and cardiologists insisted I needed even more meds or things would get worse, but instead I just said, I'm going to disregard medical advice, I'm going back to a no meds baseline, and focus hard on lifestyle changes, and everything improved. I've been emotionally stable and my echocardiogram and cardiac MRI showed my heart is back to normal. So that's my bias.
I am just a bit of a psych meds skeptic these days - I don't think the comparison to drugs like insulin carry as much weight as their advocates would like them to. For one thing, there's no brain scans or blood tests for any of these diagnoses. The diagnosis criteria is basically a "personality test", called the DSM-5, a manual heavily influenced by the pharmaceutical companies. Stimulants at least do in fact have research supporting they actually outperform placebo (unlike the massively prescribed antidepressants), but they come with a host of negative side effects.
If you're predisposed to mania, you shouldn't take stimulants. If you're predisposed to heart problems, you shouldn't take stimulants. My question is, how was I supposed to know that I was predisposed to these things short of finding out the hard way by taking the stimulants and having those negative side effects almost ruin my life/kill me?
Previously, on HN people have accused me of "doing it wrong" in some sense with the ADHD meds, but the truth is I got the diagnosis from the doctor and took the meds as prescribed.
The whole idea that we can neatly categorize this person as ADHD, this person as MDD, this person as Bipolar-2, this other person as bipolar-1, this other person as BPD, after doing a ton of investigating into mental health, I just no longer buy it.
I do think the answer is in lifestyle changes, the person who is at risk of cardiac arrest, yes they should exercise for 30 min a day and reduce sodium intake before relying on a pill if that pill carries with it a ton of other dangerous side effects.
I also agree with that other commentor, that our society, and my past self, is a bit obsessed with "success" metrics, usually judged by things like career success. The idea that, maybe if you just accept that your career won't be what it could be but that's better than drugging yourself up to achieve those goals, seem foreign to some people. Becoming "somebody" important becomes more important than just being stable and healthy.
Well, if you find yourself in my position, where you get diagnosed with heart failure and learn that ~50% of people in your position die within 5 years of diagnosis, all the sudden that big N promotion doesn't seem as important anymore. And the drugs that help you get there don't seem as worth it. So nowadays my mind still wanders constantly, my wife gets frustrated by how often I start day-dreaming mid-conversation with her, and I know that intellectually I'm capable of more career success but I'm held back primarily by my lack of focus and discipline. But I've come to just accept all that, being on stimulants to fix it, is not worth the downsides.
Stimulants have the adverse effect of harming the mitochondria/metabolism.
Most conditions improve when the metabolism is normalized. B-vitamins are pro-metabolic.
Sometimes doctors do good work. My girlfriend's doctors eventually figured out that she is a poor methylator, and can't convert folic acid into folate (Vitamin B-9). She therefore absolutely requires a dietary source of Folate, instead of the folic acid that is used to fortify many foods. She said this vitamin was profoundly helpful for her complaint of "depression".
Sometimes doctors make work for themselves. Using Stimulants to treat metabolic problems is an exercise in futility.
Deplin [0] is a patented prescription version of Vitamin B-9 aka L-Methylfolate. It's approved as an add-on treatment for when so-called antidepressants don't help with a person's symptoms. There's a genetic test that tells if a person is a poor methylator who especially needs Folate instead of folic acid.
I don't know how they decided to run the genetic test, I just heard that they did and that folate really helps her. She eventually switched to non-prescription folate (from the supplement aisle), probably mostly because of cost, or maybe some other reason.
Folate is cheap enough to experiment with: if you notice something dramatic, keep taking it.
For what it's worth, I took up running, changed my diet, and found that both of those in combination did effectively nothing to address my ADHD symptoms. I'm a lot healthier now than I was before I discovered I loved running, but to this day I use medication because it's the only thing I've tried that makes a meaningful difference.
Running and diet improvements did great things for my ADHD, but it's not consistent. I'd fall into slumps due to ADHD-fuelled depression, I think. The stimulants do a great job warding that off and keeping me consistent with exercise. Consistent exercise tends to keep me consistent with diet.
If anyone argued that stimulants are bad for my health, I could only point out that without them, my health suffers acutely through sheer neglect and it's a downward spiral.
A pill that decreases the risk of cardiac arrest is very different than a pill that is psychoactive. Many people just can't relate to taking a drug that quite literally changes your behavior on a day-to-day basis, even if it has positive effects on your life.
This is something I myself have struggled with. I suffer from anxiety but I can't bring myself to take medication because I like the person I am and I don't want to change my behavior or personality.
No one should be stopping you from taking Ritalin, but each of us is entitled to our own opinion, so the only thing that is irritating is when someone calls out an opinion another holds even if that opinion has no tangible effect on anyone's life.
"
Lanham, Md. (Jan. 8, 2019)— The message is clear. Treatment for attention-deficit/hyperactivity disorder (ADHD), along with the related health risks it poses, has the possibility of adding an average of nine to 13 years to the lifespan of children and adults diagnosed with ADHD. This is the implication of a cutting-edge research study conducted by Russell A. Barkley, Ph.D., who evaluated the connection between ADHD and 14 critical health factors including nutrition, exercise, and tobacco and alcohol use."
https://chadd.org/advocacy-blog/new-research-suggests-untrea...
ADHD is an extremely harmful condition. You are more likely to end up in jail, crash a car, suffer from diabetes, smoke etc. than neurotypical people. 9 to 13 years in life expectancy, I mean, wowzah.
And opinions held in society or groups obviously have an effect on individuals. That's how social systems work.
I feel like you're now arguing in bad faith. Medicine for heart health does not change your behavior significantly. ADHD medication does. That's the distinction I'm trying to make.
> Medicine for heart health does not change your behavior significantly.
This part of your argument is decidedly false. It's been an open secret for decades among public performers of several stripes (actors, public speakers, musicians, etc.) that beta blockers can prevent stage fright [1]. More recently, there have been multiple studies suggesting a link between statin use and increased irritability and aggression [2] [3]. Basically, the distinction between "psychoactive" and "non-psychoactive" drugs is more about the reasons people take them than it is about the drugs themselves. To a first approximation, there's no such thing as an objectively "non-psychoactive" drug.
The big question for us is, do we consider the parts of our behavior caused by whatever we suffer from to be part of our identity or personality?
I do not now. I used to -- I had a fairly major crisis of identity after my diagnosis, because a very large chunk of what I considered to be my personality turned out to be ADHD symptoms. I literally had to refind myself.
But it turned out very well, because now I define myself based upon what my actual qualities are, rather than defining myself based on symptoms of a disorder. I no longer feel like everything about who I am changed after meds; I'm still the same person I was ten years ago, I'm just now more easily able to express that self without ADHD getting in the way.
Also, in almost all cases, the "new qualities" are better than the old ones. Whereas before, "I just can't finish things" was unfortunately something I considered to be part of me, now I am able to finish things mostly the same as neurotypical people. That leaves me free to define myself based on positive qualities -- good humor, optimism, and so on.
The thing is, it became much easier for me to feel okay about taking medicine when I realized that the goal of medicine is simply to bring me back to a "normal" level. I had been operating at a deficiency of certain neurotransmitters; the medication simply brings those levels closer to normal. Once I had adopted a more biochemical perspective on my brain and identity, my initial reluctance disappeared.
A side effect of this is that I kind of no longer believe personality is fixed. I really don't find that the things we tend to call 'personality' are the sort of permanent identifying landmarks to a person we want them to be. Now I've adopted a view that puts a much stronger emphasis on the actions a person chooses to take, which I think is a better way to identify a person's qualities anyways.
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I would hesitate though with ADHD in particular, because untreated ADHD reduces your lifespan in a statistically significant way, is literal hell to live through, and the treatments are perfectly safe and extremely effective. If someone has a child who is diagnosed with ADHD, I would beg them to not let their personal prejudices against medicine keep them from getting the child the help they need. As someone who lived through it as a kid, it was physically torture. The word "restlessness" sounds benign, but I find it to be quite similar to akathisia on bad days, which is really horrific.
Oh man, sure, the medication makes me a better member of society... but am I killing the old me? Am I discriminating against the old me? In taking the medication are we declaring the me I was born as a dysfunctional useless person?
I actually came to pretty much the same conclusion, I prefer being the me that is clear headed - the medication is a requisite for that and I dislike that chemical requirement, but I prefer this me.
I think I've gotten more over this after bringing someone bipolar(with some other issues) closely into my family, they are drastically different when off balance and constantly have to fight (adjusting meds, checking Li levels) to stay on balance... And the off-balance person isn't a bad person, but they're highly internally inconsistent, they constantly put roadblocks in their way and, even when the meds are way off balance - they'll come through stable for random moments and strongly want to rebalance themselves.
Their condition is rough enough that they can't self-correct, I can mostly self-correct, it's hard but if I've run out of meds I can make it into the Doctor and get more and I feel quite lucky to be able to do that.
It is gonna sound cheesy, but what got me into my current mindset regarding it was a quote from the recent Elton John biopic. When Elton was struggling with the identity crisis and trying to articulate the mismatch of who he was vs. where he saw himself being in the future, one of the characters told him "You got to kill the person you were born to be in order to become the person you want to be".
For myself personally, I concluded that we are simply who we are at any given moment. There is no "real me", there is only "me" at a point of time (given that I act genuinely, of course). If I act differently after drinking alcohol? That is still me. If I undersleep and act cranky for the rest of the day? That is still me. If taking the meds is what it takes to kill off the parts of me that I was born with that impede the current me, then so be it.
I realize that it is a really reductionist mindset not comprehensively describing the reality, but it helps me to come to terms with myself and somewhat describes the situation as I perceive it.
That is an interesting approach, I can't rationalize on it though since it hits at part of the core issue - you are choosing someone to live. I'm a big old softy sure, but I genuinely feel anxious judging individuals in meaningful ways.
I definitely prefer the new me. There is a continual spectrum of mes from being a young kid to an adult (ship of theseus style[1]) but this is different (and I think Elton John's situation was similar). I can clearly see a me I like and an alternative me. In theory, every day of my life I make a choice to give that day to the me I like - but gods when I think about it it can get heart wrenching.
Digging in, I'm basically denying that alternative me a chance to be alive... And I've never killed that other me, it's sitting there and I might be that me tomorrow, it's just that every day so far I've chosen that today won't be the day it is me... Similarly Elton John could always return to being Reginald (or however he identifies his older identity) he just doesn't.
As someone who waxes philosophically this is an interesting consideration to dive into but thankfully most days I skip right past it and don't perseverate. It's pleasant to share though, since I don't like vocalizing it with most folks.
>And I've never killed that other me, it's sitting there and I might be that me tomorrow, it's just that every day so far I've chosen that today won't be the day it is me... Similarly Elton John could always return to being Reginald (or however he identifies his older identity) he just doesn't.
The way I see it, it isn't really "killing", as in, getting it to not exist at all anymore. That old "you" will always be there, just like a bunch of other possible "yous". The "killing off" part means getting to a point where going back to that old "you" becomes as difficult as it was for you to get to the current "you" from your old "you".
And I totally feel you on the part about thinking too hard about it. This outlook I have is definitely not comprehensive and just provides satisfaction at a cursory glance when my mind wanders there. Looking at it under a microscopic view, there are individual parts that can be deconstructed and found to be not super accurate. But overall, it seems to provide me with a good enough framework to look at my life through.
> but am I killing the old me? Am I discriminating against the old me? In taking the medication are we declaring the me I was born as a dysfunctional useless person?
What are your goals? Was the "old" you getting any closer to your goals? Is the "new" you getting closer? It's OK to take the pragmatic view of your environment and situation in life. These things matter too, especially when you have to support a family.
Kanye West has talked about this. He was recently diagnosed as bipolar and has been working with a team of doctors/psychiatrists. The medication helps but he loses his creative side because it dulls him.
A very popular medication (propranolol) diagnosed for blood pressure control also causes your heartbeat to slow. It's commonly prescribed as a first line approach to acute anxiety, if you take them they slow your heart rate and can cease panic symptoms spiralling.
I cannot think of a medication that doesn't in some way affect your psychological profile, because if you're sick then you'll behave differently.
I think it's a bit of a trap to believe that you are your authentic self only by denying yourself medication, I consider myself from 5 years ago a different person let alone pre-medication. Is it that valuable that you struggle and live unhappy for the limited years you have available?
My best personal description of it would be something like... my brain is constantly thrashing and offloading caches - with Ritalin the context switches still happen but the prior task doesn't get booted out of memory... so it's sort of like imaging running across a marshland, where every time you hit water you lose... the Ritalin might be like logs across streams, it isn't that suddenly you're always running across solid ground, you aren't constantly in single focus[1] but you can cross more of the marsh and reach the far side without getting wet.
There, that's my terrible analogy.
1. There's a flip side, staying with the marsh analogy, there are also some dykes someone built randomly in the marsh and it's really easy to run along those, and they're really comfortable... but they might not go to the far side of the marsh - but hey it's right over there and it'd be easy to get over there instead of trying to trudge through the marsh. Running on those dykes feels really good since you're definitely running, but you don't get to chose where the dyke goes and it might not be helpful for yourself to run along it.
I definitely do notice a sort of forgetfulness around the context of a project, particularly the reasons/motivation for doing it.
Thinking about this, I wonder if ADHD people struggle with being project managers? Especially when it's important to mentally keep track of the big picture and the contexts around various tasks.
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I guess this is sort of different from working memory though, or it's more subtle (because I definitely don't have any actual forgetfulness, it's easy for me to remember things etc)
I think there's an important distinction between hyperactive thought and hyperactive outward activity. Most people associate ADHD with the latter when it's really more about the former, as this essay describes well.
I was diagnosed with ADHD in my 30s because of this. I don't habe hyperactice activity so never thought I could have ADHD. And since I can't see how someone else's brain works, I didn't realize things with me were not normal. It was quite exciting to realize that a lot of things I struggled with could he explained.
Same here. My brother has it much worse, and it manifested in him with outward hyperactivity so he got treated and I did not. I got by, but when I finally got into grad school I realized I had a problem that will power couldn't fix.
Same for me, got diagnosed in my late 20s after I told my doctor that I was having serious trouble reading and holding conversations. People always thought I was antisocial because I didn't talk much, but it was because I couldn't focus enough to keep up with a conversation.
Eh, ability to restrain oneself (and keep those hyperactive thoughts internal) comes with age. I don’t think the impulsivity associated with ADHD in children disappears when those children become adults; they just learn to control the outward behaviors. I tend to interrupt people mid-discussion often; I’m guessing it’s related somehow.
That's a good point. I'm reflecting on my own experience as an adult but as a child I was definitely more active than most of my peers. As an adult I've put considerable effort and practice towards controlling myself in social situations.
They're both labeled ADHD nowadays clinically. The ADD you're talking about is called ADHD-PI or Attention Deficit Hyperactivity Disorder - Primarily Inattentive.
For anyone with ADHD who finds this long article difficult to read, I'd suggest reading it with the BeeLine Reader browser extension (I'm the founder, and anyone who wants a free 1-month pass can email me via my profile). It makes walls of text and long articles in general easier to stick with, and is fairly popular in the ADHD community.
This article works best in Clean Mode, which also reformats the text into a column.
Sorry if this is too off-topic/self-promotion-y, but hopefully it helps some folks.
Looks great !
if we punting extensions... I could never "find" text on a web page... Ctrl+F just highlights the text that is usually not enough for me to actually find it.. It needs to BLINK
As someone who spent a good chunk of their childhood and young adulthood just thinking I was garbage and morally weak this article really spoke to me. Going on medication meant the difference between being an effective human, partner, and worker, and being a depressed ball of goo stuck in a retail job.
I was diagnosed in 2019 after a long series of conversations with a therapist following a work disaster that nearly cost me my job. Getting diagnosed was like finding the missing piece of the puzzle regarding my life. My schooling history suddenly made sense, the poor financial decisions, etc. everything became clear.
The biggest thing I realized is how tightening feedback loops is the key to my productivity, I gravitated towards python because it's interpreted nature meant I could get feedback on my code in 20 seconds max as opposed to 3-5 minutes waiting for my code to build.
Adderall is a help but is not a cure all, it took me months to learn how to use it right, at first Adderall just fueled my ADHD and made everything worse. It's a constant struggle and maladaptive perfectionism is still the one thing I struggle with the most. I can't count the times of I've completed reverted my git sandbox to start from scratch after reaching a certain frustration level with code.
How do you use it right? I was on stimulants as a kid and they worked but made me feel emotionally empty and suppressed my appetite and energy. I’m 28 now and I’ve started taking it again to help with work. The appetite suppression is gone but the emotional apathy remains. If you have suggestions or experiments to make the best use of these meds I’d love to hear them. I started with the lowest possible dose.
Stimulants are bad news bro. I was diagnosed as a kid, and my sophomore year of college as well. I also didnt get enough sleep (or low quality sleep), had a terrible diet, etc. You can avoid the grips of amphetamines with regular exercise, mindfulness meditation, keto diet, yoga, etc. It's a bit harder to maintain, but you won't have to take amphetamines.
No, not everybody can. If you can manage it using those topics, great. You're not as far into the "ADHD affect my life" spectrum as other are. Awesome for you.
Get plenty of sleep the night before, try to get some form of aerobic exercise daily, start working on whatever task you need to focus on within 30 minutes of dosing (ideally before), stay hydrated, turn off notifications on your phone and block addictive sites, wear noise cancelling headphones. If you're going to listen to music have it on random shuffle so that you don't have to break focus to change the music yourself.
You may also work with your psychiatrist to try different stimulants. There's Adderal and its side chains, Ritalin and its side chains (mine is one of those - Dextroamphetamine), stimulants bonded to lysine to enforce delayed release, and non-stimulant options.
Don't feel trapped into one option that isn't working for you.
Your dosage might be too high if you're experiencing emotionally empty. I recommend looking into Vyvanse. It's been a game changer for me compared to Adderall.
28 here, diagnosed in 2019 as well. In 2016 I actually lost a job because of the 5 - 10 minutes it took to rebuild Tomcat after I fixed a JS typo. Finally the server starts up and I get called into a retro, or a planning meeting, or town hall. Then I fall behind and feel the need to catch up on work at 10pm. 4am I get to sleep to be late for the 10am standup. Meanwhile the guy adjacent to me is typing on a mechanical keyboard amd screaming through a bluetooth mic on a sales call.
Thanks for mentioning that not everybody responds well to Ritalin. I was medicated with it while in grade school, and it was not pleasant; the school nurse would check my mouth to make sure I took the pills each morning, because I would spit them out otherwise. To this day, I am not interested in taking medication for my mental health.
Ritalin in the 90's was pretty brutal for me too - when I was first put on it it was a big morning pill and I think two separate afternoon boosters - this meant that I was constantly cycling between overly sedate, level, and apathy - but I've found that switching over to a single XR pill has helped out, I think I've also benefited from being able to clump my active hours according to my own schedule so that I can be productive semi-reliably and sort of trail off in the evenings.
If you're able to get by without it then good on you - but I thought I'd mention that things have improved somewhat.
I have ADHD and OCD. I take medication. This post on ADHD hits hope with me on how people treat OCD.
"My OCD is kicking in, it needs to be aligned!"
OCD is not wanting things straight. That's human nature.
OCD can be crippling. It can take over your thoughts and your life. That's the compulsion. It takes you over. It's doesn't help with programming, it doesn't make your code neat.
It's a terrible combination since stimulant medications tend to increase anxiety and therefore worsen OCD symptoms.
My OCD is largely under control now. It took a few years of CBT; figuring out how much sleep (5 ± 1 hours for me) I need per night; and nailing-down a daily routine featuring bounded compulsive activity in order to, for instance, enable me to get out of the door in the morning.
For anyone diagnosed with ADHD, taking stimulants is associated with 8+x increase of being diagnosed with a basal ganglia and cerebellum disease later in life.
I believe this is NOT causative, but is instead a correlation between other diseases associated with Dopamine production and ADHD. I take and have continued to take stimulants for ADHD.
In my family's case, we likely have something called Dopa Responsive Dystonia (DRD), and what the author is describing sounds to me like what I experienced prior to being diagnosed with ADHD, and later with DRD.
Having said that, I'm not a doctor, so please go see an experienced movement disorder specialist if you are reading this and have any concerns.
DRD is very hard to diagnose, but easy to treat. Because the stimulants (Adderall and Ritalin) made the DRD symptoms worse, my mother happened to get early onset Parkinson's, and my grandmother also responded to carbodopa/levodopa (carbo/levo), it was fairly obvious in retrospect, but if we didn't have a family member with early onset Parkinson's I doubt it would have been picked up.
My sense is that anyone with ADHD who uses stimulants should see an experienced movement disorder neurologist or few about basal ganglia and cerebellum diseases and try out medications based on their assessment. From personal experience, it became extremely clear I had DRD after taking carbo/levo, but there's no way I would have really known without trying it. It also helps with some of the stimulant side effects, which I still continue to take because they are very effective.
My family has seen maybe six neurologists total, and only one really knew about DRD. The Dystonia Foundation has a decent doctor locator.
There's no direct link I've read about. From personal experience, having DRD increases the risk of being diagnosed with Alzheimer's, which happened to my grandma about 20 years ago, but that's just because some of the symptoms are very general, and it's especially hard to tease out with co-morbid conditions that may have some overlap.
I didn't know this, but I take my medication as rarely as possible because I hate the comedown, appetite suppression, and tolerance building that occurs. It sucks, but I had a feeling there was some long-term downside like this. Hopefully lessening frequency to occasional use also lessens the likelihood of what you describe.
I don't think it's a causative relationship. My feeling is that there are a group of disorders related to Dopamine production that overlap with ADHD, for obvious reasons, and if you have one of those you're more likely to get diagnosed with ADHD.
On the flip side, getting treatment for those disorders, provided you have one of them, can also help with some of the ADHD symptoms.
This. I will always advise people to avoid medication for ADHD and major depression if they possibly can, not because I have a moral problem with it, but because I've yet to find one case where it was sustainable long-term. (bipolar/schizophrenia/BPD are a different matter. Quite possibly because the medications aren't stimulants).
I would really suggest stopping that advise unless you're a medical professional, the long term effects should be considered and attempting to be on a methylphenidate for extended periods of time isn't to be taken lightly due to even obvious and relatively minor effects like increased blood pressure. But, for some people it makes quite a significant and noticeable differences and adding to the stigma of taking a medication by reinforcing that it's non-essential will decrease some folks' quality of life.
Presenting information about the long term effects is good and I, especially, appreciate it - but please don't attempt to judge treatment efficacy when, especially in the realm of neurological disorders, treatment efficacy can vary wildly from case to case.
So please do share your story and invite people to learn, but don't council others.
What a beautiful advise, it remembers me of two friends with major depression who stopped taking their meds and thus will not have a bad long term experience with their anti depressants.
One committed suicide last year, one the year before.
Oh, I hear you say that they only should have stopped taking them “if they possibly can”. I’m sure their families now know that they possibly couldn’t.
I would appreciate if you could work that into your future medical horoscopes...
Just because you don't have anecdotes on your hand doesn't mean that's not the case. I don't know what your definition of "long-term" is, but ultiple specialists I have seen over the years happened to mention that they have patients who have been pretty much on the same stimulant prescription for ADD for 10+ years. I didn't reach that number of years yet, but I am getting close though. Once the specialist finds the drug and dosage that works for you, there should be pretty much no need for any changes to prescription or dosage. That seems to be pretty sustainable to me.
Thank you for citing this article. It is also known that using methamphetamine increases cardiovascular risk. Prescription amphetamines might do the same.
This has always been quite concerning to me as I've had a worsening essential tremor that was slight in my early twenties but is quite observable now that I'm in my thirties. The confounding effect that really hurts me here is that my father has had a benign essential tremor for his whole life - so there's a constant see-saw internally and with medical practitioners about whether my tremor is something to be concerned about or not.
I suspect that my mom developing a tremor is what turned her DRD, which was in retrospect similar to what myself and my grandma have, into Parkinson's. As far as I can tell, for my family anyway, developing the a tremor will rapidly deplete what little Dopamine we can produce and lead to normal'ish looking Parkinson's.
The genetic defects associated with this are I believe a spectrum though, and we happen to be close to one side of it. If you have any symptoms related to DRD, I would see a movement disorder specialist and ask for a trial of carbo/levo. It'll be immediately obvious if it helps, and if you don't have any problems with Dopamine production it won't do anything (except for some mild side effects).
Segawa's is completely irrelevant in this case and not supported by any symptoms the author reports in the original article. I have diagnosed Segawa's. It is quite irresponsible to wave people off of successful treatments of ADHD, as you're doing here, because of your family's (unfortunate) history with a genetic disease. I apologize that we know little about Segawa's and you've had a journey to understand it, but there is approximately zero overlap between common ADHD symptoms and the presentation of Segawa's, which is primarily motor-related.
Please, don't read comments like these and distance yourself from treatment. There is always more to a study.
I think you're misinterpreting my post based on some of the other responses. I will update it to unambiguously state that people taking stimulants for ADHD should continue to take them, just like I have continued to.
I'm not misinterpreting your post. You diagnosed the author with Segawa's based on your experiences by pointing out you wouldn't be surprised if he "had something similar". He does not, with certainty. You're also warning folks that the only consistently successful treatments we have for this (much, much more common) hyperactivity disorder are associated with unlikely neurological outcomes. Sure, an 8x increase sounds high, until you realize that it's multiplying a mere fraction, context you do not include.
I'm sorry to appeal to authority here, but comments like these do actually harm people by shying them away from treatment (just look at your replies), and please don't write them. Again, I'm sorry you're dealing with Segawa's, but even your edits in response to my comment are making your statement more harmful because they're based in pure speculation.
I am not a doctor and I did not diagnose them with anything. I stated that what they described sounded very similar (nearly identical) to my experience, initially with ADHD and then with DRD. I have updated the initial post with clarifying statements.
I don't intend to mislead anyone. However, I do want people to be aware of possible links between ADHD and other disorders so that they can evaluate their own situation and seek medical care if they would like to.
More to the point, my family has been misdiagnosed for decades, and this likely would have been avoided if we were more aware of other possible diagnoses.
My answer to that question will come across snarky or "the medical profession appealing to authority," I'm afraid, because I'd like to see your remarks entirely removed as medically harmful. Your purpose is clear from your other, more to the point remark: if only it had been for a random HN commenter who's never been to medical school speculating about two entirely unrelated diseases based on the presence of a common hormone, you might have avoided the diagnostic history and pain in your family that you report. That's a ridiculous position, both interpersonally as well as scientifically, but I know that engaging on it with you will look like I'm trying to steer people to my field rather than encouraging independent research of our discipline.
I'm here because I'm learning to write software, but I wouldn't pretend to understand the paper or mathematic theory behind, say, Paxos because I recognize some terms in it. I know my limitations, and all I ask is that you consider them, as well. The problem with raising awareness as you are is that it's difficult to objectively remove yourself: Segawa's is _incredibly_ rare, making all of the events in your family difficult to explain. Scientifically, transferring your experiences to others is a very tall order without much further study (and I hope you, and your family, are being studied, specifically because the genetics of Segawa's are poorly understood). What people portray as medical professionals swinging the hammer on "the information that could make us irrelevant" is actually trying to stand fast to the exact same scientific discipline that you, and every member of this audience, does in _every single other context_.
Your speculation about the relationship between ADHD and Segawa's is so far off base that a second-year medical student could probably explain why; you just happen to have been diagnosed with both. Left unspoken: it is quite possible to have both, because they present and manifest in different ways.
I'm happy to modify the portions of my post you think are medically harmful. I could be wrong, and I've been wrong before. But at the same time you could be wrong, and I think you are relying a bit much on appeals to authority. Just my opinion of course. I also wouldn't sell yourself short about making contributions to other fields. If you're wrong, you're wrong, but let someone else tell you that. I had to dig around and look real hard to even begin to figure out what was going on with my grandmother and ultimately my family. I was wrong a few times along the way, but we were able to figure it out.
My guess is that DRD is under diagnosed because of reduced or low penetrance in some cases. As far as I can tell, for the majority of our lives, no single person in my immediate family would fit the diagnoses, but as a family, we apparently do, especially if someone knows where to look and what to look for. I suspect my extended family on my grandma's side has it as well, but I doubt any family with it would be diagnosed unless they happened to have someone who presented with it in an obvious way.
The urgency you're detecting in my posts is because in my experience, 10+ doctors and 4 neurologists missed it and/or mistook it for other diseases. It was especially hazardous for my grandmother because they were insisting on doing the medical version of taking her out back and shooting her even though their treatment of her in medical and custodial care settings was causing the very symptoms they claimed were due to other disorders. And yes, I do not want someone else to go through that, especially since having other relatives who also respond to carbo/levo seems to be critical in helping establish a diagnosis when there isn't someone in the family who presents in a typical way.
If you want, I can modify my post, but like I said before, I strongly suspect the presentation of ADHD with other characteristics, which are admittedly not symptoms of either disorder, increases the odds that someone has DRD or some other neurological disorder that's also contributing to the presentation of their ADHD.
If you have some compelling evidence that there is no interaction between DRD or similar and ADHD, I'm happy to see it, but from personal experience that is not the case.
Hate to break it to you, but the OP's edited comment is far less harmful than yours.
I've been suffering from a myriad of symptoms that happen to match up with Segawa's... a disease I learned about less than ten minutes ago.
> please don't write them
Please don't make statements requesting that other's don't share their experiences with misdiagnosis and rare conditions. It's rude and furthers the stigma that some conditions are too rare for their sufferers to discuss.
> Hate to break it to you, but the OP's edited comment is far less harmful than yours.
It has been significantly, damned near whole cloth, edited in several ways since I said something, so I'd ask a little consideration that I'm coming from a good place. I'm not asking for anyone to avoid discussing Segawa's; I'm specifically responding to the speculation, across multiple comments, that the common element of dopamine as a neurotransmitter makes them related diseases. Given that people attack doctors when they try to arrest harmful discussion like this, I'm taking great pains to not be rude, so I apologize for coming across that way.
If you diagnosed yourself with Segawa's based on Wikipedia, please bear in mind that my single diagnosis across my entire career involved four months of differential diagnosis and observation, and led to a publication. It's simply that rare. There are several much more common possibilities, and I'd ask you to talk with your neurologist with an open mind rather than assuming the Internet has steered you correctly. That's also part of the reason I've responded as I have, exactly due to what you're saying.
Appreciate the comment and was unaware that it had been edited after your second comment.
I won't be diagnosing myself off of Wikipedia, next to no one in my family has the symptoms that I do so I doubt it's something like Segawa's.
I appreciate the apology and hope my reply didn't come off as too aggressive. Part of my tone comes from personal experience: doctors stating that I don't have a condition because it would be "statistically unlikely"... all without running a single test.
It was edited after their second comment, but they are exaggerating how much it was edited.
I added the first italicized sentence after their first comment, and after their second comment added the second italicized sentence and modified two other non-italicized sentences. I think... I may have just modified one non-italicized sentence after their second comment.
It has not been edited near whole cloth. I added two sentences and modified two others. I think I've been very understanding of your skepticism, but at this point you're literally making stuff up.
What is your take on link to Parkinsons and Alzheimers from therapeutic doses of amphetamines 60mg and below daily?
Am I trading my future brain function for quality of life improvements in the current?
The thought of irreversibly damaging my dopamine transport system later on in life feels like I am making a deal with the devil every time I take a dose of stimulants to correct my dopamine imbalance and cognitive deficits to feel neurotypical for a fleeting period of time soon after ingestion.
Any link to hemorrhagic stroke later in life as well? Thanks for you time.
Thoughts on any neuroprotective measures I can take now like memantine or bromocriptine(sp?)?
Thanks for the info on ADHD / basal ganglia and cerebellum. I was not aware of this.
It should be noted though that the study authors were pretty clear that the correlation is unclear given that untreated ADHD sufferers had a 2.5-fold increase in the same diseases.
> Researchers postulated that the association between psychostimulant use and BG&C diseases may be a result of a more severe ADHD phenotype, rather than a direct pharmacological effect.
>"hyper mobile joints are an uncommon finding in those who do not have attention deficit disorder/attention deficit hyperactivity disorder."
>Differences in the structural integrity of temporal and parietal cortices may underlie wider behavioural phenotypical expression of hypermobility: abnormalities in superior temporal cortex are also seen in autism.11 Inferior parietal cortex can affect proprioceptive awareness and hypermobility is itself linked to dyspraxia.1 Our findings suggest that processes compromising function in neuro-developmental conditions may occur in individuals with hypermobility, putatively enhancing vulnerability to stress and anxiety.
Autism, Joint Hypermobility-Related Disorders and Pain
ASD and HRDs, specially hEDS, are conditions with a strong genetic component, a polymorphic clinical presentation, appearing both in infancy, and sharing several phenotypical features (35). Although existing data does not allow to ascertain increase prevalence of ASD in HRDs, as well as shared underlying patho-mechanisms between both conditions, there is increasing evidence suggesting that these co-occur more often than expected by chance. This requires be confirmed by further investigation which should consider the recent nosological changes both in EDS and the hypermobility spectrum disorders [see (17, 38)], and in ASD (72).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292952
Joint hypermobility and the heritable disorders of connective tissue: clinical and empirical evidence of links with psychiatry
- In 1988, Hofman et al.[58], in a sample of 30 children with MFS,observed that 17% had attention deficit disorder with or without hyperactivity. A decade later, Harris[59] stated, based on his clinical experience with 200 patients with ADHD, that "hyper mobile joints are an uncommon finding in those who do not have attention deficit disorder/attention deficit hyperactivity disorder."
In Sweden,Hollertz[60,61] also pointed out the frequent co-occurrence of ADHD and JH in adults patients. He observed that an orientation to orthopedic and rehabilitation care was common in these patients due to joint problems. Thus, this author speculates about a possible genetic marker com-mon to ADHD and EDS.
Recently, Koldas Dogan et al.[62]explored JH using the Beighton score in 54 children with ADHD compared to 36healthy controls. In this study, JH was significantly more frequentamong patients than among controls (31.5% vs. 13.9%). In accor-dance with these results,
Shiari et al.[63]also found a higher prev-alence of JH, assessed with the same method of the previous study,among Iranian children with ADHD compared to controls (74.4%vs. 12.8%), confirming an association between ADHD and abnormal collagen conditions.
JOINT HYPERMOBILITY AND AUTONOMIC HYPERACTIVITY: RELEVANCE TO NEURODEVELOPMENTAL DISORDERS
> It is likely that the importance of hypermobility and autonomic dysfunction to the generation and maintenance of psychopathology in neurodevelopmental disorders is poorly appreciated. Work underway(autonomic testing, fMRI) will test the hypothesis that autonomic reactivity and interoceptive sensitivity predispose to the expression of psychiatric symptoms, particularly anxiety
- We demonstrate for the first time that rates of hypermobility and symptoms of autonomic dysfunction are particularly high in adults with neurodevelopmental diagnoses. It is likely that the importance of hypermobility and autonomic dysfunction to the generation and maintenance of psychopathology in neurodevelop...
I always noticed a pattern of 'see one, and the other is never far behind' with autism and ADHD but I never made the time (irony much) to pin studies to it. Thanks for collecting these.
I was told by my doctor that since I have a successful career as a software engineer I do not have ADHD. I'm still fighting to get a prescription. What he doesn't understand how my coping mechanisms are probably more unhealthy then the drug. I have allocate recreation time to work, use a lot of caffeine, and sleep deprivation to overcome my ADHD. Sleep deprivation is probably the strongest tool to combat ADHD but as I get older it takes a greater toll on my body.
If your doctor is a family medicine practitioner, you really should visit a practice that specializes in ADHD. It can cost a lot more but well worth it. They’ll be much more proficient in providing an actual diagnosis and subtype along with the knowledge to help find treatments. IMHO, as others mention, medication still requires behavioral/mental habit changes which having a psychiatrist familiar with the details of ADHD will be a huge boon in incorporating into your lifestyle.
Oddly I get the bit about sleep deprivation. It can be oddly effective. I also sometimes do more effective work when I have a cold/flu as well.
Other than your experience with your doctor, what you described is near perfect recreation of my experience prior to getting medication. Afterwards those coping mechanisms nigh complete disappeared almost overnight.
Keep pushing to at least get a trial run with the medication and seeing if it helps you. Also if your doctor is seriously ignoring your concerns, consider looking for a better doctor. People often place way too much confidence in their doctors and stick with crappy doctors who don't make efforts to resolve their patients concerns.
Best of luck finding something that helps you get away from those coping mechanisms.
Note: This post is a little rambly since I am typing this up while doing something else but I felt the need to comment.
Thanks for the push. I've been working with ADHD my entire life. I never considered medication before until my son started on it and I watched an absolute transformation in the way he works at school. His 4th grade teacher literally cried it was so positive.
Ugh, this. So many lost days, weeks, months to ADHD. Just trying to keep up. Can't focus for a day? There goes the weekend. Shame, fear of losing my job, fear of work piling up - all of it. I have to make up for it at some point.
I can relate to this. I was diagnosed at 31, and my doctor at the time asked me "so, are you having issues at work? Is anyone pulling you up on your effort?"
The answer was "No". His response was "well, then what's the problem?"
The longer answer from me should have been "no, but keeping up appearances requires Herculian effort, and I pay a tremendous emotional and personal cost, I am distant from my wife and 2 kids, and at night time, the anxiety is enough to materialize a cold ball of steel in the pit of stomach".
I managed to get a diagnosis anyway, and my psychiatrist got me started on Ritalin, and then onto Concerta (I take Vyvanse now). The difference was like flipping a switch. My work output improved out of sight, I stopped being a zombie at night time because I didn't have to go through a cycle of wake up -> work -> burnout -> sleep -> recover every day, and I'm earning more than twice what I was at the time of my diagnosis, and I don't think any of that would have been possible if I'd remained in the same situation.
What I've learned over the years is that the problems associated with ADHD don't "go away" with medication, they just become more manageable, and knowing how my brain works both on and off medication has been TREMENDOUS tool for increasing self-awareness and understanding that the anxiety/procrastination/apathy etc is a function of neurochemistry, and not a harbinger of doom or destruction.
From years of amateur neurochemistry - As best as I can tell - ADD & ADHD are two sides of the same coin resulting from a dopaminergic deviation that serves the tribe but not the individual.
Most people think of dopamine as the "pleasure chemical," but in reality it is the "anticipation chemical." Dopamine says: "You got this. Almost there!" And it is up-regulated when an uncertain profit presents itself, implying that all you need is a little bit more focus and practice.
Too little dopamine and you get OCD and hoarding: the inability to decide. You can think of a hoarder's room full of stuff as decisions left unmade. When you can't decide, you open & close your car door 45 times until it sounds "just right".
And when you have too much dopamine, you do stuff with zero anxiety, but you don't stop to consider the best course of action because you pick the first, best path. Useful when running from a predator, but not when solving complex problems. Just look at people on cocaine to see how this pans out.
The best personal advice I have to handle the ups & downs of ADD/ADHD condition is to build supportive todo & reminder systems around the bipolar highs and lows. Exploit the manic highs and outsource as much rote work as you can. Find ways to help you remember and reward life-sustaining tasks during the lows.
I've been working on some software that helps me get the most out of life in this manner, which would also potentially help older, mentally-compromised patients. If this is something you are interested in, please do reach out.
Do you have sources for any of these claims about dopamine? No offense intended, and I agree that the common interpretation of dopamine as the "pleasure chemical" is wrong and oversimplifying, but much of what you're saying sounds a bit "just so" to me.
Also, while the relationship between neurochemistry and psychology is still in the dark-ages, seratonin is usually identified as the issue in anxiety related disorders such as OCD.
I’m definitely interested in the software you mentioned.
> Exploit the manic highs and outsource as much rote work as you can.
This. 1000x this. If I’ve found a flow I tell my partner that I’m canceling plans so I can exploit the focus as long as it lasts. Those bursts of work every few weeks will pay dividends for years
Ive been diagnosed with ADHD since I was in 2nd/3rd grade and have been on Ritalin and now Adderall pretty much the whole time. That article sounds exactly like my experience. This morning I have been avoiding working on a project, and I caught myself staring at my computer with my hands ready but I just couldn't start. I do feel that it is my ADHD, but I also feel that there are other emotions involved. It kind of relates to this post https://news.ycombinator.com/item?id=22124489.
My main piece of advice that I write on every post about ADHD is the following: Get plenty of sleep, exercise, and look into meditating. Using the Waking Up app by Sam Harris has really taught me so much more than I was expecting. For the first time last year I went 3 months without medicine. I wanted to gauge how strong my attention/focus muscle was without medicine. At the end of 3 months I was able to start noticing when I was distracted or in my head and that was such a be improvement for me, because it allowed me to start paying attention again. I also noticed how I was communicating with myself. I went from being negative towards myself because I knew i should be paying attention. To understanding where my mind is at that day and knowing that today might be a harder day than yesterday, but that is okay. Just take it one step at a time.
TLDR: Exercise & Meditation. Mindfulness will help keep you present and away from the endless mind games you can experience with ADHD
I recommend "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder" by Edward Hallowell and John Ratey (https://www.goodreads.com/book/show/18712223-driven-to-distr...). I discovered this book thanks to HN and a post about dyslexia. The book shows quite a few stories of adults with AD(H)D and how do they cope with work and relationships. The stories are diverse (it is certainly not all ill-behaved boys), and give a point of reference.
I wished I had known that book before. I got diagnosed only the last year, being 33 years old. Before turning 30 I hadn't suspected having ADHD, as I had quite a few misconceptions both about the condition, and what is "typical" in humans.
This is interesting, because I definitely have been a non-believer. This article makes it real.
It does seem to me that ADHD is over-diagnosed for kids, especially since the condition as described in the article really looks like what a small child seem to experience (the inability to focus, the constant distraction, etc.). And because it is much less rare to see someone in their 20s saying they have ADHD than to see some parent saying their kid has it. It is convenient for a parent to think that their kid has ADHD to explain why the kid is "late".
Here the problem really is about "lateness". Children grow up at different paces, and if a 6-year-old boy behaves like an "average" 4-year-old, people will think he has ADHD, while his brain might just need more time to develop.
There are kids who finish high school before hitting 10. Do we diagnose them with anything? Like Attention Surplus Disorder? No, because it doesn't seem to induce any trouble.
The ADHD as described in the article sounds like a nightmare to be honest, and I really wish scientists find some way to help these people.
The thing with ADHD is that some type of kids are overdiagnosed, while other types are underdiagnosed. Basically if your kid suffers from:
- Poor academic performance
- Hyperactivity
- Poor social skills (gets in trouble, fighting, etc.)
Then they're most likely gonna get recommended to ADHD evaluation. But as you might guess, a lot of kids suffer from those things without necessarily having ADHD.
Some kids, like myself, mellowed out, and lost pretty much all the traits other than those of ADD. But I did just well enough in school - despite putting zero effort into it - that I flew under the radar.
Teachers figured I was just too busy fooling around / lazy / uninterested in some topics, while my parents argued that I was too hung up in sports / gaming / playing instruments.
And unfortunately, by the time you're a teenager, you only have one idea of what ADHD looks like: It's the troubled kids in class that got diagnosed early on, and can't cope in school; The "academic losers", as they are unfortunately branded.
In fact, that's the reason I didn't get diagnosed until my late 20's. My ex-gf hinted to me that I scored very high on ADHD / ADD checklist, but no way I thought, the only people I know with ADHD are those that never graduated from HS, and now are either criminals or minimum-wage workers.
Well, got myself evaluated, and sure enough, ADD. It was a thorough process, and took a LONG time.
I’m 31 and have ADHD (diagnosed in my teens) and I’m pretty sure NOBODY with ADHD is going to have the wherewithal to read this entire article! Unless it happens to magically coincide with their hyper-focus topic of the moment!
In all seriousness, I skimmed parts of the article and kept scrolling and it just kept going and going and going... like the Energizer bunny. I guess the author found a doctor to prescribe stimulants; they do make it easy to write long rants.
I can identify with some of his analogies, not all. The forgetfulness, standing at desk with power supply / getting “stuck”, lots of that sounds familiar. Some of the stuff he talks about is behavioral though and if it can be called lazy, it probably is at least partially lazy. I could never file TPS reports everyday, but I can do it occasionally. My brain’s capable of it. I just don’t like doing boring things. And yeah, I probably wouldn’t last if I had to do boring things everyday for a job. But the article makes it sound like he’s actually not capable of doing a boring thing.
The more interesting parts of ADHD are the stuff that is lesser-known and often overlooked, like mood swings and anger/irritability issues. Ironically stimulants pretty much cured lifelong mood issues for me. I used to blow up on people all the time; now I’m easygoing.
> Unless it happens to magically coincide with their hyper-focus topic of the moment!
It's funny. People with ADHD suffer from attention deficit but at the same time they display hyperattention when they encounter a subject they like. I've experienced it as well: once I start programming I have no problem doing it for 12 hours straight. I've found this trait in many ADHD patients. There's usually something that really turns them on and I always try to find it.
I think of it as an signal/noise ratio problem. Very high signal is needed to grab their attention and there is very low tolerance for noise.
The way I've come to describe it with my therapist is that it feels like, internally, I have 12 different brains. All of them are constantly scanning around, interested in different things, making it very hard to focus on one thing, but conversely making me very good at understanding a thing as a whole.
The other part of this analogy is that when there is something that grabs my interest, it grabs it with all 12 brains and I bury myself in that interest until I burn out after a few hours.
I find that ADHD makes me a very good architect and a very bad regular programmer.
I think as awful this sounds, it is also why often adhd people can synthesize a lot of information very quickly because their brains have this rapid association chain which can lead to absolutely lucid insights, downside is that it's hard for them to stay on topic and not go into rambling monologue mode.
I always had that. I can’t go as deep on subjects without force of will, hard. But I have always had a knack for integrating information and learning new things with a relatively high amount of new things but not a lot of density for each thing. This can add up, sneakily, to very dense knowledge on a subject and I have made that a part of how I learn. It’s great learning new frameworks, languages, and subjects. That surface scan and seeing the whole of something comes easily.
> I find that ADHD makes me a very good architect and a very bad regular programmer.
I know what you mean. I think if I could click with someone who's really organized and good at execution we could turn one of my 9 billion potentially-pretty-good ideas into an awesome company (I have a pet theory that this pattern is often why it takes 2 to found), but I have never really been able to connect with neurotypicals. They can play along where I can't even tune in, and worse, they are content where I am passionate.
* There's usually something that really turns them on and I always try to find it.*
Yep, and that something can drift over years, days, even minutes. I find code very conducive to hyperfocus, maybe more so than something like playing guitar - it's funny, because so much of coding can be mundane and repetitive, but that quality seems to help with getting started and finding a flow state.
I rarely hyperfocus on writing music or playing instruments anymore, but I used to zone out and play for hours. I'm not sure what changes in a person that makes that more difficult one day than the next.
If you think code can be repetitive, try learning to play an instrument.
Playing the same chords over and over again, making fewer and fewer mistakes, all while this song you used to love, you are now beginning to have serious doubts about.
Those with ADHD spend 90% of their time imagining, thinking, doing everything and nothing. And to any observer they look stupid, or undisciplined, or lazy.
Like the hunt, when somebody with ADHD encounters an situation with very high (perceived) consequences, they will lock into intense hyperfocus, completely singular in their goal.
So the modes of operation are 1) philosophize and daydream or 2) hunt
Is this real? I have no idea, probably not, but it helps me reason about myself better than feeling like a permanent victim
There's a few theories out there around sensory processing difficulties, which I've been looking into a lot lately to pretty good effect. Check out The Highly Sensitive Person. (Seriously. get yourself a pair of earplugs and see how that alters your sense of focus on moderately interesting tasks, if it does anything, you should read the book). The TLDR is that when engaging in a task you have to reach the correct activation level to perform it, and it's a struggle for some people.
Some people think that a lot of ADHD people or misdiagnosed, others that it's just another symptom of ADHD.
Which is why some people have to fidget, or listen to music, or move around in order to get stuff done. Or why I'm a worse driver if I can't have the radio on.
The pinnacle of this for me was about half a dozen years ago, I was slugging out some code for a personal project. But I was also feeling nostalgic for an old movie (can't recall which, but let's say it was The Princess Bride). So I put it on in the background. But this isn't quite getting me in The Zone, so this is the scene my partner walks into:
I'm sitting on the couch typing. In all likelihood my knee is bouncing (makes laptops a bit tricky). There's 90's music coming out of my laptop, The Princess Bride is on the TV.
Her head is about to explode. You would think I was killing kittens. She has an ADHD diagnosis, and this plan I have enacted is so anathema to her coping mechanisms that she can't even bear to witness it. Which is too bad because I was getting rather a lot done.
So strange that I have said almost exactly these words. The characteristics that we depended on for survival as hunters now make life difficult in the middle class.
My theory extends to my desire for action and my risk taking behavior as a younger person.
I have had the exact same thought. I have imagined myself being predisposed to being a great hunter. I would have no problem just idling away, alone in nature all day, until the final moment came.
Well, you described me to a T. So, I'd say yes it's pretty accurate. I think there's also some overlap w/ ASD, which I think I may also have to an extent. Undiagnosed though on that front.
Hyperfocus is a coping skill if you suffer ADHD. Everyone can do it, but people who suffer from ADHD learn to get very good at getting into that state, because without it they struggle to maintain focus.
I have a pet theory that it's much easier for ADHD people to enter Flow state.
But also that Flow state is often a bad way to write code.
One, virtually everyone has a tremendous case of Sunk Cost Fallacy around things done in Flow state. If someone spent 10 hours in a week working on code that you say is badly conceived in a code review, you'll get pushback and grumbling. Argue with someone who did the PR in a single sitting? They will fight you. Hard. This is the most amazing code ever written (because I felt amazing while I was writing it). The rush goes to their heads.
Two, writing code for other people requires empathy. Rumination. Flow state is considerably absent of both of those. So the problems and gotchas you know about ahead of time get handled, but anything you find along the way is very likely to get ignored. The quantity of your code goes way, way up, the quality goes considerably in the other direction.
I made a conscious decision a while back (making official an unconscious one I'd already made) to stop seeking out Flow state. I felt better, but objectively, it hasn't done me any huge favors professionally. From a practical standpoint, me writing less code means that people who write more baroque code than I do at my worst get to set the narrative for larger slices of the codebase. But I've also done something I hate: reason that if a lot of something is bad, none of it is better.
>Two, writing code for other people requires empathy. Rumination. Flow state is considerably absent of both of those. So the problems and gotchas you know about ahead of time get handled, but anything you find along the way is very likely to get ignored. The quantity of your code goes way, way up, the quality goes considerably in the other direction.
Yeah, I thought "flow" required extremely low resistance in the task (i.e., someone sewing, playing an instrument, or playing a relatively simple game competently and with no interruption of confusion, frustration, or distraction).
I wish I could code like that. xD Constant typing to an ambient soundtrack. Instead, it's a minefield of
"uh wait I have to Google this thing",
"uh, what should happen here?",
"oh no, an error with a complicated message I probably also have to Google".
And I can only carry on the rubber ducking to competently deal with those with a FULL MARSHALLING of my mental resources, which seems too strenuous for "flow" and is exhausting after a few hours.
It doesn’t have to be that low friction. Generally you can maximize the effectiveness of your short term memory while in flow state. Part of your brain is smashing away at the low friction parts, the rest is strategizing, prioritizing.
There were times before I accepted that “massive refactor” is an oxymoron where I would keep some very complicated task lists in my head and manage to recall nearly all of them. Day to day? I can’t remember your name twenty seconds after you’ve told it to me, unless I work at it.
A common trick to remembering someones name is to repeat it, verbally, when they tell you, and to associate that name with something or someone else, mentally.
A study was done to pay people to build sand castles. In the experimental group, the people were told afterwards to knock down their sand castle (because the researchers said they wanted a different sand castle or something to that effect). In the control group, people were also told to build a new sand castle but in a different spot and so they would leave their other castle there. In the experimental group, people became very very demotivated and felt that their work was pointless and boring. It doesn't matter if you're ADHD or not, if your expectations are greater than reality and you have to kick your sandcastle over after building it, you're not going to do as well at your job.
As a code reviewer they should be giving you a compliment sandwich where the criticism or constructive feedback is placed in between two compliments. As a coder, I've found adding async and await to functions does a lot to make your code look sexier to code reviewers even if it doesn't have a perceptible performance impact on non-network calls.
If I were to comment on a new plan for you, I'd say let flow state be your friend and not your enemy. After all, you have a chair you probably have to sit in for ~8 hours a day while you stare at a computer screen full of code and that's hard for anyone to do for that long let alone someone with ADHD. Flow state will give you an advantage over others. Invariably, your flow state will break. Use that time to spend more time talking to the stakeholders in your group because sometimes stakeholders want what they want and nothing else. They'll appreciate the time you took to listen to them, they'll trust and believe in you more (instead of you being an unknown variable), they'll be more confident that they'll get what they want, and you'll benefit from the confirmation bias. If you deliver what they want, it's less likely that their sandcastle will get kicked over -- though still not unlikely.
5-10 years ago there was a study that said that contrary to common wisdom, 20 minutes is not the minimum necessary to get cardio benefits from exercise. 3x7 minutes also works. This changed my life. I'd gotten so out of shape that 12 minutes hurt, and also if you disappear at work for 25 minutes at a stretch people will talk. 8 minutes twice a day and once after work is easy.
Getting away from the desk for 5 minutes can give you a lot of perspective, and unstick you from a host of problems. I think if I go back (when I go back?) I'll find a pomodoro app that lets you customize the intervals.
I think I agree with everything except this:
> As a code reviewer they should be giving you a compliment sandwich where the criticism or constructive feedback is placed in between two compliments.
Manageable when the code review is 50 lines. Not so easy to do when it's over 500 lines. Damned awkward when the person outranks you, too. I don't know where the cutoff is, but I feel like there's a point where this advice feels like victim blaming, or at least codependency. Don't put your coworkers in this situation, please.
As for knocking over the sandcastle, I agree this is something all humans wrestle with, maybe developers especially. Almost nobody wants to accept that their code is ephemeral. We always push back. Zen or a little horticulture can give you perspective. Kids might too, but that takes decades to play out. Plants are always changing, and they'll never be exactly the way you picture them in your head for longer than a moment. They're alive, and making them 'do' anything is a negotiation that often goes in directions you didn't anticipate. For good or ill.
If anyone has ever tried pushing two strong magnets together at the spots where the same poles are facing one another, where the magnets repel instead of attract, they can understand a bit about what its like to try and focus on something that isn't very stimulating on ADHD.
Each time you try, just as you get close, they slide off one another and all around, until they stick at a different spot. Those sticky spots, are all the very stimulating tasks.
Attention Deficit isn't an inability to focus, it's an inability to exert executive control over focus. When there's nothing interesting going on this manifests as wandering attention. When there's something interesting going on this manifests as a crippling inability to process background events like appointments and bedtime.
I have had this problem through my whole life... My parents and I have never understood that this definition is ADHD and always assumed it was inability to focus. My mom have always been big about don't take pills unless you absolutely have too.
However it isn't until older age I finally been able to force my exert executive control to focus. It has taken a lot of practice and challenging myself and it wasn't until the age of 26 I finally been able to go to college. I keep challenging myself and I feel it get easier and easier every year.
So now I start to question the inability part. Or if it's something you can actually practice and get over.
I went down into dark depression 2 years back. Wife just had our first baby. I was 38. I used my kid to draw me out of depression so I didn't do anything stupid to myself. Went to therapy over a year ago, was diagnosed with ADHD. At the same time I started doing crossfit and lost 90 pounds in 3 months. My PCP prescribed me Vyvanse, and just being able to focus a little better and see my life change for better and maybe some of the coping stuff I picked up from therapy and I've not had any depression really since day one of therapy.
Honestly, I think therapy had the least effect except realization what was wrong. Drugs I think helped the most.. lately it feels like they're not as good though, or I feel like I'm in a funk. I don't know if that's just life or being overworked or just I need a dose change. Maybe if I cut it cold turkey a week, then get back on it'd reboot or something.
TLDR: I just feel I'm getting off track a lot more lately than I was the previous 14 months. Not sure what I should do, maybe go back to therapy? Maybe focus more on mindfulness/stoicism? Up my dose of Vyvanse? Go back to the gym? All the above?
> TLDR: I just feel I'm getting off track a lot more lately than I was the previous 14 months. Not sure what I should do, maybe go back to therapy? Maybe focus more on mindfulness/stoicism? Up my dose of Vyvanse? Go back to the gym? All the above?
My understanding is that tolerance is essentially inevitable when you're taking stimulants. I've made a point of checking in with a psychiatrist on a monthly basis so they can help me measure it semi-objectively and adjust if necessary. When resistance does start to develop, a psychiatrist will also have plenty of options for managing it; for example, I think that some people rotate between amphetamine salts, methylphenidate, and other stimulants over the course of several years. They'll also be able to help you figure out which other courses of action would be most helpful, figuring out what issues are actually causing you the most problems and how to address those effectively and so on.
TL;DR There are specialists for "I think my medication isn't working any more" and I'd strongly recommend talking to one, both for this specific problem and on an ongoing basis so you're not forced to try to observe your head from the inside.
im having a similar issue and am also prescribed vyvanse (or elvanse as its called here) i like to test theories out myself so ive tried taking extra and it does seem to help so i plan on asking about a dosage increase at my next review
i also tried cold turkey for near a month in the hope it would lower my tolerance but sadly no such luck, it did however give me some spare meds with which to try the higher dose
it literally does have to do with it because it was part of the results of being tested for adhd. i had mentioned the iq thing because i meant to elaborate. it was explained to me that the testing is designed to be independent of iq. however, i am a little suspicious of that fact.
when i say performed well above average i meant that i fell statistically well away from results that point to adhd.
It's can be a fleeting or an obsessive focus. Also, if you tack on depression, it's difficult (for me) to prioritize and proportionality/negative cognitive distortions get in the way of almost everything and depression makes everything seem and feel 1000x harder.
it becomes even stranger when you have both ADD and autism, sometimes i can be completely lost in something for long tracks of time to the point that it blocks out most everything else and other times the slightest thing will shift my focus entirely
it makes it difficult to become good at things you naturally arent good at, once ive been knocked off my obsessive focus on something theres a solid chance ill likely never go back to it. at times i can become almost an expert at things in a very short space of time but as soon as something else takes my focus the new subject basically erases the previous one from my memory
medication has helped greatly but i think i may need to either get my dose adjusted or shift to an alternative medication as im starting to fall back into getting easily distracted again
crap i just noticed i spent so long reading and thinking about this that im now late for work, its this sort of thing that causes issues (and yet here i am wasting more time writing this!)
That's interesting to hear about ADHD causing mood swings/anger/irritability and the stimulants doing away with them. Is that a common trait of the illness? I only noticed that after I started taking stimulants my temper became a lot more short. It's to the point that I have to be really cognizant of it lest I inadvertently snap at someone due to some biological response (really not good as a leader in an organization).
So I'm not a researcher, just a sufferer, but my understanding is that yes, emotional regulation issues are common with ADHD. Attention-deficit is kind of a misnomer; a lot of doctors now think "executive functioning disorder" would be a better name. Executive functioning is sort of the layer that sits on top of our underlying systems - whether they be behavioral or emotional - and allows us some level of conscious agency over that stuff.
Poor executive functioning is why I could never make myself start writing a paper prior to the day or two before it was due, despite the rising sense of panic I would get for weeks. (This is key -- it's not laziness, because good lord did I wish I were able to do the work. To me, lazy ~= apathy, and what I felt was just about the polar opposite of apathy.)
Poor executive functioning is also why, unmedicated, it was sometimes difficult to not let my initial emotional reactions just come flying out. It was like there was an express lane between my limbic system and my action system, totally bypassing my ability to control it. I would find myself snapping out something and as it was coming out of my mouth, I would be kicking myself and thinking "Why in god's name am I saying this right now?"
Medication has helped with all of the above and more.
What I will say is that stimulants also can have a tendency to put some people on edge and increase sympathetic nervous system activity, so shorter temper could be a side effect for sure. If it's affecting you that strongly, maybe speak with your doctor about a slightly lower dose?
Or is there a possibility that you only became aware of your tendency to have a short temper once you became medicated? An interesting chicken/egg question; I'm just asking rhetorically, mind, because I have a lot of similar questions.
Poor executive functioning is why I could never make myself start writing a paper prior to the day or two before it was due, despite the rising sense of panic I would get for weeks. (This is key -- it's not laziness, because good lord did I wish I were able to do the work. To me, lazy ~= apathy, and what I felt was just about the polar opposite of apathy.)
That sounds like a good explanation for why I've been avoiding studying for something for weeks but feeling guilty, even sick, the whole time about it.
I don't know though. It's hard for me to not call that lazy, and I don't think lazy denotes apathy. Isn't it possible to be lazy and still care about a thing?
Poor executive functioning is also why, unmedicated, it was sometimes difficult to not let my initial emotional reactions just come flying out. It was like there was an express lane between my limbic system and my action system, totally bypassing my ability to control it. I would find myself snapping out something and as it was coming out of my mouth, I would be kicking myself and thinking "Why in god's name am I saying this right now?"
I still struggle with emotional impulsivity anytime I take a few days off meds. Drug holidays can be surreal. Or sometimes they might not be special at all. But I've taken time off before and noticed everything - birds, wind in the air, music on the radio, and it felt so surreal that I broke down crying.
Stress is dopagenic. You have learned through trial and error that procrastination will help you get enough dopamine to focus. Those habits don't go away even after you find proper medication
Since we're comparing notes, do you find yourself hearing sounds that nobody else hears?
Executive function may be involved, but the inability to filter sensory information is a pretty big part of things for many people.
When I'm two rooms away shouting "What is the dog eating?" to two people who are sitting in the same room as the dog, that's not about executive function.
Actually, I'd argue that it is. The other people's executive function is what allows their sensory filtering: they can almost completely filter out sounds their brain has decided is unimportant.
Is that while the medication is at its peak, or more toward the tail end of the cycle? The extended amphetamine release Vyvanse, for example, can leave you feeling tired after it wears off. Especially on "vacations", like weekends or other extended periods, until you readjust. Such exhaustion would likely shorten anyone's temper, but especially someone with ADHD.
All I gotta say, a good specialist will definitely attempt to go through different medications with you, as what works great for some people might have side effects for others. And there are new ADHD medications being released too, some of which end up working fabulously for people who previously couldn't find one that works for them without any impairing side effects.
For me it's while it's at its peak. I personally use IR as opposed to XR. This was because I personally have a high propensity for insomnia (to the point that if I have coffee after like 2 or 3 PM I risk not sleeping). So I essentially am prescribed to take it twice a day but rarely go for the second dose. If I do take the second dose I have an insanely productive day but often get no sleep.
Back to the topic of the irritability/temper, yeah it's basically when it's active. Afterwards I'm a bit tired but otherwise totally kosher. For context, I am also on a very low dose of 5 mg. 10mg starts putting me on "talk really fast, move really fast" sort of stimulant buzz. 20mg was utterly uncomfortable. IIRC the higher doses exacerbated the positives and negatives: even better focus, even less patience, even shorter temper.
So, the mood swing thing was something I didn't identify with ADHD until I saw it mentioned in a book called "Driven to Distraction". I can't remember the exact details, but I think in the first few pages the author talks about a patient who was often getting in arguments with his boss or spouse and losing his temper in frustration, and I guess what I took from it was that a lot of his emotional instability was either a symptom of ADHD or stemming from his inability to focus.
In regards to your comment about shortened temper on stimulants, I think this is very normal and expected, and I have experienced the same at times. I don't know how to explain it, but I think overall I'm more agreeable than I was before I was medicated. This might be an age thing; I honestly don't know. Maybe I just grew out of it (I was the kid who threw tantrums lol).
> I only noticed that after I started taking stimulants my temper became a lot more short. It's to the point that I have to be really cognizant of it
That scans closer to my experience. I’ve been on Adderal for years, and when I started it I learned that I have the potential to get angry much quicker.
It can manifest differently in anyone. My father, my sister, and myself were all diagnosed with ADHD around the same time. My father has taken medication regularly for years without issue, and my sister used it "tactically" for the purposes of doing schoolwork and testing, and would be focused but really drowsy.
I, on the opposite end of the spectrum, would get strong symptoms of depression, and a constant feeling of nausea and lack of appetite to the point of being suspected of anorexia/bulimia by my physician. I tried a wide variety of medications throughout grade school and high school, and eventually gave up because they all gave me negative side effects of some kind.
That's interesting to hear about ADHD causing mood
swings/anger/irritability and the stimulants doing
away with them. Is that a common trait of the illness
For me, absolutely not.
The stimulants made me crankier and more high-strung.
However, sometimes it was a net improvement in my mood because I was getting my stuff done and therefore my stress level was lowered.
I use modafinil now which is less effective for the ADHD but also makes me less cranky.
I know many people who were more angry with stimulants, especially Vyvanse (According to my wife, I definitely had that side-effect).
However, one symptom of ADHD is something my therapist refers to as "explosiveness" which is a very sudden change from not angry to extremely angry and then often right back to not angry. Note that this can also be a symptom of bipolar, and misdiagnosis between the two is why they tend to screen for bipolar before prescribing ADHD meds.
This is not what I experienced on Vyvanse; rather my baseline level of "being annoyed at things" was much higher, so it was easier to make me angry.
The types of medications prescribed for ADHD tend to make one overconfident. They may stop certain variants of mood swings but do they really make you a more pleasant person to be around? My experience and observations tell me that's unlikely to be the case.
ADHD is related to some dopamine dysfunctions which a decent proportion of people correct for with aggression[1] - I think predominantly men do this - since conflict will supply the reward response our brains should have given out for success. So a lot of confrontational people that have un-diagnosed ADHD will actually level out with medication.
1. Sort of a vast simplification, but basically hulking out and raging - maybe physically, maybe passive aggressively, maybe verbally - the form it takes varies wildly.
Yes, this is pretty spot on. In my specific case, most of the aggression gets channeled toward my work and makes me good at what I do. The stimulants (pushed on me by multiple doctors) almost ruined my career, and my life, in more ways than one! Took years away from me. Any other aggression that happens to be there is just a part of who I am, and taking that away is a bug, not a feature. The side effects and danger that comes with any of those drugs is not worth it in many cases.
Hah. I really liked parts and skipped and scrolled more than a few. It looks a lot like some very helpful reddit posts I've made in the past.
I sent the article to my girlfriend though and she'll read all of it and ask me questions about it so I can cleverly get a proxy summary. ADHD Lifehack!
I never heard about this since reading two articles today (one here and one on Reddit). And I think that this thins explains perfectly every aspect of my personality.
Yes, me too I didn't read all the article, as I skipped around parts in articles, books, and similar stuff.
I'm very fortunate that I learned how to read at a very very young age. As such, I'm an incredibly fast reader, when reading for comprehension, I'm close to 700 wpm. So reading to me is easy bc I can read faster than my mind can get distracted.
I think that's the hardest part of ADHD, you'll always find some exceptions to the "rules" used to diagnose it.
Hmm, I have no idea what my wpm measure is, but I've never been able to identify with the perception of ADHD being something only low-IQ kids have. People I know with ADHD-symptoms are typically bright and creative, above-average humans.
I think this comment was a response to the implication that ADHD people won't be able to read long form content without hyperfocusing from your gp comment.
"Long form" is at least partly a function of reading speed.
This is my impression too, but I wonder how much is selection bias.
I think a lot of times ADHD is spotted because a kid is bright, but underachieving. There's a glaring disconnect between potential and performance... could be many reasons, many of which aren't ADHD, but it grabs teachers' and parents' attention.
But, what about a kid whose intelligence is not above average? If they are underperforming, would it be so obvious? I wonder if a lot of folks with ADHD in this category are more likely to go undiagnosed.
I was diagnosed with ADHD. I live in South East Asia (always hot and humid) and found that the stimulants made me just too hot. Ended up trying modafinil. I would take it first day of the week get the momentum going and usually didn't need it for the rest of the week until productivity waned.
I found that getting started and momentum going is my biggest challenge. Maintaining it for several days after was not as hard.
I'm homeless, live in a vehicle and can't hold a job (getting along with people). My parents insisted ADD was a fad and that I was normal, yet all of my peers said I was weird. Not many friends. Under-treated depression until 30. Lived withdrawn for several years. Finally on atomoxetine at 40, which helps some. Lots of plans but no sustained focus and execution to get anything done. I somehow slogged through getting a CS degree over 10 years, but went bankrupt and have $9k in undischargeable student loan debt. My cognition is declining, I sleep on a very odd schedule and don't really have any purpose or use because I'm too old. Intervention earlier and don't do as I did... because you can basically never recover from homelessness without help but there is no help.
Thousands of words and no mention of diet. I was diagnosed ADHD in 5th grade, tried just about every medication out there, and never landed on a workable long-term solution until I modified my diet. Medication always had mixed results. Many allowed me to focus and better control impulses, but the emotional crash at the end of the day was too much. Others caused insomnia or palpitations. Cutting sugar and limiting carbs, however has been transformational. I won't say it's right for everyone, but everyone with ADHD should at least try cleaning up their diet. It's a no lose option.
I was diagnosed with ADHD around the 3rd grade (2 separate psychiatrists diagnosed me) and have never heard about diets as working above all others. Are there any studies or information about this route or is it perhaps changing your eating behavior allowed you to do those same things with other parts of your life?
I don't know about studies but here's an anecdote. I've experimented with many potential factors for my ADHD over many years, and the strongest and cleanest correlation I've found is: More carbs and sugar => More brain fog.
The book Healing ADHD by Dr Amen reccomends diet, and exercise based treatment, as well as stimulants and coaching. It's been a long time since I've read it, but at the time I used some of the techniques, and they worked really well. I should probably read it again.
That said, it's always possible that an intervention works well in a subgroup of high-responders (this can be true even if the particular intervention is a placebo, not that that's necessarily the explanation here), so everyone saying it works for them should probably keep it up.
Nor coffee or other "normalized" liquid stimulants. The coffee sweet-spot-of-productivity is so difficult to attain, or even find. Is it even worth experimenting with if other avenues have failed?
It would be interesting to hear the author's thoughts on this, and on alcohol.
> but everyone with ADHD should at least try cleaning up their diet. It's a no lose option.
It is extremely difficult for someone with ADHD to change their diet. It's difficult even for neurotypical people. I know that it and exercise are obviously beneficial, but from experience there's a "loss" in that trying and failing consistently to improve my lifestyle really takes its toll on my motivation and self-esteem. Not to say that I'm not still trying... but it's hard.
My trick is to cook a roast and just eat roast beef and frozen vegetables for a few days. Very little effort required, and once ketosis kicks in and the brain fog lifts you have the clarity to make more sustainable diet changes.
No such effect exists for me. Plus, it would require following through on going shopping so I have roast beef and frozen veggies in the house (or remember to take them with me to work). That's not happening in an unmedicated state. I'm lucky if I can put together a remotely healthy meal while unmedicated.
I usually do it over a weekend because I always forget to pack a lunch, too. As an aside, my tip for that issue is to go to the grocery store on your lunch break and stock up on healthy foods you can keep at work to make lunch there. Anyway, my suggestion was to try cleaning up your diet to see if it works. It sounds like you've already done that without positive results. Diet clearly isn't the solution for you. It was for me. Btw, I'm 37. I was on Adderall as recently as 2014. It took years of struggling to find something that works for me.
I was diagnosed with ADHD 10 years ago. Tried a few drugs, and while it definitely helped with the ADHD symptoms, the other side effects that affected my daily life were too much.
I switched my diet from a high carb to high protein, high fat. Instead of a bagel for breakfast, I'll eat a couple eggs, a breakfast meat, and every once in a while a piece of toast. Tons of whole fresh fruit all day. Lunch is similar: think a chipotle style meal with a base of protein and rice and some light veggies. More fruit and raw vegetables and nuts for snacks. Dinner is the same thing - protein base but fewer carbs and more veggies. I'll have some candy in the evening from time to time.
I also started lifting weights 3x a week. I love it cause it's the most efficient way for me to exercise - I spend 60-120 minutes in the gym three times and work my whole body. Heavy squats, deadlifts and presses - strengthens the back and hips, makes sitting in a chair much easier, and is a really great vector for activating that hyperfocus we love so much. I read a book called Starting Strength that basically gave me all the info I needed to get started.
Since starting this routine about 8 or 9 years ago, I find I'm sleeping better, my focus is way better, I'm much more pleasant to be around socially, I'm way less impulsive and interruptive, I make fewer stupid rash decisions, and I'm generally in a better, chipper mood a lot more.
Edit: Might add: I drink coffee like it's going out of style and don't find that caffeine really affects my focus all that much - more my energy levels. They're similar but on different axes.
Likewise, diet made a huge difference for me. I really like eating once in the evening and sticking to a super-low carb diet. I'm sure it's different for everyone, but for me it's a miraculous contrast to eating carby breakfast, lunch, and dinner.
When I eat regular meals I'm _constantly_ hungry and my focus goes to total shit. I tend to have to manage my weight because even when I expressly try not to, I eat too much. It's weird. I also eat worse food. It seems to be a vicious cycle.
The problem for me with changing my diet is that (a) it takes sustained concentration to change habits, and (b) it takes real planning and scheduling to do something like keto. Guess what I'm bad at, since I have ADHD?
I'm going to go talk to a psych this year if I can stop putting it off but one thing I started on a whim a last year was take iron supplements. Apparently my mother (diagnosed ADHD in her 60s) had iron deficiency so maybe I do too.
After just a day or two I experienced very unusual (for me) clarity. I googled and apparently it can help ADHD symptoms.
I definitely ate enough meat and various other things, so I'm not sure what the supplements did or if they're a placebo. Perhaps I just process iron poorly and need a big hit at once.
I'm a recreational weightlifter/bodybuilder and I agree that diet makes a huge difference. But, I am concerned about all the talk of cutting something out, like with keto. We should be talking about balance and increasing nutrients that are lacking instead.
In my case, I got some rather severe digestive issues similar to IBS that turned out to be similar to what vegetarians get after several years if they don't watch their nutrients and vitamins. I spent 2 years battling it without knowing what was causing it. After days of conversations with some very smart friends, one of them suggested a connection between tryptophan and serotonin (which is made from it in the gut).
Long story short, I started eating pork again (mainly bacon) after avoiding it for 20 years due to ethical concerns, and my digestive issues cleared up in a matter of days. My acne went away and my mood stabilized almost overnight. It was one of the most miraculous things I've experienced in many years. I also added psyllium husk fiber with meals 1-3 times a day and have maintained proper digestive function for several months now.
Some things that really help me are zinc gluconate for immune function and recovery from exercise 1-7 times per week (too much will make you feel bad, a headache in my case), omega 3 capsules and glucosamine/chondroitin (which is for joint health but the mechanism likely happens through the gut as well). I also eat 2-4 whole eggs per day based on how hard I'm hitting the gym. My feeling is that the lack of fat in our diet from the 1980s till today has really wrecked most people's metabolisms and they are simultaneously frantically starving, fat from eating too much, and chronically malnourished.
I agree. I stopped Ritalin and changed my diet and other 'ways of life'. I can't say it's as good as using Ritalin but I have found a middle way I can work with. had been using drugs for 10 years but felt I should be able to do without. After all that time I feel I understand my own worth a bit more and have enough self-knowledge to get by as I do right now.
I relate a lot. I'm 28 and I have an ADHD diagnosis. There has been a lot of public debate on this topic in Sweden of late. I got my diagnosis at age 23 and had already finished a bachelor degree. My first psychologist said "I'm sure you dont have ADHD if you finished a bachelor" lol although at the time my life was a rollercoaster. Today im doing great and love the challenging nature of software development. However i eat medicine and realise that exercise and routines are extremely important to mitigate symptoms.
Meds didn't work for me, they just made me feel in overdrive, and I have a high sense of awareness so I always knew in the back of my mind the drugs were just making me high for a short amount of time. It never felt like real progress.
However, exercise, diet, and prayer cause my symptoms to almost vanish. In particular, keeping sugar content extremely low. Also being aware of my cues when I know my leg is going to start bouncing up and down and the impulse of doing anything _but_ my work is about to kick in (such as viewing this site for hours), and using behavioral modification techniques to mitigate this. Making good habits is especially important for ADHD people. It's not easy, but take comfort knowing it is doable. You can make progress today.
Same here. For my initial consultations they figured I couldn't have ADHD, as I already had a Bachelors and Masters degree. I had to walk them through my academic years, explaining that it was a long, long string of all-nighters and last second hand-ins; It just so happens that the school material was something I picked up quite easily, while I totally and utterly failed in easy electives which did not interest me.
Be careful with the stimulants -- I say this not as a value judgment but because they can have cognitive side effects that impair your ability to understand you're having those side effects.
Even when they work well there will be some collateral damage with stimulants. I was a great employee on them, but I was a shitty, narcissistic friend. The focus many people get from stimulants is an inward focus, which makes it easy to get things done but hard to empathize with other people. As a result I didn't have many friends, and once I started wanting more out of life I realized the stimulants were holding me back from personal growth. The inward focus clouded my ability to understand why people didn't like me -- I couldn't make enough space for another person to even see why people didn't want to be around me.
I'm not saying that stimulants don't help (they totally do) but you should understand what you want out of your life and how that aligns what you get out of the drugs.
I have the opposite experience. I am formally diagnosed with ADHD, none of my friends would dispute the diagnosis. When I am on stimulants (Vyvanse and Dex) I have a ton more patience and emotional equilibrium. I pay attention to other people longer and more deeply... aka empathy. I can sustain an outward focus without distraction. When I am off meds I am distracted by my own free-running cognitive and emotional processes, and I have to spend effort looking inward to manage them.
I have had no temptation to abuse the stimulants. I don't really enjoy them, on the balance, but they make an incredible difference that meditation, high quality diet and physical activity can't even begin to approach. They really calm me down.
My wife prefers me medicated. I'm apparently nicer, more patient, more even-tempered and easier to get along with.
I find myself almost in tears reading certain parts of the article. Growing up I was also the, “Smart, but lazy” kid, and my parents just told me I was a bad kid who needed more discipline. I always felt like my brain just worked differently and spent decades feeling fundamentally “broken” because I was just too “unmotivated” and didn’t have enough “will-power”. To this day I struggle with feeling inadequate because of the message I heard.
That being said, I’m fortunate in that I’ve worked with a therapist who saw the ADHD (along with PTSD) symptoms and put a name to them. They pointed out that I’d basically been self-medicating with caffeine since I was a young kid. Even just having the acknowledgment and having words put to it has made a huge difference for me. Now I know it’s not some moral failing and laziness. My brain is just different and I have to figure out ways to make it work (currently those ways are medication, writing, therapy, and some incorporation of Buddhist teachings in my life).
I'm 34 and I am finally meeting a psychiatrist soon for what I suspect has been ADHD all along. I do not suffer from depression or anxiety (to my knowledge).
I have a perfectly healthy lifestyle - I run 5 days a week, about 40 miles total, eat healthily and sleep well. During my runs (which physically feel painful) I have few moments of clarity in my head. Other than running though my mind has a thousand thoughts all at once that I cannot control...
I tell a story, interrupt myself, get 6 levels deep and then essentially have a stack overflow and can't recover to my main point that took me down that spiral. Nobody can follow my thought process. What I do know is that my mind is stimulated by strong feelings.
I sit at my desk to do work, notice a story about the DOT / airlines soon banning ESAs and proceed to research the legal authority according to the ADA and other provisions in U.S. Code.
I waste a lot of time thinking about the stuff I need to do, but I can't get myself to do it. So I don't do anything that is fun for me, nor the work I need to do itself. Only under immense stress due to deadlines (and the potential negative consequences of failing to deliver) I can force myself to crank out work that is of reasonable quality. This is how I went through all of high school and college for example. I was completely sleep deprived as a result.
Never in my life have I been able to finish reading a book for school - I'm bilingual (learned English as a second language), but this isn't a language problem for me. I simply don't know what I read at the top of the page when I get to the bottom. I read incredibly slowly (I have to imagine hearing someone speak the words - this is called subvocalization). If I focus on reading for fun it will probably take me 3-4 months to get through one fantasy books. If I can read 3 books in a year I had a very good year.
At a dinner in a restaurant I cannot pay attention to my friend (or date) in front of me, because other conversations around me draw in my attention and trigger my brain when interesting subjects are raised.
I am not able to focus without extreme stimulation and am completely at the mercy of my brain / mind. This means I can't listen to people well, I get impatient and interrupt people at inappropriate moments.
Yes I'm high-functioning and I do well, I have a crazy amount of energy, but this isn't a healthy way to live. I am not lazy, but my mind is. I am convinced I'm only operating at 20% of my true cognitive potential and output potential.
For these and many more reasons I will be seeking diagnosis for ADHD (or ADD?) soon.
Before going down a road that involves powerful stimulants that have a high likelihood of abuse or misuse -- the danger is that they're fun, and one develops a tolerance, just like other similar illegal drugs -- it might be worthwhile to investigate a mediation practice, or other exercises to improve your attention. If you're already high functioning its likely not as bad as it seems.
From experience: First thing to go with the stimulants is healthy sleep; it's often hard to sleep on amphetamines. But in the morning, because you've got a script, you can take a pill and not worry about it (but the body remembers). Next thing to go is healthy eating; you simply don't need to eat when under the influence, or you do -- but you forget. Soon, those things combined could have the potential to turn a high functioning and healthy life into quite the opposite. But in the beginning -- especially if you've never experimented with stimulants recreationally -- you'll feel better than you ever have. Stimulants are euphoric. It's a trap, it wears off. Side-effects are likely. I've said it in a previous comment, but it's profound and interesting until it's not, and once the stimulants are gone a dark depression is very possible.
Attention is like a muscle, but also -- attention isn't everything. It could also be ones attitude towards these things.
Be skeptical -- understand that there might be blind spots in your thinking about your problems.
I don't know about others, but fun isn't the word I'd use to describe the ADHD medication which I'm basically chained to for life because I cannot function without it, and yet causes me so many other problems that I need to work around or cope with like loss of appetite (food is no longer a thing I enjoy), insomnia, anxiety, restlessness and mood swings. Where's the fun part again?
Are you willing to be skeptical yourself and understand that you might have blind spots just like the people you're talking to?
> But in the beginning -- especially if you've never experimented with stimulants recreationally -- you'll feel better than you ever have. Stimulants are euphoric. It's a trap, it wears off. Side-effects are likely. I've said it in a previous comment, but it's profound and interesting until it's not, and once the stimulants are gone a dark depression is very possible.
As I said further down. It's most certainly not fun later. And it was a difficult as all hell to finally quit.
I can absolutely believe that this was your experience, but where I lose you is when you state with certainty that everyone else will experience this the same way you did. I certainly didn't.
Not my experience at all. Took Vyvanse and Dex for a few years. Able to stay at the therapeutic dose, had no temptation to exceed it. 10-15 mg equivalent of Dex changes my day, and will do so month after month after month. Under psychiatric supervision I did go as high as 40 mg, but that was too much. Side effects are not great, makes me jittery, elevates my heart rate, but the mental benefits are amazing. The stuff completely calms me down. (I have ADHD, for real.)
I have been on and off stimulants many times, short, medium and long intervals. The worst that happens is when I go off I've got no energy at all for 3 days.
When I would restart stimulants I would get the euphoric effect for a time, and then it would fade away over a few weeks. I have never been tempted to chase it.
I have NOT found that, when taken at a therapeutic dosage, people with ADD/ADHD thinktheir medications are fun other than the "fun" feeling of satisfaction you get when you complete a task.
I have found that people who do not have ADD/ADHD find those same medications to be fun, however, even at a therapeutic dose.
Otherwise your comments on the effects are spot on. Personally I had to make a choice in my mid-twenties, the meds or a happy-go-lucky life where I feel unfulfilled but I have a fun time.
I used to just sit all day, thinking about what I needed to do, yelling at myself in my head to do it, but never doing anything. Just constant maladaptive daydreaming. I have inattentive type ADD. I didn't develop mental executive functions until I was 28. I started recognizing there was a "manager" in my brain that wasn't there before. I sobbed when I found out most of my peers developed that 10 years earlier.
From what I've seen, people with ADD/ADHD go through a cycle of recognizing then denying that they have a disability. I have done this personally 4-5 times in my life. I will accept I have a disability and deal with it, then eventually decide that it was my environment that was causing the symptoms, only to later come to a point where I once again have to accept I have a disability that cannot be managed entirely with CBT, task lists, meditation, mindfulness, etc... I'm happy for those that feel they can do it without medication, but I also have to wonder if I'm just meeting those people at a point in time before they have to get back on medication again...
You're right. Any psychiatrist that prescribes Adderall will tell you that it affects those with ADD differently than those without. Personally, I have never gotten high from it. In fact my medication made me drowsy as a child.
A lot of the medical advice in this thread is dangerous. If anyone reading this thinks they have ADHD, seek a qualified professional's opinion - they aren't guaranteed to be right but (respectfully) the odds are much better than some dude on HN.
> You're right. Any psychiatrist that prescribes Adderall will tell you that it affects those with ADD differently than those without.
This is based on the assumption that the person being diagnosed does indeed have ADHD, and is not, say, afflicted by a poor home life, or poverty, or any other contextual scenario that may lead to the inability to focus, temporary or otherwise. These are important questions because of the overprescription crisis we are in. Millions of children are being given these medications; many are misdiagnosed.
And this isn't "medical advice" -- this is a frame of personal experience with an emphasis on very textbook side-effects: potential for loss of appetite; potential for loss of sleep; danger of misuse and / or abuse. All things a psychiatrist, if responsible, will / would have discussed before writing a script, but oftentimes don't.
> Before going down a road that involves powerful stimulants that have a high likelihood of abuse or misuse -- the danger is that they're fun, and one develops a tolerance, just like other similar illegal drugs -- it might be worthwhile to investigate a mediation practice, or other exercises to improve your attention. If you're already high functioning its likely not as bad as it seems.
Sure sounds like advice to me. You're not just throwing this stuff into the ether for a purely academically interested observer.
I would argue that they are not powerful stimulants at therapeutic doses and have little risk of dependency. I can take my meds as prescribed for months on end, stop taking them cold turkey and have no withdraw symptoms other than the fog and inability to get started comes back as soon as they are out of my system. I personally take prescribed methamphetamine which would be considered to be the strongest in it's class and honestly it's not fun or buzzy or euphoric at therapeutic doses and not as addictive as people make it out to be. Opiates and nicotine have 100x the addition profile when compared to amphetamines.
As a note to abuse my medicine at recreational doses of meth I would consume my months prescription in about 4 to 5 days. Not enough time to get physically addicted and it would suck for the foggy rest of the month. I think the risk is overblown.
I have been on an XR methylphenidate for going on two decades now - it's a pricey medication, I'm a rational person, I'm well aware of how many magic booster packs I could hawk my meds for in high school - I'm also aware that some folks take it recreationally, but a few times I've accidentally doubled up my meds and it feels terrible to me.
I haven't abused my meds personally or traded them on the street, and I do regularly trial myself off of meds to make sure the effect is still noticeable. I am happy you can get away with not using pharmaceutical aides, but a lot of folks can't and, while good life style changes are always good, please don't paint these medications in a negative light. They are really helpful and believe me it absolutely makes a difference - and a lot of people don't follow their GP's advice because they're afraid of being over medicated or becoming dependent.
People should do what they're comfortable doing, but for people with more severe ADHD stepping off that ledge can mean falling all the way down into a really dark place and needing the help of friends and family to get you back to stability.
And, there is absolutely nothing to be ashamed about in taking medication to help you maintain a healthy state.
ADHD is not a disease. It’s a collection of symptoms that have been arbitrarily grouped together. My son’s psychiatrist who was diagnosing my son for ADHD said that it’s psychiatry’s dirty little secret.
Back in the 60s or 70s ( I can’t remember what he said) people were starting to notice that kids were having behavioral problems, trouble focusing etc.
So what they did was collect a group of symptoms, and then arbitrarily said “if the child has 6 out of 11 of these symptoms then they have ADHD.”
The reason why they chose 6 was because if they chose 5 then too little number of children would get diagnosed, and if they chose 7, then too many children would get diagnosed. Having 6 would mean that 7-10% of kids would get diagnosed which “looked right” so they chose 7.
It’s not a real disease like other diseases, it’s a collection of symptoms. Which is why kids get misdiagnosed all the time. Anxiety can produce ADHD-like symptoms. Other things like giftedness and boredom can also fry diagnosed as ADHD.
There really are children with focus issues where medication like adderall will absolutely help. It will make kids with anxiety worse though so a misdiagnosis will ruin lives. But the origins of where ADHD came from explains why there is so many issues with ADHD disgnoses.
You can yes - in fact, I was listening to “D for Diagnosis” on BBC Radio 4 last night. The show title was “Ever Changing Labels” and a psychiatrist made the point (3’20” into the programme) that what we call “depression” in DSM-V has 9 symptoms and if you have 5 out of those 9 symptoms you are diagnosed as having “depression”. But in reality 5 out of 9 gives a huge number - 15,000+ - variations. So there is no one form of “depression” and yet people are diagnosed with depression all the time.
> But I’m reality 5 out of 9 gives a huge number - 15,000+ - variations. So there is no one form of “depression”
And? Do you know how many different kinds of cancer there are? We're talking about psychogical disorders that affect people's minds and personalities, of course their presentations are going to be very different. That doesn't make them not real or mean it's not useful to group them together. Diagnosis guides treatment, and most depression responds to the same treatments. You're fallaciously assuming that because there's not a single biological marker for named psychiatric conditions that they don't exist. That's not how any psychiatrist sees it.
I always think that when people start a comment so aggressively it’s not really worth responding. However, that aside: I’m not “fallaciously” anything!
I responded to a question that was posed “could you explain away depression with a similar argument” with a relevant piece of information.
You seem to think I’m arguing depression doesn’t exist. I am not. Forgive me if that was how it appeared, but please, for everyone’s sake, try to keep things civil.
> Now could you explain away major depression using the same logic?
> You can yes
> You seem to think I’m arguing depression doesn’t exist. I am not.
That is precisely what you were trying to do. And the response to your comment was in fact civil. Claiming that your argument is fallacious attacks your argument, not you, and is perfectly appropriate for civil discourse.
I'm sorry, I didn't mean to be aggressive. As someone with ADHD and a history of depression (misdiagnosed as having bipolar disorder at one point), this is an emotive topic for me.
That's OK - and I very much appreciate the apology. I also have ADHD and one of the most important people in my life suffers from a combination of complex mental health disorders which are sometimes absolutely crippling (and was also misdiagnosed for years), so my intent was absolutely not to say that these things don't exist.
He wrote an example argument to how one could argue depression away in the same way. He does not seem to encourage that kind of arguing, just showing how stupid the "5 out of x symptoms does not equal an illness" argument is.
I think a lot of stuff related to depression and ADHD is environmental too. Instead of fixing or helping just drug everyone is the plan. If you're sick of the cold winter, hate your job, etc don't think pills is the answer, should try to move somewhere warmer with a better job.
Then kids not paying attention in school, maybe it's boring or they feel it's useless to them so forcing them to do what they don't want, instead of tailoring their education instead it's one size fit's all. Plus teachers recommend getting kids checked, because then you are labeled as disabled and the school gets extra funding to go into the teachers pension program.
There's someone I know who was told their kid didn't have ADHD, so shopped around and went to another doctor, and then eventually went to another doctor. Kinda like the whole antibiotics resistance thing, people expect if they have a cold that the doctor will give them pills even if it isn't going to really help. Seems like doctors in general just love drugging people, instead of fixing a symptom at the root of the cause drug them and then drug them more for the side effects to cover them up. It'd be like taking your car to the mechanic for a check engine light, and instead of checking the OBD codes and stuff they just unplug the check engine light.
I think a lot of psychiatry is just a form of massive insurance fraud, there's a nonprofit organization that makes documentaries called CCHR. However CCHR is founded by the church of scientology which I know many not a fan of but I think they have some good information. I really wish CCHR would disconnect it self from scientology so it could stand on it's own as I really like their message, but I feel a bit of a conflict since it's related to scientology which is an entire topic on it's own, I guess you have to pay thousands just to level up and all these other horror stories about scientology.
I think drugging children is also a form child abuse, and destroying childhood creativity. Probably if they pushed this stuff when Albert Einstein, Steve Jobs or other successful startup founders were children, who knows if they'd be as successful as they ended up being. One of the pills pushed ended up making males grow large breasts too. Then there's reports another drug can cause brain damage too along with heart conditions(which usually you think it happens in older people but young people can have heart attacks too on this crap). They even want to drug 3 and 5 year olds too. If I was in power, I'd have these drug makers and so called doctors imprisoned for life. Also diet and exercise some believe also helps, add these GMOs and other chemicals in the food, artificial sweeteners can mess with dopamine receptors, etc. So I think I see the larger picture, but many just want a pill and then go back to watching TV or smoking instead of trying to improve their families healthy lifestyle. Kinda like how parents don't even try to teach their children, they just send them to school. Lazy parenting is also part of the problem.
But I guess not a one solution fits all, some people say the pills and stuff helped them. I think counselors could be valuable too, maybe even help you see things from another prospective but some insurance companies won't pay for a counselor unless you also are on drugs. Some people don't even feel like anyone cares about them either, so I think having someone to listen and who seems on your side with issues is also a positive, but I know some counselors want to record your sessions so I find that kinda creepy also as feels less private so you could be less open about things.
It highlights common misconceptions with psychiatric methods as well as small critiques of those methods.
If you're on the flipside and benefit from the drug prescriptions: good for you. I think if it were more generally acknowledged that there can be sub-clinical or contextual forms of ADHD my life would benefit.
You diagnose a disease by the symptoms, this goes for any disease or disorder. Problem is that there are not actual diseases here but rather groupings of symptoms (as you say, its not just for ADHD though) and that its a checklist which is filled out often based solely on verbal questions answered by a child.
Another interesting thing to consider is that a lot of psychological disorders are culture bound (and therefor in my humble opinion irrelevant as groupings even for psychiatric purposes).
> It’s not a real disease like other diseases, it’s a collection of symptoms.
Any disease with "syndrome" in its name is just a collection of symptoms. That's literally what syndrome means.
Your information about ADHD is offensively wrong, and its underdiagnosis and undertreatment due to misinformation ruins far more lives than than there are people with anxiety being mistakenly prescribed stimulants.
It's not a useful truth, at least not in the way you've characterized it. The way you characterize it says more about a misunderstanding of scientific knowledge in general, but especially medical science.
Age 10 is roughly when children begin to realize that their parents, and adults in general, can be as fallible and ignorant as children. It can be a shocking revelation, but eventually you move past it. But some people's response is to develop a deep cynicism about what maturity means, which can stunt their own maturity. (Notably, we all tend to feel like it's a deeply personal revelation that gives us unique insight--like we're more mature than others for having the revelation. But it's a whole different revelation to realize and appreciate that everybody goes through this phase.)
It can also be a shocking revelation when you learn that in science in general, but especially in medical science, the things we don't know are unfathomably more numerous than the things we [believe we] know with certainty. But just because we don't fully comprehend a phenomenon doesn't mean we can't develop useful knowledge about the phenomenon, and to develop reliable treatments (medicine) or processes (chemistry, engineering). Were it otherwise progress would be impossible. Science is a process, not a product.
Of course, just like adults who became cynical at age 10, there are professionals in all domains who harbor cynicism stemming from their educational revelations. It's not healthy.
The extreme ones may say things like, "it's all a lie", but the lie is on them.
When people go to a medical professional for help, they don't need to know the messy details. Some people might benefit, but others might react poorly. What they expect (knowingly or not) is to be given medical advice that already incorporates the unknowns; that already takes into account the fact that something is not well understood. The same is true for every other profession.
FWIW, the term Downs Syndrome comes from before the cause was known. Today people often use the term trisomy 21, perhaps because of the cultural baggage related to the older term, but also because strictly speaking it's no longer a syndrome. There are other trisomies, like trisomy 18.
It's not a useful truth, at least not in the way you've characterized it.
It think it is much more useful to think of things as they are rather than as what they are not.
In this example:
I think it is more useful to think "what is causing my ADHD behaviour?" Rather than using the explanatory model "I am behaving like this because of ADHD."
The former can lead to finding models that allows one to mitigate ADHD behaviour. The later leads to the same thing over and over.
Are you hinting that I stoped developing as a ten year old?
I get that people expect that. Don't see why it matters in this context.
I guessed that was the case when I wrote about downs syndrome. Lets hope we find good causal models for ADHD to.
> Are you hinting that I stoped developing as a ten year old?
No, definitely not. I was just trying to analogize the "dirty little secret" bit to another dirty little secret we all directly experience. They're not really dirty little secrets; they're life, and there's nothing substantive that can be gleaned from stating these facts alone.
Similar to the Murray Gell-Mann Amnesia, though in our own private and professional lives we understand reality is complex and ignorance reigns, notwithstanding the polite fictions we maintain, somehow when we discover hints of this reality in other fields we think it's a noteworthy insight and something to criticize.
> I think it is more useful to think "what is causing my ADHD behaviour?" Rather than using the explanatory model "I am behaving like this because of ADHD."
> The former can lead to finding models that allows one to mitigate ADHD behaviour. The later leads to the same thing over and over.
If you don't have ADHD or a similar disability, then in the best possible way, what you think is useful doesn't really matter. What causes my behaviour is that my brain is literally retarded - it thinks in a different way from the neurotypical one. Knowing that that is the source of behaviours is extremely liberating and useful for developing a good mindset for coping with them, as is explained in the article we're commenting on. Asking "what is causing it?" is the dead end.
What causes my behaviour is that my brain is literally retarded
That is a very infectious way of modelling the world.
Asking "what is causing it?" is the dead end.
It certainly is not. If I have problems geting the information from a book in to my brain. The cause can be said to be that I am trying to read it. Solution: Get it as an audiobook instead.
I do have an ADHD diagnosis but I don't think that justifies my thoughts in any way.
> The cause can be said to be that I am trying to read it.
No it can't, because most other people can get the information from reading it just fine. The cause is that you're reading it with ADHD.
But we're talking at odds here - I'm not talking about finding coping strategies, but looking for the root cause of ADHD. For the current state of medical science, the latter doesn't really help with the former.
My son was diagnosed with severe ADHD by one neuropsychologist. Medication was strongly recommended. He was then brought to a psychiatrist, the best in my area to the point where he is well-known, and he said that my son actually has General Anxiety Disorder. His ADHD-like behavior is caused because of severe anxiety.
If we had treated him as severe ADHD, he would have gone on medication. The medication would have exacerbated his anxiety and caused worse behavior and we would have increased the dose. The entire thing would have ruined his childhood from the misdiagnosis.
So you are very wrong. The cause of the ADHD behavior is required. There are many children who would benefit from medication. But many children would have their lives ruined by the medication as well if misdiagnosed.
That’s why I was saying it’s a collection of symptoms and because it’s up to individual therapists to diagnose, it gets misdiagnosed very very often.
> If we had treated him as severe ADHD, he would have gone on medication. The medication would have exacerbated his anxiety and caused worse behavior and we would have increased the dose. The entire thing would have ruined his childhood from the misdiagnosis.
You've imagined a situation. You're catastrophising. Increasing the dose when symptoms get worse would be profoundly stupid on your part and that of the psychiatrist: that's the part where they'd reassess the diagnosis. You have the gall to call me "deadly wrong" about my lived experience of ADHD based on an imagined situation?
Perhaps not, but there are discernible differences in the brain in people with severe ADHD symptoms.
And the (current) lack of a causal model doesn't stop it from being real, nor does it stop the current treatments from helping people operate at a closer-to-normal level.
It would be shoking if there were no differences in the brains of people with ADHD behaviour.
Your brain regulates your behaviour.
No one here is saying that ADHD is not real, well I am certainly not. What is being said is that ADHD is not the cause of behaviour, it is the behaviour.
"It’s not a real disease like other diseases" is not a truth. Not being "a single thing" doesn't make it not a real disease; there are plenty of physical diseases that present as syndromes with no known cause.
Quibbling with the classification is missing the forest for the trees here, I think. It's a chronic condition that requires some kind of treatment to be dealt with. People have the same kind of quarrels with defining alcoholism or drug addiction as a disease, but we have limited time on this planet and we can argue about labels or we can spend that time instead trying to address the actual concerns.
I guess where it becomes a problem is when we try to find the most suitable treatment for it. I know from experience that these labels can dictate the whole treatment plan in public hospitals/clinics without much further investigation whether that label's approved standard treatment plan really is suitable for your particular case or not.
This is wrong, studies have shown that ADHD brains are fundamentally different from non-ADHD brains in the sense that they have reduced frontal lobe (read: executive functioning, ie. cognitive inhibition, working memory, decision making) matter.
No you are wrong. The fact that ADHD is a mostly subjective collection of behavioral traits, many people get lumped in as ADHD. So many people called ADHD would have normal brains.
There are a core set of people who definitely have brains that are different and need medication etc.But the way it is currently diagnosed lumps too many people and makes it useless to call all people with ADHD the same.
My son with Generalized Anxiety Disorder was diagnosed with severe ADHD. This is the problem because many things can cause the same set of behaviors so a diagnosis of ADHD is not accurate enough.
Medicine, as a science, is expected to fix the human body while it's running without taking it apart. Unlike other fields, modern psychiatry is still mostly clinical. Of course, it is deeply flawed, but it is our best shot nevertheless. And, unlike the one doctor that told you otherwise, there's widespread consensus in the medical community that ADHD is very much a thing. I'd rather believe in them.
> Back in the 60s or 70s ( I can’t remember what he said) people were starting to notice that kids were having behavioral problems, trouble focusing etc.
Unscientific personal observation, but I wonder if TV has a role in this. Didn't kids start watching a lot of TV around that time?
Also, I feel kids in poor countries with no TV (not that there's much of that left now) have little to no ADHD.
With all of these types of conversations and threads I am more curious to hear from the disciplined, focused people who seem to be the goal for what Adderiddlinvanse fixes.
I have wondered if I have ADD many times in the past. Mostly, because I was in school and being forced to do a task that I didn't enjoy, nor wanted to enjoy. When I have found things that I do genuinely enjoy, I can focus for hours and hours on end.
I am not opposed to any diagnosis or treatment, but I really have never met anyone who can truly focus on anything, at any moment for a super long amount of time. From my own experience and the conversations I have had with friends that take Adderall/etc. it seems like we have believed that there exists a significant portion of the population that has an uncanny ability to focus on tasks, both fun and boring. I certainly think there are a few people out there like this, but anecdataly, most people I know are more towards to the distractable/ADD/ADHD spectrum than the focused types.
I bring this up, because if our perception of how many people around us have this god-like ability to focus is wrong, I suspect many people will take medicine under a misconception.
Like I said, don't want to ignore the extreme cases, but genuinely would like to hear from a few people that read this and can confidently say they can do most/all tasks without breaking focus.
This is a good point. People have an incentive to act as if they have 100% focus all the time, especially at the workplace, and especially in American-style culture. So, many people also feel as if they are broken because they get distracted. There is probably a significant portion of the population that truly has a disorder, but for the rest of the population, should we really be calling distraction behavior a "disorder" if it's a massive portion of the population?
I think much of the modern issue with focus can be attributed to the Digital Age. How can anyone focus with all these alerts and dings and emails and sounds everywhere all the time? And multitasking is worshipped like it's the modern man's solution to all problems. We're still drinking the 60s Kool-Aid, as if the modern, fancy, carefree Jetsons' lifestyle is right around the corner. It isn't. We're still the same human beings with the same old problems, except now we have additional problems due to the onset of technology.
(Not that technology doesn't solve certain issues, of course.)
Possibly. I would say the effects vary quite a bit. I have a close family member that has very rough ADHD, but can pull all nighters working on hobbies without medicine. As with anything, might just be an exceptional case.
If this article is an ADD test, I failed .i skimmed the article and skipped the middle. I dunno what I have but I will skim if I get the gist of what the author is saying. I Everyone's behavior is different. Some cannot focus, other lose focus too easily, others cannot finish.
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[ 3.0 ms ] story [ 318 ms ] threadImagine if there was a pill to reduce risk of cardiac arrest, with some increased risk of something relatively minor. Can you imagine the uproar if cardiologists denied prescribing the pill, instead forcing people to spend 30m a day running? Sure, it's "better" in some metrics to just run, but that's their choice to make. Doctors should be doctors, not moral guides.
Source: been there
It's kinda hilarious that, when going off Ritalin, things don't slow down (or become "less upped by the upper") they stop - this article touches on it but ADHD can feel the most torturous when it impedes even your leisure - especially when coupled with depression. Ever spent a day off staring at a wall dreading the possibility that you might waste a day until you realize the sun has gone down? Yup, so much fun.
>Ever spent a day off staring at a wall dreading the possibility that you might waste a day until you realize the sun has gone down?
That sounds silly and boring. I was daydreaming instead of looking at the wall.
I surmise that the people who have a problem with the idea of someone taking medication feel otherwise.
Are you kidding? Life in a capitalistic economy is _absolutely_ a competition.
Considering that those are some of the hardest and most dangerous jobs, it probably is better for you that it's done somewhere else for cheaper. This means that everything that depends on those jobs, such as the price of food, will also be cheaper for you. You can learn another job and do that. I realize that many people don't really want to do that, but it is an improvement for society.
>In capitalism you have to fight for your right to feed yourself, and if you are in the bottom x% of society, you quite literally have to live on the streets.
This is true by definition, because if you are homeless then you're by definition poorer than somebody that is not homeless. Essentially, it's not an argument, but I do understand that there are poor people under capitalism, but they are much better off than poor people 100 years ago, and they're much better off than middle class people 150-200 years ago. Society, especially the US, is so rich that almost anyone has a supercomputer in their pocket. All western countries offer lots of support for the homeless and poor.
There are entire large groups of people in this world who feel the need to drag other people down with them. Some of them are extremely good at it. Pray you never attract their attention. It's a nightmare.
Not trying to make any kind of judgment about this being good or bad. Just trying to point out reality. This is the world we live in - performance matters.
This is literally every Saturday for me. I'm thinking about keeping my Ritalin by my bed. I don't understand why it's so difficult and it makes me really frustrated - I just can't get out of bed. I try to wake up and my mind goes "naw". I sit up to get out of bed, sit there for 40 minutes, and still can't get myself to get out of bed. Stare at my Pillow, some reddit posts, another 45 minutes are gone.
Now it's 2pm, I've wasted half the day. My depression tells me it's because I'm a lazy piece of shizzle.
Source: Diagnosed with ADD/Aspergers/Depression/Anxiety... Horaay :(
When you have those stuff, you need to take meds AND join the gardening club.
You can't go manic at the gardening club.
So, no, it does not seem like a "a pharmaceutical spiral brought on by a sick process", whatever the blazes that means.
I got up 10 minutes early! I thought I was running on time! Suddenly I'm supposed to be there in 5 minutes! WHY?!!? It's like time isn't freaking linear!!!!
One thing that always goes through my head is just feeling like society is made for a model of human that just isn't me. There's a society out there that would suit me great, but I missed the boat on that. It was probably in the distant past before things got big, noisy, and complicated.
It’s an extended release methylphenidate that you take at night time, and 12ish hours later it actually takes effect.
"either your performance, judged by coworkers, will be equivalent or below theirs and the stimulant is seen as the only thing keeping you in your job (which can get super depressing internally) - or, if you're doing well in your position, it can breed internal and external doubt as to whether your performance would just be normal and is being boosted by the caffeine."
the difference between them lies only in the degree of effectiveness. I dream that within my lifetime uppers will be as de stigmatized as weed.
Literally experiencing this right now while getting a degree in software engineering. Got diagnosed during my first year with AD(H)D and I'm currently in my fourth, final year. Looking back at things I have no clue how I even managed to pass the harder subjects/courses. All I remember is I took my meds and studied about 12 hours a day 3 weeks straight during the hardest parts.
Before I had never studied more than 2 hours a day and I would start only about 5 - 8 days before a test.
I often wonder if I could work at a software company without my medicine because of this and it actually worries me.
(Some?) Antihypertensive drugs can contribute to harm to the liver. They're unlikely to cause anything on their own, but if your liver is already not the healthiest it can make things worse.
>Yes, I get that "lifestyle changes" could help, but I don't want to change my lifestyle.
As far as I've read about ADHD, nothing comes close to the effect that medication has in treating the issue.
No. Just don't entertain this idea. You can go 20 years since the first time someone told you you may be ADHD or depressed with subsequent diagnoses. Then tell yourself it's all in behavior no one needs drugs. But twenty years on you'll still find yourself in the same cyclical patterns of periodic depression or chronic inability to select your attention to a task. "Lifestyle changes" could help with the right crutch. But if you need Ritalin or another drug to learn those lifestyle changes so be it.
In your (not quite perfect) comparison. It's as if the pill will reduce cardiac arrest and improve peoples aptitude to learn to run for 30 minutes daily.
There are about a dozen factors with a positive correlation with each other, but they are not links in a causal chain. One does not simply "fix" them, they all have feedback on one another.
The knowledge of how they are related helps, but does not fix.
If I didn't have kids I probably wouldn't have gotten help. I did it for them. I'm glad I did now – everyone deserves help.
As a diagnosed sufferer of ADHD, my experience is that Adderall works better than Ritalin, but the extended release stuff shortens my temper. If I'm still having a bad day, an energy drink can help.
On boredom: I can be bored, but lack the drive to do anything to make me less bored. When I'm having fun, it is difficult to switch to the next thing I need to do.
I am just a bit of a psych meds skeptic these days - I don't think the comparison to drugs like insulin carry as much weight as their advocates would like them to. For one thing, there's no brain scans or blood tests for any of these diagnoses. The diagnosis criteria is basically a "personality test", called the DSM-5, a manual heavily influenced by the pharmaceutical companies. Stimulants at least do in fact have research supporting they actually outperform placebo (unlike the massively prescribed antidepressants), but they come with a host of negative side effects.
If you're predisposed to mania, you shouldn't take stimulants. If you're predisposed to heart problems, you shouldn't take stimulants. My question is, how was I supposed to know that I was predisposed to these things short of finding out the hard way by taking the stimulants and having those negative side effects almost ruin my life/kill me?
Previously, on HN people have accused me of "doing it wrong" in some sense with the ADHD meds, but the truth is I got the diagnosis from the doctor and took the meds as prescribed.
The whole idea that we can neatly categorize this person as ADHD, this person as MDD, this person as Bipolar-2, this other person as bipolar-1, this other person as BPD, after doing a ton of investigating into mental health, I just no longer buy it.
I do think the answer is in lifestyle changes, the person who is at risk of cardiac arrest, yes they should exercise for 30 min a day and reduce sodium intake before relying on a pill if that pill carries with it a ton of other dangerous side effects.
I also agree with that other commentor, that our society, and my past self, is a bit obsessed with "success" metrics, usually judged by things like career success. The idea that, maybe if you just accept that your career won't be what it could be but that's better than drugging yourself up to achieve those goals, seem foreign to some people. Becoming "somebody" important becomes more important than just being stable and healthy.
Well, if you find yourself in my position, where you get diagnosed with heart failure and learn that ~50% of people in your position die within 5 years of diagnosis, all the sudden that big N promotion doesn't seem as important anymore. And the drugs that help you get there don't seem as worth it. So nowadays my mind still wanders constantly, my wife gets frustrated by how often I start day-dreaming mid-conversation with her, and I know that intellectually I'm capable of more career success but I'm held back primarily by my lack of focus and discipline. But I've come to just accept all that, being on stimulants to fix it, is not worth the downsides.
Most conditions improve when the metabolism is normalized. B-vitamins are pro-metabolic.
Sometimes doctors do good work. My girlfriend's doctors eventually figured out that she is a poor methylator, and can't convert folic acid into folate (Vitamin B-9). She therefore absolutely requires a dietary source of Folate, instead of the folic acid that is used to fortify many foods. She said this vitamin was profoundly helpful for her complaint of "depression".
Sometimes doctors make work for themselves. Using Stimulants to treat metabolic problems is an exercise in futility.
I don't know how they decided to run the genetic test, I just heard that they did and that folate really helps her. She eventually switched to non-prescription folate (from the supplement aisle), probably mostly because of cost, or maybe some other reason.
Folate is cheap enough to experiment with: if you notice something dramatic, keep taking it.
[0] https://deplin.com/what-is-deplin
If anyone argued that stimulants are bad for my health, I could only point out that without them, my health suffers acutely through sheer neglect and it's a downward spiral.
This is something I myself have struggled with. I suffer from anxiety but I can't bring myself to take medication because I like the person I am and I don't want to change my behavior or personality.
No one should be stopping you from taking Ritalin, but each of us is entitled to our own opinion, so the only thing that is irritating is when someone calls out an opinion another holds even if that opinion has no tangible effect on anyone's life.
ADHD is an extremely harmful condition. You are more likely to end up in jail, crash a car, suffer from diabetes, smoke etc. than neurotypical people. 9 to 13 years in life expectancy, I mean, wowzah.
And opinions held in society or groups obviously have an effect on individuals. That's how social systems work.
This part of your argument is decidedly false. It's been an open secret for decades among public performers of several stripes (actors, public speakers, musicians, etc.) that beta blockers can prevent stage fright [1]. More recently, there have been multiple studies suggesting a link between statin use and increased irritability and aggression [2] [3]. Basically, the distinction between "psychoactive" and "non-psychoactive" drugs is more about the reasons people take them than it is about the drugs themselves. To a first approximation, there's no such thing as an objectively "non-psychoactive" drug.
[1] https://www.nytimes.com/2004/10/21/arts/mixed-reviews-for-a-...
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005588/
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488854/
I do not now. I used to -- I had a fairly major crisis of identity after my diagnosis, because a very large chunk of what I considered to be my personality turned out to be ADHD symptoms. I literally had to refind myself.
But it turned out very well, because now I define myself based upon what my actual qualities are, rather than defining myself based on symptoms of a disorder. I no longer feel like everything about who I am changed after meds; I'm still the same person I was ten years ago, I'm just now more easily able to express that self without ADHD getting in the way.
Also, in almost all cases, the "new qualities" are better than the old ones. Whereas before, "I just can't finish things" was unfortunately something I considered to be part of me, now I am able to finish things mostly the same as neurotypical people. That leaves me free to define myself based on positive qualities -- good humor, optimism, and so on.
The thing is, it became much easier for me to feel okay about taking medicine when I realized that the goal of medicine is simply to bring me back to a "normal" level. I had been operating at a deficiency of certain neurotransmitters; the medication simply brings those levels closer to normal. Once I had adopted a more biochemical perspective on my brain and identity, my initial reluctance disappeared.
A side effect of this is that I kind of no longer believe personality is fixed. I really don't find that the things we tend to call 'personality' are the sort of permanent identifying landmarks to a person we want them to be. Now I've adopted a view that puts a much stronger emphasis on the actions a person chooses to take, which I think is a better way to identify a person's qualities anyways.
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I would hesitate though with ADHD in particular, because untreated ADHD reduces your lifespan in a statistically significant way, is literal hell to live through, and the treatments are perfectly safe and extremely effective. If someone has a child who is diagnosed with ADHD, I would beg them to not let their personal prejudices against medicine keep them from getting the child the help they need. As someone who lived through it as a kid, it was physically torture. The word "restlessness" sounds benign, but I find it to be quite similar to akathisia on bad days, which is really horrific.
Oh man, sure, the medication makes me a better member of society... but am I killing the old me? Am I discriminating against the old me? In taking the medication are we declaring the me I was born as a dysfunctional useless person?
I actually came to pretty much the same conclusion, I prefer being the me that is clear headed - the medication is a requisite for that and I dislike that chemical requirement, but I prefer this me.
I think I've gotten more over this after bringing someone bipolar(with some other issues) closely into my family, they are drastically different when off balance and constantly have to fight (adjusting meds, checking Li levels) to stay on balance... And the off-balance person isn't a bad person, but they're highly internally inconsistent, they constantly put roadblocks in their way and, even when the meds are way off balance - they'll come through stable for random moments and strongly want to rebalance themselves.
Their condition is rough enough that they can't self-correct, I can mostly self-correct, it's hard but if I've run out of meds I can make it into the Doctor and get more and I feel quite lucky to be able to do that.
It is gonna sound cheesy, but what got me into my current mindset regarding it was a quote from the recent Elton John biopic. When Elton was struggling with the identity crisis and trying to articulate the mismatch of who he was vs. where he saw himself being in the future, one of the characters told him "You got to kill the person you were born to be in order to become the person you want to be".
For myself personally, I concluded that we are simply who we are at any given moment. There is no "real me", there is only "me" at a point of time (given that I act genuinely, of course). If I act differently after drinking alcohol? That is still me. If I undersleep and act cranky for the rest of the day? That is still me. If taking the meds is what it takes to kill off the parts of me that I was born with that impede the current me, then so be it.
I realize that it is a really reductionist mindset not comprehensively describing the reality, but it helps me to come to terms with myself and somewhat describes the situation as I perceive it.
I definitely prefer the new me. There is a continual spectrum of mes from being a young kid to an adult (ship of theseus style[1]) but this is different (and I think Elton John's situation was similar). I can clearly see a me I like and an alternative me. In theory, every day of my life I make a choice to give that day to the me I like - but gods when I think about it it can get heart wrenching. Digging in, I'm basically denying that alternative me a chance to be alive... And I've never killed that other me, it's sitting there and I might be that me tomorrow, it's just that every day so far I've chosen that today won't be the day it is me... Similarly Elton John could always return to being Reginald (or however he identifies his older identity) he just doesn't.
As someone who waxes philosophically this is an interesting consideration to dive into but thankfully most days I skip right past it and don't perseverate. It's pleasant to share though, since I don't like vocalizing it with most folks.
1. https://en.wikipedia.org/wiki/Ship_of_Theseus
The way I see it, it isn't really "killing", as in, getting it to not exist at all anymore. That old "you" will always be there, just like a bunch of other possible "yous". The "killing off" part means getting to a point where going back to that old "you" becomes as difficult as it was for you to get to the current "you" from your old "you".
And I totally feel you on the part about thinking too hard about it. This outlook I have is definitely not comprehensive and just provides satisfaction at a cursory glance when my mind wanders there. Looking at it under a microscopic view, there are individual parts that can be deconstructed and found to be not super accurate. But overall, it seems to provide me with a good enough framework to look at my life through.
What are your goals? Was the "old" you getting any closer to your goals? Is the "new" you getting closer? It's OK to take the pragmatic view of your environment and situation in life. These things matter too, especially when you have to support a family.
It's quite the dilemma really.
I cannot think of a medication that doesn't in some way affect your psychological profile, because if you're sick then you'll behave differently.
I think it's a bit of a trap to believe that you are your authentic self only by denying yourself medication, I consider myself from 5 years ago a different person let alone pre-medication. Is it that valuable that you struggle and live unhappy for the limited years you have available?
There, that's my terrible analogy.
1. There's a flip side, staying with the marsh analogy, there are also some dykes someone built randomly in the marsh and it's really easy to run along those, and they're really comfortable... but they might not go to the far side of the marsh - but hey it's right over there and it'd be easy to get over there instead of trying to trudge through the marsh. Running on those dykes feels really good since you're definitely running, but you don't get to chose where the dyke goes and it might not be helpful for yourself to run along it.
I definitely do notice a sort of forgetfulness around the context of a project, particularly the reasons/motivation for doing it.
Thinking about this, I wonder if ADHD people struggle with being project managers? Especially when it's important to mentally keep track of the big picture and the contexts around various tasks.
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I guess this is sort of different from working memory though, or it's more subtle (because I definitely don't have any actual forgetfulness, it's easy for me to remember things etc)
Ritalin functions as a DRI (Dopamine reuptake inhibitor).
One of the theories is that ADHD could be a lack of Dopamine.
This article works best in Clean Mode, which also reformats the text into a column.
Sorry if this is too off-topic/self-promotion-y, but hopefully it helps some folks.
1: https://chrome.google.com/webstore/detail/beeline-reader/ifj...
https://chrome.google.com/webstore/detail/blink-find-finding...
This extension makes your CTRL+F actually blink
The biggest thing I realized is how tightening feedback loops is the key to my productivity, I gravitated towards python because it's interpreted nature meant I could get feedback on my code in 20 seconds max as opposed to 3-5 minutes waiting for my code to build.
Adderall is a help but is not a cure all, it took me months to learn how to use it right, at first Adderall just fueled my ADHD and made everything worse. It's a constant struggle and maladaptive perfectionism is still the one thing I struggle with the most. I can't count the times of I've completed reverted my git sandbox to start from scratch after reaching a certain frustration level with code.
Also, your comment on python ... very very true
Don't feel trapped into one option that isn't working for you.
If you're able to get by without it then good on you - but I thought I'd mention that things have improved somewhat.
I also find that a vegetarian diet, low in carbs helps a lot for me. But I can' t keep to it very well without the adderall unfortunately.
"My OCD is kicking in, it needs to be aligned!"
OCD is not wanting things straight. That's human nature.
OCD can be crippling. It can take over your thoughts and your life. That's the compulsion. It takes you over. It's doesn't help with programming, it doesn't make your code neat.
It's a terrible combination since stimulant medications tend to increase anxiety and therefore worsen OCD symptoms.
My OCD is largely under control now. It took a few years of CBT; figuring out how much sleep (5 ± 1 hours for me) I need per night; and nailing-down a daily routine featuring bounded compulsive activity in order to, for instance, enable me to get out of the door in the morning.
I believe this is NOT causative, but is instead a correlation between other diseases associated with Dopamine production and ADHD. I take and have continued to take stimulants for ADHD.
https://www.nature.com/articles/s41386-018-0207-5
In my family's case, we likely have something called Dopa Responsive Dystonia (DRD), and what the author is describing sounds to me like what I experienced prior to being diagnosed with ADHD, and later with DRD.
Having said that, I'm not a doctor, so please go see an experienced movement disorder specialist if you are reading this and have any concerns.
DRD is very hard to diagnose, but easy to treat. Because the stimulants (Adderall and Ritalin) made the DRD symptoms worse, my mother happened to get early onset Parkinson's, and my grandmother also responded to carbodopa/levodopa (carbo/levo), it was fairly obvious in retrospect, but if we didn't have a family member with early onset Parkinson's I doubt it would have been picked up.
https://en.wikipedia.org/wiki/Dopamine-responsive_dystonia
My sense is that anyone with ADHD who uses stimulants should see an experienced movement disorder neurologist or few about basal ganglia and cerebellum diseases and try out medications based on their assessment. From personal experience, it became extremely clear I had DRD after taking carbo/levo, but there's no way I would have really known without trying it. It also helps with some of the stimulant side effects, which I still continue to take because they are very effective.
My family has seen maybe six neurologists total, and only one really knew about DRD. The Dystonia Foundation has a decent doctor locator.
https://dystonia-foundation.org/living-dystonia/find-a-docto...
On the flip side, getting treatment for those disorders, provided you have one of them, can also help with some of the ADHD symptoms.
Presenting information about the long term effects is good and I, especially, appreciate it - but please don't attempt to judge treatment efficacy when, especially in the realm of neurological disorders, treatment efficacy can vary wildly from case to case.
So please do share your story and invite people to learn, but don't council others.
But ironically it helps me even enough as a cure on it's own. I no longer take or need stimulants.
Also that tends to go away once you build your tolerance, it's just kind of overwhelming at first because the weed these days is really strong.
I actually smoke to reduce my anxiety as well.
The genetic defects associated with this are I believe a spectrum though, and we happen to be close to one side of it. If you have any symptoms related to DRD, I would see a movement disorder specialist and ask for a trial of carbo/levo. It'll be immediately obvious if it helps, and if you don't have any problems with Dopamine production it won't do anything (except for some mild side effects).
Please, don't read comments like these and distance yourself from treatment. There is always more to a study.
Source: Board-certified neurologist.
I'm sorry to appeal to authority here, but comments like these do actually harm people by shying them away from treatment (just look at your replies), and please don't write them. Again, I'm sorry you're dealing with Segawa's, but even your edits in response to my comment are making your statement more harmful because they're based in pure speculation.
I don't intend to mislead anyone. However, I do want people to be aware of possible links between ADHD and other disorders so that they can evaluate their own situation and seek medical care if they would like to.
More to the point, my family has been misdiagnosed for decades, and this likely would have been avoided if we were more aware of other possible diagnoses.
I'm here because I'm learning to write software, but I wouldn't pretend to understand the paper or mathematic theory behind, say, Paxos because I recognize some terms in it. I know my limitations, and all I ask is that you consider them, as well. The problem with raising awareness as you are is that it's difficult to objectively remove yourself: Segawa's is _incredibly_ rare, making all of the events in your family difficult to explain. Scientifically, transferring your experiences to others is a very tall order without much further study (and I hope you, and your family, are being studied, specifically because the genetics of Segawa's are poorly understood). What people portray as medical professionals swinging the hammer on "the information that could make us irrelevant" is actually trying to stand fast to the exact same scientific discipline that you, and every member of this audience, does in _every single other context_.
Your speculation about the relationship between ADHD and Segawa's is so far off base that a second-year medical student could probably explain why; you just happen to have been diagnosed with both. Left unspoken: it is quite possible to have both, because they present and manifest in different ways.
My guess is that DRD is under diagnosed because of reduced or low penetrance in some cases. As far as I can tell, for the majority of our lives, no single person in my immediate family would fit the diagnoses, but as a family, we apparently do, especially if someone knows where to look and what to look for. I suspect my extended family on my grandma's side has it as well, but I doubt any family with it would be diagnosed unless they happened to have someone who presented with it in an obvious way.
The urgency you're detecting in my posts is because in my experience, 10+ doctors and 4 neurologists missed it and/or mistook it for other diseases. It was especially hazardous for my grandmother because they were insisting on doing the medical version of taking her out back and shooting her even though their treatment of her in medical and custodial care settings was causing the very symptoms they claimed were due to other disorders. And yes, I do not want someone else to go through that, especially since having other relatives who also respond to carbo/levo seems to be critical in helping establish a diagnosis when there isn't someone in the family who presents in a typical way.
If you want, I can modify my post, but like I said before, I strongly suspect the presentation of ADHD with other characteristics, which are admittedly not symptoms of either disorder, increases the odds that someone has DRD or some other neurological disorder that's also contributing to the presentation of their ADHD.
If you have some compelling evidence that there is no interaction between DRD or similar and ADHD, I'm happy to see it, but from personal experience that is not the case.
I've been suffering from a myriad of symptoms that happen to match up with Segawa's... a disease I learned about less than ten minutes ago.
> please don't write them
Please don't make statements requesting that other's don't share their experiences with misdiagnosis and rare conditions. It's rude and furthers the stigma that some conditions are too rare for their sufferers to discuss.
It has been significantly, damned near whole cloth, edited in several ways since I said something, so I'd ask a little consideration that I'm coming from a good place. I'm not asking for anyone to avoid discussing Segawa's; I'm specifically responding to the speculation, across multiple comments, that the common element of dopamine as a neurotransmitter makes them related diseases. Given that people attack doctors when they try to arrest harmful discussion like this, I'm taking great pains to not be rude, so I apologize for coming across that way.
If you diagnosed yourself with Segawa's based on Wikipedia, please bear in mind that my single diagnosis across my entire career involved four months of differential diagnosis and observation, and led to a publication. It's simply that rare. There are several much more common possibilities, and I'd ask you to talk with your neurologist with an open mind rather than assuming the Internet has steered you correctly. That's also part of the reason I've responded as I have, exactly due to what you're saying.
I won't be diagnosing myself off of Wikipedia, next to no one in my family has the symptoms that I do so I doubt it's something like Segawa's.
I appreciate the apology and hope my reply didn't come off as too aggressive. Part of my tone comes from personal experience: doctors stating that I don't have a condition because it would be "statistically unlikely"... all without running a single test.
I added the first italicized sentence after their first comment, and after their second comment added the second italicized sentence and modified two other non-italicized sentences. I think... I may have just modified one non-italicized sentence after their second comment.
Am I trading my future brain function for quality of life improvements in the current?
The thought of irreversibly damaging my dopamine transport system later on in life feels like I am making a deal with the devil every time I take a dose of stimulants to correct my dopamine imbalance and cognitive deficits to feel neurotypical for a fleeting period of time soon after ingestion.
Any link to hemorrhagic stroke later in life as well? Thanks for you time.
Thoughts on any neuroprotective measures I can take now like memantine or bromocriptine(sp?)?
It should be noted though that the study authors were pretty clear that the correlation is unclear given that untreated ADHD sufferers had a 2.5-fold increase in the same diseases.
> Researchers postulated that the association between psychostimulant use and BG&C diseases may be a result of a more severe ADHD phenotype, rather than a direct pharmacological effect.
https://scientonline.org/open-access/dystonia-and-its-treatm...
Neurodevelopmental Disorders (Autism, ADHD, Delayed Speech/language, dyspraxia)
>"hyper mobile joints are an uncommon finding in those who do not have attention deficit disorder/attention deficit hyperactivity disorder."
>Differences in the structural integrity of temporal and parietal cortices may underlie wider behavioural phenotypical expression of hypermobility: abnormalities in superior temporal cortex are also seen in autism.11 Inferior parietal cortex can affect proprioceptive awareness and hypermobility is itself linked to dyspraxia.1 Our findings suggest that processes compromising function in neuro-developmental conditions may occur in individuals with hypermobility, putatively enhancing vulnerability to stress and anxiety.
Autism, Joint Hypermobility-Related Disorders and Pain
ASD and HRDs, specially hEDS, are conditions with a strong genetic component, a polymorphic clinical presentation, appearing both in infancy, and sharing several phenotypical features (35). Although existing data does not allow to ascertain increase prevalence of ASD in HRDs, as well as shared underlying patho-mechanisms between both conditions, there is increasing evidence suggesting that these co-occur more often than expected by chance. This requires be confirmed by further investigation which should consider the recent nosological changes both in EDS and the hypermobility spectrum disorders [see (17, 38)], and in ASD (72). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292952
Joint hypermobility and the heritable disorders of connective tissue: clinical and empirical evidence of links with psychiatry
- In 1988, Hofman et al.[58], in a sample of 30 children with MFS,observed that 17% had attention deficit disorder with or without hyperactivity. A decade later, Harris[59] stated, based on his clinical experience with 200 patients with ADHD, that "hyper mobile joints are an uncommon finding in those who do not have attention deficit disorder/attention deficit hyperactivity disorder."
In Sweden,Hollertz[60,61] also pointed out the frequent co-occurrence of ADHD and JH in adults patients. He observed that an orientation to orthopedic and rehabilitation care was common in these patients due to joint problems. Thus, this author speculates about a possible genetic marker com-mon to ADHD and EDS.
Recently, Koldas Dogan et al.[62]explored JH using the Beighton score in 54 children with ADHD compared to 36healthy controls. In this study, JH was significantly more frequentamong patients than among controls (31.5% vs. 13.9%). In accor-dance with these results,
Shiari et al.[63]also found a higher prev-alence of JH, assessed with the same method of the previous study,among Iranian children with ADHD compared to controls (74.4%vs. 12.8%), confirming an association between ADHD and abnormal collagen conditions.
JOINT HYPERMOBILITY AND AUTONOMIC HYPERACTIVITY: RELEVANCE TO NEURODEVELOPMENTAL DISORDERS
> It is likely that the importance of hypermobility and autonomic dysfunction to the generation and maintenance of psychopathology in neurodevelopmental disorders is poorly appreciated. Work underway(autonomic testing, fMRI) will test the hypothesis that autonomic reactivity and interoceptive sensitivity predispose to the expression of psychiatric symptoms, particularly anxiety
- We demonstrate for the first time that rates of hypermobility and symptoms of autonomic dysfunction are particularly high in adults with neurodevelopmental diagnoses. It is likely that the importance of hypermobility and autonomic dysfunction to the generation and maintenance of psychopathology in neurodevelop...
Oddly I get the bit about sleep deprivation. It can be oddly effective. I also sometimes do more effective work when I have a cold/flu as well.
Keep pushing to at least get a trial run with the medication and seeing if it helps you. Also if your doctor is seriously ignoring your concerns, consider looking for a better doctor. People often place way too much confidence in their doctors and stick with crappy doctors who don't make efforts to resolve their patients concerns.
Best of luck finding something that helps you get away from those coping mechanisms.
Note: This post is a little rambly since I am typing this up while doing something else but I felt the need to comment.
Ugh, this. So many lost days, weeks, months to ADHD. Just trying to keep up. Can't focus for a day? There goes the weekend. Shame, fear of losing my job, fear of work piling up - all of it. I have to make up for it at some point.
The answer was "No". His response was "well, then what's the problem?"
The longer answer from me should have been "no, but keeping up appearances requires Herculian effort, and I pay a tremendous emotional and personal cost, I am distant from my wife and 2 kids, and at night time, the anxiety is enough to materialize a cold ball of steel in the pit of stomach".
I managed to get a diagnosis anyway, and my psychiatrist got me started on Ritalin, and then onto Concerta (I take Vyvanse now). The difference was like flipping a switch. My work output improved out of sight, I stopped being a zombie at night time because I didn't have to go through a cycle of wake up -> work -> burnout -> sleep -> recover every day, and I'm earning more than twice what I was at the time of my diagnosis, and I don't think any of that would have been possible if I'd remained in the same situation.
What I've learned over the years is that the problems associated with ADHD don't "go away" with medication, they just become more manageable, and knowing how my brain works both on and off medication has been TREMENDOUS tool for increasing self-awareness and understanding that the anxiety/procrastination/apathy etc is a function of neurochemistry, and not a harbinger of doom or destruction.
Most people think of dopamine as the "pleasure chemical," but in reality it is the "anticipation chemical." Dopamine says: "You got this. Almost there!" And it is up-regulated when an uncertain profit presents itself, implying that all you need is a little bit more focus and practice.
Too little dopamine and you get OCD and hoarding: the inability to decide. You can think of a hoarder's room full of stuff as decisions left unmade. When you can't decide, you open & close your car door 45 times until it sounds "just right".
And when you have too much dopamine, you do stuff with zero anxiety, but you don't stop to consider the best course of action because you pick the first, best path. Useful when running from a predator, but not when solving complex problems. Just look at people on cocaine to see how this pans out.
The best personal advice I have to handle the ups & downs of ADD/ADHD condition is to build supportive todo & reminder systems around the bipolar highs and lows. Exploit the manic highs and outsource as much rote work as you can. Find ways to help you remember and reward life-sustaining tasks during the lows.
I've been working on some software that helps me get the most out of life in this manner, which would also potentially help older, mentally-compromised patients. If this is something you are interested in, please do reach out.
> Exploit the manic highs and outsource as much rote work as you can.
This. 1000x this. If I’ve found a flow I tell my partner that I’m canceling plans so I can exploit the focus as long as it lasts. Those bursts of work every few weeks will pay dividends for years
My main piece of advice that I write on every post about ADHD is the following: Get plenty of sleep, exercise, and look into meditating. Using the Waking Up app by Sam Harris has really taught me so much more than I was expecting. For the first time last year I went 3 months without medicine. I wanted to gauge how strong my attention/focus muscle was without medicine. At the end of 3 months I was able to start noticing when I was distracted or in my head and that was such a be improvement for me, because it allowed me to start paying attention again. I also noticed how I was communicating with myself. I went from being negative towards myself because I knew i should be paying attention. To understanding where my mind is at that day and knowing that today might be a harder day than yesterday, but that is okay. Just take it one step at a time.
TLDR: Exercise & Meditation. Mindfulness will help keep you present and away from the endless mind games you can experience with ADHD
I wished I had known that book before. I got diagnosed only the last year, being 33 years old. Before turning 30 I hadn't suspected having ADHD, as I had quite a few misconceptions both about the condition, and what is "typical" in humans.
It does seem to me that ADHD is over-diagnosed for kids, especially since the condition as described in the article really looks like what a small child seem to experience (the inability to focus, the constant distraction, etc.). And because it is much less rare to see someone in their 20s saying they have ADHD than to see some parent saying their kid has it. It is convenient for a parent to think that their kid has ADHD to explain why the kid is "late".
Here the problem really is about "lateness". Children grow up at different paces, and if a 6-year-old boy behaves like an "average" 4-year-old, people will think he has ADHD, while his brain might just need more time to develop.
There are kids who finish high school before hitting 10. Do we diagnose them with anything? Like Attention Surplus Disorder? No, because it doesn't seem to induce any trouble.
The ADHD as described in the article sounds like a nightmare to be honest, and I really wish scientists find some way to help these people.
- Poor academic performance
- Hyperactivity
- Poor social skills (gets in trouble, fighting, etc.)
Then they're most likely gonna get recommended to ADHD evaluation. But as you might guess, a lot of kids suffer from those things without necessarily having ADHD.
Some kids, like myself, mellowed out, and lost pretty much all the traits other than those of ADD. But I did just well enough in school - despite putting zero effort into it - that I flew under the radar.
Teachers figured I was just too busy fooling around / lazy / uninterested in some topics, while my parents argued that I was too hung up in sports / gaming / playing instruments.
And unfortunately, by the time you're a teenager, you only have one idea of what ADHD looks like: It's the troubled kids in class that got diagnosed early on, and can't cope in school; The "academic losers", as they are unfortunately branded.
In fact, that's the reason I didn't get diagnosed until my late 20's. My ex-gf hinted to me that I scored very high on ADHD / ADD checklist, but no way I thought, the only people I know with ADHD are those that never graduated from HS, and now are either criminals or minimum-wage workers.
Well, got myself evaluated, and sure enough, ADD. It was a thorough process, and took a LONG time.
In all seriousness, I skimmed parts of the article and kept scrolling and it just kept going and going and going... like the Energizer bunny. I guess the author found a doctor to prescribe stimulants; they do make it easy to write long rants.
I can identify with some of his analogies, not all. The forgetfulness, standing at desk with power supply / getting “stuck”, lots of that sounds familiar. Some of the stuff he talks about is behavioral though and if it can be called lazy, it probably is at least partially lazy. I could never file TPS reports everyday, but I can do it occasionally. My brain’s capable of it. I just don’t like doing boring things. And yeah, I probably wouldn’t last if I had to do boring things everyday for a job. But the article makes it sound like he’s actually not capable of doing a boring thing.
The more interesting parts of ADHD are the stuff that is lesser-known and often overlooked, like mood swings and anger/irritability issues. Ironically stimulants pretty much cured lifelong mood issues for me. I used to blow up on people all the time; now I’m easygoing.
It's funny. People with ADHD suffer from attention deficit but at the same time they display hyperattention when they encounter a subject they like. I've experienced it as well: once I start programming I have no problem doing it for 12 hours straight. I've found this trait in many ADHD patients. There's usually something that really turns them on and I always try to find it.
I think of it as an signal/noise ratio problem. Very high signal is needed to grab their attention and there is very low tolerance for noise.
The other part of this analogy is that when there is something that grabs my interest, it grabs it with all 12 brains and I bury myself in that interest until I burn out after a few hours.
I find that ADHD makes me a very good architect and a very bad regular programmer.
I know what you mean. I think if I could click with someone who's really organized and good at execution we could turn one of my 9 billion potentially-pretty-good ideas into an awesome company (I have a pet theory that this pattern is often why it takes 2 to found), but I have never really been able to connect with neurotypicals. They can play along where I can't even tune in, and worse, they are content where I am passionate.
Yep, and that something can drift over years, days, even minutes. I find code very conducive to hyperfocus, maybe more so than something like playing guitar - it's funny, because so much of coding can be mundane and repetitive, but that quality seems to help with getting started and finding a flow state.
I rarely hyperfocus on writing music or playing instruments anymore, but I used to zone out and play for hours. I'm not sure what changes in a person that makes that more difficult one day than the next.
Playing the same chords over and over again, making fewer and fewer mistakes, all while this song you used to love, you are now beginning to have serious doubts about.
Those with ADHD spend 90% of their time imagining, thinking, doing everything and nothing. And to any observer they look stupid, or undisciplined, or lazy.
Like the hunt, when somebody with ADHD encounters an situation with very high (perceived) consequences, they will lock into intense hyperfocus, completely singular in their goal.
So the modes of operation are 1) philosophize and daydream or 2) hunt
Is this real? I have no idea, probably not, but it helps me reason about myself better than feeling like a permanent victim
Some people think that a lot of ADHD people or misdiagnosed, others that it's just another symptom of ADHD.
Which is why some people have to fidget, or listen to music, or move around in order to get stuff done. Or why I'm a worse driver if I can't have the radio on.
The pinnacle of this for me was about half a dozen years ago, I was slugging out some code for a personal project. But I was also feeling nostalgic for an old movie (can't recall which, but let's say it was The Princess Bride). So I put it on in the background. But this isn't quite getting me in The Zone, so this is the scene my partner walks into:
I'm sitting on the couch typing. In all likelihood my knee is bouncing (makes laptops a bit tricky). There's 90's music coming out of my laptop, The Princess Bride is on the TV.
Her head is about to explode. You would think I was killing kittens. She has an ADHD diagnosis, and this plan I have enacted is so anathema to her coping mechanisms that she can't even bear to witness it. Which is too bad because I was getting rather a lot done.
My theory extends to my desire for action and my risk taking behavior as a younger person.
But also that Flow state is often a bad way to write code.
One, virtually everyone has a tremendous case of Sunk Cost Fallacy around things done in Flow state. If someone spent 10 hours in a week working on code that you say is badly conceived in a code review, you'll get pushback and grumbling. Argue with someone who did the PR in a single sitting? They will fight you. Hard. This is the most amazing code ever written (because I felt amazing while I was writing it). The rush goes to their heads.
Two, writing code for other people requires empathy. Rumination. Flow state is considerably absent of both of those. So the problems and gotchas you know about ahead of time get handled, but anything you find along the way is very likely to get ignored. The quantity of your code goes way, way up, the quality goes considerably in the other direction.
I made a conscious decision a while back (making official an unconscious one I'd already made) to stop seeking out Flow state. I felt better, but objectively, it hasn't done me any huge favors professionally. From a practical standpoint, me writing less code means that people who write more baroque code than I do at my worst get to set the narrative for larger slices of the codebase. But I've also done something I hate: reason that if a lot of something is bad, none of it is better.
I need a new plan, and I need it bad.
Yeah, I thought "flow" required extremely low resistance in the task (i.e., someone sewing, playing an instrument, or playing a relatively simple game competently and with no interruption of confusion, frustration, or distraction).
I wish I could code like that. xD Constant typing to an ambient soundtrack. Instead, it's a minefield of "uh wait I have to Google this thing", "uh, what should happen here?", "oh no, an error with a complicated message I probably also have to Google".
And I can only carry on the rubber ducking to competently deal with those with a FULL MARSHALLING of my mental resources, which seems too strenuous for "flow" and is exhausting after a few hours.
But if you're sewing, you're just sewing.
There were times before I accepted that “massive refactor” is an oxymoron where I would keep some very complicated task lists in my head and manage to recall nearly all of them. Day to day? I can’t remember your name twenty seconds after you’ve told it to me, unless I work at it.
As a code reviewer they should be giving you a compliment sandwich where the criticism or constructive feedback is placed in between two compliments. As a coder, I've found adding async and await to functions does a lot to make your code look sexier to code reviewers even if it doesn't have a perceptible performance impact on non-network calls.
If I were to comment on a new plan for you, I'd say let flow state be your friend and not your enemy. After all, you have a chair you probably have to sit in for ~8 hours a day while you stare at a computer screen full of code and that's hard for anyone to do for that long let alone someone with ADHD. Flow state will give you an advantage over others. Invariably, your flow state will break. Use that time to spend more time talking to the stakeholders in your group because sometimes stakeholders want what they want and nothing else. They'll appreciate the time you took to listen to them, they'll trust and believe in you more (instead of you being an unknown variable), they'll be more confident that they'll get what they want, and you'll benefit from the confirmation bias. If you deliver what they want, it's less likely that their sandcastle will get kicked over -- though still not unlikely.
Getting away from the desk for 5 minutes can give you a lot of perspective, and unstick you from a host of problems. I think if I go back (when I go back?) I'll find a pomodoro app that lets you customize the intervals.
I think I agree with everything except this:
> As a code reviewer they should be giving you a compliment sandwich where the criticism or constructive feedback is placed in between two compliments.
Manageable when the code review is 50 lines. Not so easy to do when it's over 500 lines. Damned awkward when the person outranks you, too. I don't know where the cutoff is, but I feel like there's a point where this advice feels like victim blaming, or at least codependency. Don't put your coworkers in this situation, please.
As for knocking over the sandcastle, I agree this is something all humans wrestle with, maybe developers especially. Almost nobody wants to accept that their code is ephemeral. We always push back. Zen or a little horticulture can give you perspective. Kids might too, but that takes decades to play out. Plants are always changing, and they'll never be exactly the way you picture them in your head for longer than a moment. They're alive, and making them 'do' anything is a negotiation that often goes in directions you didn't anticipate. For good or ill.
Each time you try, just as you get close, they slide off one another and all around, until they stick at a different spot. Those sticky spots, are all the very stimulating tasks.
However it isn't until older age I finally been able to force my exert executive control to focus. It has taken a lot of practice and challenging myself and it wasn't until the age of 26 I finally been able to go to college. I keep challenging myself and I feel it get easier and easier every year.
So now I start to question the inability part. Or if it's something you can actually practice and get over.
There are many books on the subject of good exercises, and some therapists that specialise in helping adhd people.
Honestly, I think therapy had the least effect except realization what was wrong. Drugs I think helped the most.. lately it feels like they're not as good though, or I feel like I'm in a funk. I don't know if that's just life or being overworked or just I need a dose change. Maybe if I cut it cold turkey a week, then get back on it'd reboot or something.
TLDR: I just feel I'm getting off track a lot more lately than I was the previous 14 months. Not sure what I should do, maybe go back to therapy? Maybe focus more on mindfulness/stoicism? Up my dose of Vyvanse? Go back to the gym? All the above?
My understanding is that tolerance is essentially inevitable when you're taking stimulants. I've made a point of checking in with a psychiatrist on a monthly basis so they can help me measure it semi-objectively and adjust if necessary. When resistance does start to develop, a psychiatrist will also have plenty of options for managing it; for example, I think that some people rotate between amphetamine salts, methylphenidate, and other stimulants over the course of several years. They'll also be able to help you figure out which other courses of action would be most helpful, figuring out what issues are actually causing you the most problems and how to address those effectively and so on.
TL;DR There are specialists for "I think my medication isn't working any more" and I'd strongly recommend talking to one, both for this specific problem and on an ongoing basis so you're not forced to try to observe your head from the inside.
i also tried cold turkey for near a month in the hope it would lower my tolerance but sadly no such luck, it did however give me some spare meds with which to try the higher dose
This has nothing to do with ADHD.
> i would often under perform on the easier parts and over perform on the harder parts
It is very common that people with ADHD perform better on harder things and will have a problem focusing on simpler (and thus boring) problems.
it literally does have to do with it because it was part of the results of being tested for adhd. i had mentioned the iq thing because i meant to elaborate. it was explained to me that the testing is designed to be independent of iq. however, i am a little suspicious of that fact.
when i say performed well above average i meant that i fell statistically well away from results that point to adhd.
it makes it difficult to become good at things you naturally arent good at, once ive been knocked off my obsessive focus on something theres a solid chance ill likely never go back to it. at times i can become almost an expert at things in a very short space of time but as soon as something else takes my focus the new subject basically erases the previous one from my memory
medication has helped greatly but i think i may need to either get my dose adjusted or shift to an alternative medication as im starting to fall back into getting easily distracted again
crap i just noticed i spent so long reading and thinking about this that im now late for work, its this sort of thing that causes issues (and yet here i am wasting more time writing this!)
Poor executive functioning is why I could never make myself start writing a paper prior to the day or two before it was due, despite the rising sense of panic I would get for weeks. (This is key -- it's not laziness, because good lord did I wish I were able to do the work. To me, lazy ~= apathy, and what I felt was just about the polar opposite of apathy.)
Poor executive functioning is also why, unmedicated, it was sometimes difficult to not let my initial emotional reactions just come flying out. It was like there was an express lane between my limbic system and my action system, totally bypassing my ability to control it. I would find myself snapping out something and as it was coming out of my mouth, I would be kicking myself and thinking "Why in god's name am I saying this right now?"
Medication has helped with all of the above and more.
What I will say is that stimulants also can have a tendency to put some people on edge and increase sympathetic nervous system activity, so shorter temper could be a side effect for sure. If it's affecting you that strongly, maybe speak with your doctor about a slightly lower dose?
Or is there a possibility that you only became aware of your tendency to have a short temper once you became medicated? An interesting chicken/egg question; I'm just asking rhetorically, mind, because I have a lot of similar questions.
That sounds like a good explanation for why I've been avoiding studying for something for weeks but feeling guilty, even sick, the whole time about it.
I don't know though. It's hard for me to not call that lazy, and I don't think lazy denotes apathy. Isn't it possible to be lazy and still care about a thing?
Poor executive functioning is also why, unmedicated, it was sometimes difficult to not let my initial emotional reactions just come flying out. It was like there was an express lane between my limbic system and my action system, totally bypassing my ability to control it. I would find myself snapping out something and as it was coming out of my mouth, I would be kicking myself and thinking "Why in god's name am I saying this right now?"
I still struggle with emotional impulsivity anytime I take a few days off meds. Drug holidays can be surreal. Or sometimes they might not be special at all. But I've taken time off before and noticed everything - birds, wind in the air, music on the radio, and it felt so surreal that I broke down crying.
Why in god's name am I saying this right now...
Executive function may be involved, but the inability to filter sensory information is a pretty big part of things for many people.
When I'm two rooms away shouting "What is the dog eating?" to two people who are sitting in the same room as the dog, that's not about executive function.
Actually, I'd argue that it is. The other people's executive function is what allows their sensory filtering: they can almost completely filter out sounds their brain has decided is unimportant.
The cars don’t even have to be that loud or close by. A few tens of metres away at 30mph and I still can’t hear anything anyone says.
Sometimes I have to swap places with a friend when walking down the pavement just so I can try to hold a conversation.
Back to the topic of the irritability/temper, yeah it's basically when it's active. Afterwards I'm a bit tired but otherwise totally kosher. For context, I am also on a very low dose of 5 mg. 10mg starts putting me on "talk really fast, move really fast" sort of stimulant buzz. 20mg was utterly uncomfortable. IIRC the higher doses exacerbated the positives and negatives: even better focus, even less patience, even shorter temper.
In regards to your comment about shortened temper on stimulants, I think this is very normal and expected, and I have experienced the same at times. I don't know how to explain it, but I think overall I'm more agreeable than I was before I was medicated. This might be an age thing; I honestly don't know. Maybe I just grew out of it (I was the kid who threw tantrums lol).
That scans closer to my experience. I’ve been on Adderal for years, and when I started it I learned that I have the potential to get angry much quicker.
I, on the opposite end of the spectrum, would get strong symptoms of depression, and a constant feeling of nausea and lack of appetite to the point of being suspected of anorexia/bulimia by my physician. I tried a wide variety of medications throughout grade school and high school, and eventually gave up because they all gave me negative side effects of some kind.
The stimulants made me crankier and more high-strung.
However, sometimes it was a net improvement in my mood because I was getting my stuff done and therefore my stress level was lowered.
I use modafinil now which is less effective for the ADHD but also makes me less cranky.
However, one symptom of ADHD is something my therapist refers to as "explosiveness" which is a very sudden change from not angry to extremely angry and then often right back to not angry. Note that this can also be a symptom of bipolar, and misdiagnosis between the two is why they tend to screen for bipolar before prescribing ADHD meds.
This is not what I experienced on Vyvanse; rather my baseline level of "being annoyed at things" was much higher, so it was easier to make me angry.
1. Sort of a vast simplification, but basically hulking out and raging - maybe physically, maybe passive aggressively, maybe verbally - the form it takes varies wildly.
This is not really a trait of the Inattentive-subtype. However, a person grows up:
- Being frequently told that they are a disappointment.
- Would have succeeded (at something they really cared about) if they'd actually cared.
- Being tuned out because they're talking in a way that seems scattered or boring to the listener.
Can develop an unhealthy relationship with anger.
I sent the article to my girlfriend though and she'll read all of it and ask me questions about it so I can cleverly get a proxy summary. ADHD Lifehack!
Yes, me too I didn't read all the article, as I skipped around parts in articles, books, and similar stuff.
I'll admit, I skimmed it. But I bookmarked it!
How many bookmarks do you have left to read?
I think that's the hardest part of ADHD, you'll always find some exceptions to the "rules" used to diagnose it.
"Long form" is at least partly a function of reading speed.
I think a lot of times ADHD is spotted because a kid is bright, but underachieving. There's a glaring disconnect between potential and performance... could be many reasons, many of which aren't ADHD, but it grabs teachers' and parents' attention.
But, what about a kid whose intelligence is not above average? If they are underperforming, would it be so obvious? I wonder if a lot of folks with ADHD in this category are more likely to go undiagnosed.
I found that getting started and momentum going is my biggest challenge. Maintaining it for several days after was not as hard.
When writing to us... maybe just try bullet points.... Don't run past the page fold - or I'm out.
For example: https://www.ncbi.nlm.nih.gov/pubmed/23495677
This particular study found that phospholipid improves ADHD symptoms in children (4-14 yo).
There's some ongoing research about the neurotransmitters related to ADHD: https://psychcentral.com/lib/neurotransmitters-involved-in-a...
However, I don't know if any comprehensive studies have been conducted about the effects of diet to ADHD, it could be tricky to study that.
That said, it's always possible that an intervention works well in a subgroup of high-responders (this can be true even if the particular intervention is a placebo, not that that's necessarily the explanation here), so everyone saying it works for them should probably keep it up.
It would be interesting to hear the author's thoughts on this, and on alcohol.
EDIT: ...and on exercise.
That's one of the advantages of the prescribed stimulants; they're effective at doses that have no physical side effects.
It is extremely difficult for someone with ADHD to change their diet. It's difficult even for neurotypical people. I know that it and exercise are obviously beneficial, but from experience there's a "loss" in that trying and failing consistently to improve my lifestyle really takes its toll on my motivation and self-esteem. Not to say that I'm not still trying... but it's hard.
I'll do this when I find myself slipping, too.
No such effect exists for me. Plus, it would require following through on going shopping so I have roast beef and frozen veggies in the house (or remember to take them with me to work). That's not happening in an unmedicated state. I'm lucky if I can put together a remotely healthy meal while unmedicated.
I switched my diet from a high carb to high protein, high fat. Instead of a bagel for breakfast, I'll eat a couple eggs, a breakfast meat, and every once in a while a piece of toast. Tons of whole fresh fruit all day. Lunch is similar: think a chipotle style meal with a base of protein and rice and some light veggies. More fruit and raw vegetables and nuts for snacks. Dinner is the same thing - protein base but fewer carbs and more veggies. I'll have some candy in the evening from time to time.
I also started lifting weights 3x a week. I love it cause it's the most efficient way for me to exercise - I spend 60-120 minutes in the gym three times and work my whole body. Heavy squats, deadlifts and presses - strengthens the back and hips, makes sitting in a chair much easier, and is a really great vector for activating that hyperfocus we love so much. I read a book called Starting Strength that basically gave me all the info I needed to get started.
Since starting this routine about 8 or 9 years ago, I find I'm sleeping better, my focus is way better, I'm much more pleasant to be around socially, I'm way less impulsive and interruptive, I make fewer stupid rash decisions, and I'm generally in a better, chipper mood a lot more.
Edit: Might add: I drink coffee like it's going out of style and don't find that caffeine really affects my focus all that much - more my energy levels. They're similar but on different axes.
When I eat regular meals I'm _constantly_ hungry and my focus goes to total shit. I tend to have to manage my weight because even when I expressly try not to, I eat too much. It's weird. I also eat worse food. It seems to be a vicious cycle.
After just a day or two I experienced very unusual (for me) clarity. I googled and apparently it can help ADHD symptoms.
I definitely ate enough meat and various other things, so I'm not sure what the supplements did or if they're a placebo. Perhaps I just process iron poorly and need a big hit at once.
In my case, I got some rather severe digestive issues similar to IBS that turned out to be similar to what vegetarians get after several years if they don't watch their nutrients and vitamins. I spent 2 years battling it without knowing what was causing it. After days of conversations with some very smart friends, one of them suggested a connection between tryptophan and serotonin (which is made from it in the gut).
Long story short, I started eating pork again (mainly bacon) after avoiding it for 20 years due to ethical concerns, and my digestive issues cleared up in a matter of days. My acne went away and my mood stabilized almost overnight. It was one of the most miraculous things I've experienced in many years. I also added psyllium husk fiber with meals 1-3 times a day and have maintained proper digestive function for several months now.
Some things that really help me are zinc gluconate for immune function and recovery from exercise 1-7 times per week (too much will make you feel bad, a headache in my case), omega 3 capsules and glucosamine/chondroitin (which is for joint health but the mechanism likely happens through the gut as well). I also eat 2-4 whole eggs per day based on how hard I'm hitting the gym. My feeling is that the lack of fat in our diet from the 1980s till today has really wrecked most people's metabolisms and they are simultaneously frantically starving, fat from eating too much, and chronically malnourished.
However, exercise, diet, and prayer cause my symptoms to almost vanish. In particular, keeping sugar content extremely low. Also being aware of my cues when I know my leg is going to start bouncing up and down and the impulse of doing anything _but_ my work is about to kick in (such as viewing this site for hours), and using behavioral modification techniques to mitigate this. Making good habits is especially important for ADHD people. It's not easy, but take comfort knowing it is doable. You can make progress today.
Even when they work well there will be some collateral damage with stimulants. I was a great employee on them, but I was a shitty, narcissistic friend. The focus many people get from stimulants is an inward focus, which makes it easy to get things done but hard to empathize with other people. As a result I didn't have many friends, and once I started wanting more out of life I realized the stimulants were holding me back from personal growth. The inward focus clouded my ability to understand why people didn't like me -- I couldn't make enough space for another person to even see why people didn't want to be around me.
I'm not saying that stimulants don't help (they totally do) but you should understand what you want out of your life and how that aligns what you get out of the drugs.
I have had no temptation to abuse the stimulants. I don't really enjoy them, on the balance, but they make an incredible difference that meditation, high quality diet and physical activity can't even begin to approach. They really calm me down.
My wife prefers me medicated. I'm apparently nicer, more patient, more even-tempered and easier to get along with.
That being said, I’m fortunate in that I’ve worked with a therapist who saw the ADHD (along with PTSD) symptoms and put a name to them. They pointed out that I’d basically been self-medicating with caffeine since I was a young kid. Even just having the acknowledgment and having words put to it has made a huge difference for me. Now I know it’s not some moral failing and laziness. My brain is just different and I have to figure out ways to make it work (currently those ways are medication, writing, therapy, and some incorporation of Buddhist teachings in my life).
I knew a neurologist who had ADHD.
I have a perfectly healthy lifestyle - I run 5 days a week, about 40 miles total, eat healthily and sleep well. During my runs (which physically feel painful) I have few moments of clarity in my head. Other than running though my mind has a thousand thoughts all at once that I cannot control...
I tell a story, interrupt myself, get 6 levels deep and then essentially have a stack overflow and can't recover to my main point that took me down that spiral. Nobody can follow my thought process. What I do know is that my mind is stimulated by strong feelings.
I sit at my desk to do work, notice a story about the DOT / airlines soon banning ESAs and proceed to research the legal authority according to the ADA and other provisions in U.S. Code. I waste a lot of time thinking about the stuff I need to do, but I can't get myself to do it. So I don't do anything that is fun for me, nor the work I need to do itself. Only under immense stress due to deadlines (and the potential negative consequences of failing to deliver) I can force myself to crank out work that is of reasonable quality. This is how I went through all of high school and college for example. I was completely sleep deprived as a result.
Never in my life have I been able to finish reading a book for school - I'm bilingual (learned English as a second language), but this isn't a language problem for me. I simply don't know what I read at the top of the page when I get to the bottom. I read incredibly slowly (I have to imagine hearing someone speak the words - this is called subvocalization). If I focus on reading for fun it will probably take me 3-4 months to get through one fantasy books. If I can read 3 books in a year I had a very good year.
At a dinner in a restaurant I cannot pay attention to my friend (or date) in front of me, because other conversations around me draw in my attention and trigger my brain when interesting subjects are raised.
I am not able to focus without extreme stimulation and am completely at the mercy of my brain / mind. This means I can't listen to people well, I get impatient and interrupt people at inappropriate moments.
Yes I'm high-functioning and I do well, I have a crazy amount of energy, but this isn't a healthy way to live. I am not lazy, but my mind is. I am convinced I'm only operating at 20% of my true cognitive potential and output potential.
For these and many more reasons I will be seeking diagnosis for ADHD (or ADD?) soon.
From experience: First thing to go with the stimulants is healthy sleep; it's often hard to sleep on amphetamines. But in the morning, because you've got a script, you can take a pill and not worry about it (but the body remembers). Next thing to go is healthy eating; you simply don't need to eat when under the influence, or you do -- but you forget. Soon, those things combined could have the potential to turn a high functioning and healthy life into quite the opposite. But in the beginning -- especially if you've never experimented with stimulants recreationally -- you'll feel better than you ever have. Stimulants are euphoric. It's a trap, it wears off. Side-effects are likely. I've said it in a previous comment, but it's profound and interesting until it's not, and once the stimulants are gone a dark depression is very possible.
Attention is like a muscle, but also -- attention isn't everything. It could also be ones attitude towards these things.
Be skeptical -- understand that there might be blind spots in your thinking about your problems.
I don't know about others, but fun isn't the word I'd use to describe the ADHD medication which I'm basically chained to for life because I cannot function without it, and yet causes me so many other problems that I need to work around or cope with like loss of appetite (food is no longer a thing I enjoy), insomnia, anxiety, restlessness and mood swings. Where's the fun part again?
Are you willing to be skeptical yourself and understand that you might have blind spots just like the people you're talking to?
As I said further down. It's most certainly not fun later. And it was a difficult as all hell to finally quit.
Either way, I think we're actually on the same page here, based on what you wrote above.
I have been on and off stimulants many times, short, medium and long intervals. The worst that happens is when I go off I've got no energy at all for 3 days.
When I would restart stimulants I would get the euphoric effect for a time, and then it would fade away over a few weeks. I have never been tempted to chase it.
Everyone's mileage is different.
I have found that people who do not have ADD/ADHD find those same medications to be fun, however, even at a therapeutic dose.
Otherwise your comments on the effects are spot on. Personally I had to make a choice in my mid-twenties, the meds or a happy-go-lucky life where I feel unfulfilled but I have a fun time.
I used to just sit all day, thinking about what I needed to do, yelling at myself in my head to do it, but never doing anything. Just constant maladaptive daydreaming. I have inattentive type ADD. I didn't develop mental executive functions until I was 28. I started recognizing there was a "manager" in my brain that wasn't there before. I sobbed when I found out most of my peers developed that 10 years earlier.
From what I've seen, people with ADD/ADHD go through a cycle of recognizing then denying that they have a disability. I have done this personally 4-5 times in my life. I will accept I have a disability and deal with it, then eventually decide that it was my environment that was causing the symptoms, only to later come to a point where I once again have to accept I have a disability that cannot be managed entirely with CBT, task lists, meditation, mindfulness, etc... I'm happy for those that feel they can do it without medication, but I also have to wonder if I'm just meeting those people at a point in time before they have to get back on medication again...
A lot of the medical advice in this thread is dangerous. If anyone reading this thinks they have ADHD, seek a qualified professional's opinion - they aren't guaranteed to be right but (respectfully) the odds are much better than some dude on HN.
This is based on the assumption that the person being diagnosed does indeed have ADHD, and is not, say, afflicted by a poor home life, or poverty, or any other contextual scenario that may lead to the inability to focus, temporary or otherwise. These are important questions because of the overprescription crisis we are in. Millions of children are being given these medications; many are misdiagnosed.
And this isn't "medical advice" -- this is a frame of personal experience with an emphasis on very textbook side-effects: potential for loss of appetite; potential for loss of sleep; danger of misuse and / or abuse. All things a psychiatrist, if responsible, will / would have discussed before writing a script, but oftentimes don't.
A reminder that "your milage may vary".
Sure sounds like advice to me. You're not just throwing this stuff into the ether for a purely academically interested observer.
As a note to abuse my medicine at recreational doses of meth I would consume my months prescription in about 4 to 5 days. Not enough time to get physically addicted and it would suck for the foggy rest of the month. I think the risk is overblown.
I haven't abused my meds personally or traded them on the street, and I do regularly trial myself off of meds to make sure the effect is still noticeable. I am happy you can get away with not using pharmaceutical aides, but a lot of folks can't and, while good life style changes are always good, please don't paint these medications in a negative light. They are really helpful and believe me it absolutely makes a difference - and a lot of people don't follow their GP's advice because they're afraid of being over medicated or becoming dependent.
People should do what they're comfortable doing, but for people with more severe ADHD stepping off that ledge can mean falling all the way down into a really dark place and needing the help of friends and family to get you back to stability.
And, there is absolutely nothing to be ashamed about in taking medication to help you maintain a healthy state.
Back in the 60s or 70s ( I can’t remember what he said) people were starting to notice that kids were having behavioral problems, trouble focusing etc.
So what they did was collect a group of symptoms, and then arbitrarily said “if the child has 6 out of 11 of these symptoms then they have ADHD.”
The reason why they chose 6 was because if they chose 5 then too little number of children would get diagnosed, and if they chose 7, then too many children would get diagnosed. Having 6 would mean that 7-10% of kids would get diagnosed which “looked right” so they chose 7.
It’s not a real disease like other diseases, it’s a collection of symptoms. Which is why kids get misdiagnosed all the time. Anxiety can produce ADHD-like symptoms. Other things like giftedness and boredom can also fry diagnosed as ADHD.
There really are children with focus issues where medication like adderall will absolutely help. It will make kids with anxiety worse though so a misdiagnosis will ruin lives. But the origins of where ADHD came from explains why there is so many issues with ADHD disgnoses.
And? Do you know how many different kinds of cancer there are? We're talking about psychogical disorders that affect people's minds and personalities, of course their presentations are going to be very different. That doesn't make them not real or mean it's not useful to group them together. Diagnosis guides treatment, and most depression responds to the same treatments. You're fallaciously assuming that because there's not a single biological marker for named psychiatric conditions that they don't exist. That's not how any psychiatrist sees it.
I responded to a question that was posed “could you explain away depression with a similar argument” with a relevant piece of information.
You seem to think I’m arguing depression doesn’t exist. I am not. Forgive me if that was how it appeared, but please, for everyone’s sake, try to keep things civil.
> You can yes
> You seem to think I’m arguing depression doesn’t exist. I am not.
That is precisely what you were trying to do. And the response to your comment was in fact civil. Claiming that your argument is fallacious attacks your argument, not you, and is perfectly appropriate for civil discourse.
What a load of crap. You’re projecting something here I’m afraid.
Then kids not paying attention in school, maybe it's boring or they feel it's useless to them so forcing them to do what they don't want, instead of tailoring their education instead it's one size fit's all. Plus teachers recommend getting kids checked, because then you are labeled as disabled and the school gets extra funding to go into the teachers pension program.
There's someone I know who was told their kid didn't have ADHD, so shopped around and went to another doctor, and then eventually went to another doctor. Kinda like the whole antibiotics resistance thing, people expect if they have a cold that the doctor will give them pills even if it isn't going to really help. Seems like doctors in general just love drugging people, instead of fixing a symptom at the root of the cause drug them and then drug them more for the side effects to cover them up. It'd be like taking your car to the mechanic for a check engine light, and instead of checking the OBD codes and stuff they just unplug the check engine light.
I think a lot of psychiatry is just a form of massive insurance fraud, there's a nonprofit organization that makes documentaries called CCHR. However CCHR is founded by the church of scientology which I know many not a fan of but I think they have some good information. I really wish CCHR would disconnect it self from scientology so it could stand on it's own as I really like their message, but I feel a bit of a conflict since it's related to scientology which is an entire topic on it's own, I guess you have to pay thousands just to level up and all these other horror stories about scientology.
I think drugging children is also a form child abuse, and destroying childhood creativity. Probably if they pushed this stuff when Albert Einstein, Steve Jobs or other successful startup founders were children, who knows if they'd be as successful as they ended up being. One of the pills pushed ended up making males grow large breasts too. Then there's reports another drug can cause brain damage too along with heart conditions(which usually you think it happens in older people but young people can have heart attacks too on this crap). They even want to drug 3 and 5 year olds too. If I was in power, I'd have these drug makers and so called doctors imprisoned for life. Also diet and exercise some believe also helps, add these GMOs and other chemicals in the food, artificial sweeteners can mess with dopamine receptors, etc. So I think I see the larger picture, but many just want a pill and then go back to watching TV or smoking instead of trying to improve their families healthy lifestyle. Kinda like how parents don't even try to teach their children, they just send them to school. Lazy parenting is also part of the problem.
But I guess not a one solution fits all, some people say the pills and stuff helped them. I think counselors could be valuable too, maybe even help you see things from another prospective but some insurance companies won't pay for a counselor unless you also are on drugs. Some people don't even feel like anyone cares about them either, so I think having someone to listen and who seems on your side with issues is also a positive, but I know some counselors want to record your sessions so I find that kinda creepy also as feels less private so you could be less open about things.
Stop it.
If you're on the flipside and benefit from the drug prescriptions: good for you. I think if it were more generally acknowledged that there can be sub-clinical or contextual forms of ADHD my life would benefit.
Another interesting thing to consider is that a lot of psychological disorders are culture bound (and therefor in my humble opinion irrelevant as groupings even for psychiatric purposes).
Any disease with "syndrome" in its name is just a collection of symptoms. That's literally what syndrome means. Your information about ADHD is offensively wrong, and its underdiagnosis and undertreatment due to misinformation ruins far more lives than than there are people with anxiety being mistakenly prescribed stimulants.
Downs syndrome as a counter example has a known messurabe causal model.
It is truth, regardless if it is offensive or not. Regardless of your interpretation.
Age 10 is roughly when children begin to realize that their parents, and adults in general, can be as fallible and ignorant as children. It can be a shocking revelation, but eventually you move past it. But some people's response is to develop a deep cynicism about what maturity means, which can stunt their own maturity. (Notably, we all tend to feel like it's a deeply personal revelation that gives us unique insight--like we're more mature than others for having the revelation. But it's a whole different revelation to realize and appreciate that everybody goes through this phase.)
It can also be a shocking revelation when you learn that in science in general, but especially in medical science, the things we don't know are unfathomably more numerous than the things we [believe we] know with certainty. But just because we don't fully comprehend a phenomenon doesn't mean we can't develop useful knowledge about the phenomenon, and to develop reliable treatments (medicine) or processes (chemistry, engineering). Were it otherwise progress would be impossible. Science is a process, not a product.
Of course, just like adults who became cynical at age 10, there are professionals in all domains who harbor cynicism stemming from their educational revelations. It's not healthy. The extreme ones may say things like, "it's all a lie", but the lie is on them.
When people go to a medical professional for help, they don't need to know the messy details. Some people might benefit, but others might react poorly. What they expect (knowingly or not) is to be given medical advice that already incorporates the unknowns; that already takes into account the fact that something is not well understood. The same is true for every other profession.
FWIW, the term Downs Syndrome comes from before the cause was known. Today people often use the term trisomy 21, perhaps because of the cultural baggage related to the older term, but also because strictly speaking it's no longer a syndrome. There are other trisomies, like trisomy 18.
I think it is more useful to think "what is causing my ADHD behaviour?" Rather than using the explanatory model "I am behaving like this because of ADHD."
The former can lead to finding models that allows one to mitigate ADHD behaviour. The later leads to the same thing over and over.
Are you hinting that I stoped developing as a ten year old?
I get that people expect that. Don't see why it matters in this context.
I guessed that was the case when I wrote about downs syndrome. Lets hope we find good causal models for ADHD to.
No, definitely not. I was just trying to analogize the "dirty little secret" bit to another dirty little secret we all directly experience. They're not really dirty little secrets; they're life, and there's nothing substantive that can be gleaned from stating these facts alone.
Similar to the Murray Gell-Mann Amnesia, though in our own private and professional lives we understand reality is complex and ignorance reigns, notwithstanding the polite fictions we maintain, somehow when we discover hints of this reality in other fields we think it's a noteworthy insight and something to criticize.
> The former can lead to finding models that allows one to mitigate ADHD behaviour. The later leads to the same thing over and over.
If you don't have ADHD or a similar disability, then in the best possible way, what you think is useful doesn't really matter. What causes my behaviour is that my brain is literally retarded - it thinks in a different way from the neurotypical one. Knowing that that is the source of behaviours is extremely liberating and useful for developing a good mindset for coping with them, as is explained in the article we're commenting on. Asking "what is causing it?" is the dead end.
I do have an ADHD diagnosis but I don't think that justifies my thoughts in any way.
No it can't, because most other people can get the information from reading it just fine. The cause is that you're reading it with ADHD.
But we're talking at odds here - I'm not talking about finding coping strategies, but looking for the root cause of ADHD. For the current state of medical science, the latter doesn't really help with the former.
My son was diagnosed with severe ADHD by one neuropsychologist. Medication was strongly recommended. He was then brought to a psychiatrist, the best in my area to the point where he is well-known, and he said that my son actually has General Anxiety Disorder. His ADHD-like behavior is caused because of severe anxiety.
If we had treated him as severe ADHD, he would have gone on medication. The medication would have exacerbated his anxiety and caused worse behavior and we would have increased the dose. The entire thing would have ruined his childhood from the misdiagnosis.
So you are very wrong. The cause of the ADHD behavior is required. There are many children who would benefit from medication. But many children would have their lives ruined by the medication as well if misdiagnosed.
That’s why I was saying it’s a collection of symptoms and because it’s up to individual therapists to diagnose, it gets misdiagnosed very very often.
You've imagined a situation. You're catastrophising. Increasing the dose when symptoms get worse would be profoundly stupid on your part and that of the psychiatrist: that's the part where they'd reassess the diagnosis. You have the gall to call me "deadly wrong" about my lived experience of ADHD based on an imagined situation?
Perhaps not, but there are discernible differences in the brain in people with severe ADHD symptoms.
And the (current) lack of a causal model doesn't stop it from being real, nor does it stop the current treatments from helping people operate at a closer-to-normal level.
No one here is saying that ADHD is not real, well I am certainly not. What is being said is that ADHD is not the cause of behaviour, it is the behaviour.
But not diagnosing anything would also not resolve the problem for the patient, if there really are specific symptoms.
I guess where it becomes a problem is when we try to find the most suitable treatment for it. I know from experience that these labels can dictate the whole treatment plan in public hospitals/clinics without much further investigation whether that label's approved standard treatment plan really is suitable for your particular case or not.
In the US there is a larger percentage of the population who are diagnosed than in other countries, but even there, adult ADHD is under diagnosed.
There are a core set of people who definitely have brains that are different and need medication etc.But the way it is currently diagnosed lumps too many people and makes it useless to call all people with ADHD the same.
My son with Generalized Anxiety Disorder was diagnosed with severe ADHD. This is the problem because many things can cause the same set of behaviors so a diagnosis of ADHD is not accurate enough.
Unscientific personal observation, but I wonder if TV has a role in this. Didn't kids start watching a lot of TV around that time?
Also, I feel kids in poor countries with no TV (not that there's much of that left now) have little to no ADHD.
I have wondered if I have ADD many times in the past. Mostly, because I was in school and being forced to do a task that I didn't enjoy, nor wanted to enjoy. When I have found things that I do genuinely enjoy, I can focus for hours and hours on end.
I am not opposed to any diagnosis or treatment, but I really have never met anyone who can truly focus on anything, at any moment for a super long amount of time. From my own experience and the conversations I have had with friends that take Adderall/etc. it seems like we have believed that there exists a significant portion of the population that has an uncanny ability to focus on tasks, both fun and boring. I certainly think there are a few people out there like this, but anecdataly, most people I know are more towards to the distractable/ADD/ADHD spectrum than the focused types.
I bring this up, because if our perception of how many people around us have this god-like ability to focus is wrong, I suspect many people will take medicine under a misconception.
Like I said, don't want to ignore the extreme cases, but genuinely would like to hear from a few people that read this and can confidently say they can do most/all tasks without breaking focus.
I think much of the modern issue with focus can be attributed to the Digital Age. How can anyone focus with all these alerts and dings and emails and sounds everywhere all the time? And multitasking is worshipped like it's the modern man's solution to all problems. We're still drinking the 60s Kool-Aid, as if the modern, fancy, carefree Jetsons' lifestyle is right around the corner. It isn't. We're still the same human beings with the same old problems, except now we have additional problems due to the onset of technology.
(Not that technology doesn't solve certain issues, of course.)
One of the hallmarks of ADHD is not being able to get started and stay focused on things you do enjoy, not just things anyone would find unenjoyable.